Weak opioids Flashcards
Codeine
Mild to moderate pain
- 30-60 mg every 6 hours
Dry or painful cough
- Codeine linctus
- 15-30 mg up to QDS
Acute diarrhoea
- 15-60 mg up to QDS
MHRA - codeine in children
- Restricted use in children due to reports of morphine toxicity
- Acute moderate pain in children over 12 only if it cannot be relieved by other painkillers.
- Max dose for 12-18 years = 240 mg daily for 5 days
- Up to QDS with no less than 6 hour intervals.
Codeine - children
Not recommended in children with compromised breathing:
- Severe cardiac or respiratory conditions/infections
- Multiple trauma or extensive surgical procedures
- Neuromuscular disorders
Codeine - contraindications
Ultra rapid metabolisers
- CYP2D6
- Causes morphine toxicity
Children under 18 who undergo removal of tonsils or adenoid for treatment of obstructive sleep apnoea
Codeine - BF
Do not give
Passes to baby through milk
Codeine - counselling
Recognise signs and symptoms of toxicity
Stop and seek medical attention
Codeine + dihydrocodeine
Never give IV
- Severe reaction similar to anapylaxis
Dihydrocodeine - MHRA
Co-dydramol
- Prescribe and dispense by strength to minimise risk of medication error and risk of accidental overdose.
Tramadol
Acts on opioid receptors and serotonergic/noradrenergic pathways
- NA + 5-HT reuptake inhibitor
Tramadol - side effects
Increased risk of bleeding
Lowers seizure threshold
Psychiatric reactions
Tramadol interactions - Lowers seizure threshold
SSRIs
TCA
Antiepileptics (effect antagonised)
Tramadol interactions - increased serotonergic effect/risk of serotonin syndrome
SSRIs
TCAs
5-HT1 agonists
MAOIs
Tramadol interactions - increased risk of bleeding
Warfarin
- enhances anticoagulant effect of coumarins
