Codeine

Summary about Codeine

Antitussive and analgesic molecule, used, respectively, against dry cough or against pain. It usually comes in the form of a syrup or drops.

For more details see below or in the summary.

Name

Molecule name

Codeine in medicines in general is presented as a codeine salt: ex. hemihydricus codeine phosphate

Chemical name of Codeine : 5R,6S – 7,8- dihydro-4,5-epoxy-3-methoxy-N-methylformin-6-ol (source : wikipedia)

Origin and chemical aspect

Codeine is an opium alkaloid (found in the poppy) of the opiate class that differs from morphine only by the presence of a methyl group above the hydroxy group of the carbon atom 3 of the benzyl group. This methyl group has an advantage over morphine, it decreases the first-pass effect and thus increases oral bioavailability.

It is estimated that 10% of codeine is transformed into morphine, thus being considered a ”light” morphine. We must remember that one out of 15 people does not have the effect of codeine (slow metabolism) and on the contrary 1 out of 30 people (fast metabolism) codeine has a very significant effect. Excess codeine turns into morphine, causing undesirable effects.

Dosage and Posology

Codeine dosage:

It varies according to the indication. Consult your doctor or pharmacist for more information.

For example, against dry cough for an adult at the initial dose (orally): 10 to 20 mg of codeine every 6 hours, and 10 to 30 mg maintenance dose. oral): 15 to 30 mg of codeine every 6 hours, and 15 to 60 mg as a maintenance dose.

Codeine Dosage
In general, codeine remains in an adult’s body for 6 hours. See also dosage above. Note that the dose may vary for each person, so consult your doctor.

codeine effects

Antitussive (acts by reducing the cough reflex by decreasing the excitability of the cough center), analgesic (the dose is higher than for antitussive action).

codeine indications

Dry cough , mild to moderate pain , laryngitis and diarrhea .

Read also: United States: Codeine continues to be prescribed to children despite adverse effects

codeine side effects

Constipation, nausea, vomiting, gastrointestinal problems, euphoria, sleep disturbances, respiratory depression (rare with usual doses, but more frequent in children. In the United States, codeine is strictly contraindicated in children), codeine dependence, drowsiness, etc.

Read also: United States: Codeine continues to be prescribed to children despite adverse effects

contraindication of codeine

Persons dependent on other opiates (heroin, morphine) are at high risk of codeine dependence, hypersensitivity to codeine, cough (productive cough) after tonsillectomy. Codeine can cause death in some children with a genetic anomaly, respiratory failure (regardless of the degree, in the United States it is strictly contraindicated due to a high risk of respiratory depression, also read the news below), asthma, pregnancy, lactation.

In Europe, since 2015 the use of codeine to treat cough is contraindicated for children under 12 years old.

Patients known to be ultra-rapid metabolizers of CYP2D6 substrates.

Interactions with codeine

Possible interactions with Fluoxetine, sedative drugs, narcotics, neuroleptics, alcohol, etc.

In what form?

Available in pharmacies (OTC) or prescribed in the form of tablets, syrups, drops (liquid solution).

The use of codeine should be used with caution during pregnancy and breastfeeding

codeine in pregnancy

Like all medicines, during pregnancy it is not advised to take a medication unless prescribed by your doctor or pharmacist. In this case, consult a specialist and read the package leaflet. According to studies, codeine should only be taken if necessary (eg after the 3rd trimester of pregnancy), but in our opinion never during the first trimester of pregnancy.

Lactation and Codeine: theoretically contraindicated during lactation. Consult a doctor or pharmacist.

Codeine Addiction

Interview held on November 14, 2007 with Dr. Thierry Buclin, pharmacologist at CHUV (Lausanne, Switzerland), on the risk of codeine addiction

Dr. Buclin, first of all what is codeine ?

Codeine is a substance derived from opium like morphine, as it belongs to the class of opiates. Codeine is chemically very similar to morphine, being mostly converted into small amounts of morphine, which acts as a mild pain reliever. However, not all people have enzymes capable of this chemical transformation. For genetic reasons, in about 1 in 15 people, codeine has virtually no effect (Slow metabolism). On the other hand, in about 1 in 30 people (Rapid Metabolism) may develop an extraordinarily significant effect.

A significant number of people consume codeine in excess, what are the physical and psychological risks of this abusive use?

The physical hazards are relatively harmless and consist mainly of constipation.

Psychological risks are more problematic. There is mainly a loss of freedom for the patient, a reduced presence in the world, a certain indifference to society. Codeine-dependent people are often a little aloof and lose their fighting spirit. A vicious circle can then drive that person into social isolation.

For an addicted person, what advice do you give, for that person to ”get rid” of codeine? Should we be concerned about an addiction to heroin or cocaine?

First you should know that codeine dependence is less than heroin or cocaine, these drugs provide a more intense pleasure, making it more difficult to make the person “get rid” of these substances.:

A codeine addict should, however, seriously consider stopping using codeine. Therefore I recommend the withdrawal scheme as follows:

First step, the addict’s awareness of how codeine affects their daily life.

Recognize, have the desire to stop using codeine. Identify why codeine negatively affects your daily life: loss of freedom, high cost to acquire the substance, loss of energy, …

Prepare a specific withdrawal schedule, with gradual dose reduction, such a week plan: in the first 2 days we withdraw ¾ of the dose, in the 3rd and 4th day we withdraw more than half, etc. A doctor or pharmacist can help you establish this withdrawal pattern. The doctor will also help you with the physical symptoms that usually appear with withdrawal from this drug, these are usually pain and diarrhea.

Finally, apply the third program. Through your own volition or with the help of a health professional.

People addicted to codeine can be former heroin addicts, but also people who started directly with codeine, the latter are generally more susceptible to dependence.

Finally, if I have a dry cough, what do you suggest as an effective alternative?

The effectiveness of antitussives (codeine, dextromethorphan,…) has never been so great, to suppress the cough, it is used slightly to improve the condition of the cough. You should know that the simple act of coughing does not always require taking cough medicine. My advice when coughing, especially in winter (low humidity), is to use a humidifier in the apartment at night.

To summarize, codeine should only be used in certain cases, for example, when a person coughs a lot at night, which prevents him from sleeping. I think codeine should be consumed with caution, especially when it is to be used for a short period of time, but I am not in favor of banning its use.

Read also: United States: Codeine continues to be prescribed to children despite adverse effects

Jeanne Kenney
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I’m a stylist trainer, a content creator, and an entrepreneur passion. Virgo sign and Pisces ascendant, I move easily between my dreams, the crazy world I want, and my feet on the ground to carry out my projects.

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