Codeine

Question 1

Give 2 examples of codeines

Answer 1

• Codeine phosphate

- Dihydrocodeine

Question 2

What is codeine?

Answer 2

A weak opioid

Question 3

What is the mechanism of action of codeine?

Answer 3

Simultaneously acts at the opioid receptors to cause euphoria and analgesia, and at the medulla to suppress the cough reflex

Question 4

What are the routes of delivery of codeine?

Answer 4

• PO

- IM

Question 5

Is codeine available as slow release?

Answer 5

Yes

Question 6

Why should codeine not be given IV?

Answer 6

Causes reaction similar to anaphylaxis

Question 7

What are the indications for codeine?

Answer 7

• Mild to moderate pain of acute or chronic nature
• Diarrhoea
• Cough suppression

Question 8

In what conditions are all opioids, including codeine, contraindicated?

Answer 8

• Respiratory depression
• Head injury
• Raised ICP
• Paralytic ileus

Question 9

What conditions is codeine contraindicated in?

Answer 9

• Acute ulcerative colitis
• Antibiotic-associated colitis
• Known ultra-rapid codeine metabolisers
• <18 year olds who have undergone tonsillectomy to treat sleep apnoea

Question 10

Describe the use of codeine in > 12 year olds?

Answer 10

MHRA has recommended that codeine is only used to treat acute severe pain in > 12 year olds if other non-opioid analgesia has failed to control the child’s pain

Question 11

When should codeine be avoided?

Answer 11

• Breastfeeding

- Renal and hepatic impairment

Question 12

How does the metabolism of codeine affect the risk of taking it?

Answer 12

There is variation in metabolism, but some patients being CYP2D6 ultra-rapid codeine metabolisers and are at high risk of opioid toxicity, whereas other patients are slow metabolisers

Question 13

What monitoring is required with codeine?

Answer 13

Review pain control within hours of taking codeine in acute pain or schedule a timely review of pain control in patients with chronic pain

Question 14

What might codeine interact with?

Answer 14

• Alcohol
• Sedatives
• Hypnotics
• General anaesthetic agents

Question 15

What might happen if codeine is given with these drugs?

Answer 15

Depress the CNS and increase risk of respiratory depression

Question 16

What are the common side effects of codeine?

Answer 16

• Nausea and vomiting
• Constipation
• Respiratory depression
• Hypotension
• Paralytic ileus
• Provoked seizures by lowering seizure threshold

Question 17

What patient counselling is required with codeine?

Answer 17

• Impairment of normal abilities
• Bowel obstruction
• Breastfeeding
• Alcohol

Question 18

What should the patient be told regarding impairment of normal abilities with codeine?

Answer 18

Codeine may affect your ability to drive or operate machinery due to sedative effects. Should not drive or operative machinery if feel dizzy or drowsy after taking this medication. Driving at the start of opioid therapy, and following dose changes, is not recommended

Question 19

What should the patient be told about bowel obstruction with codeine?

Answer 19

Excessive codeine can cause mechanical and paralytic bowel obstruction, so patients should be warned to stop taking codeine if bloating or distention occur

Question 20

What should the patient be told about breastfeeding with codeine?

Answer 20

It is preferable to avoid codeine since it enters the breastmilk in small amounts

Question 21

What should the patient be told about alcohol with codeine?

Answer 21

Avoid alcohol whilst taking opioids due to the increased risk of respiratory depression, since both drugs depress the CNS