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Codeine
(prescription opioids)
Summary of Opioids
Opioids are commonly prescribed because of their effective
analgesic, or pain relieving, properties. Studies have shown that
properly managed medical use of opioid analgesic compounds is safe
and rarely causes addiction. Taken exactly as prescribed, opioids
can be used to manage pain effectively.
Among the compounds that fall within this class—sometimes referred
to as narcotics—are morphine, codeine, and related medications.
Morphine is often used before or after surgery to alleviate severe
pain. Codeine is used for milder pain. Other examples of opioids
that can be prescribed to alleviate pain include oxycodone (OxyContin—an
oral, controlled release form of the drug); propoxyphene (Darvon);
hydrocodone (Vicodin); hydromorphone (Dilaudid); and meperidine
(Demerol), which is used less often because of its side effects. In
addition to their effective pain relieving properties, some of these
medications can be used to relieve severe diarrhea (Lomotil, for
example, which is diphenoxylate) or severe coughs (codeine).
Opioids act by attaching to specific proteins called opioid
receptors, which are found in the brain, spinal cord, and
gastrointestinal tract. When these compounds attach to certain
opioid receptors in the brain and spinal cord, they can effectively
change the way a person experiences pain.
In addition, opioid medications can affect regions of the brain that
mediate what we perceive as pleasure, resulting in the initial
euphoria that many opioids produce. They can also produce
drowsiness, cause constipation, and, depending upon the amount
taken, depress breathing. Taking a large single dose could cause
severe respiratory depression or death.
Opioids may interact with other medications and are only safe to use
with other medications under a physician's supervision. Typically,
they should not be used with substances such as alcohol,
antihistamines, barbiturates, or benzodiazepines. Since these
substances slow breathing, their combined effects could lead to
life-threatening respiratory depression.
Codeine
Codeine is sometimes marketed in combination preparations with
paracetamol (acetaminophen) as
co-codamol or paracod (best known in North America as Tylenol
3), with
aspirin as
co-codaprin or with
ibuprofen. These combinations provide greater pain relief than
either agent alone (drug synergy; see
synergy). Codeine is also commonly compounded with other pain
killers or muscle relaxers such as
Fioricet with Codeine,
Soma Compound/Codeine, etc. Codeine-only products can be
obtained with a prescription as a time release tablet (eg. Codeine
Contin(r) 100mg).
In
the
United States, codeine is
regulated by the
Controlled Substances Act. It
is a Schedule II controlled substance for pain-relief products
containing codeine alone or more than 90 mg per dosage unit. In
combination with aspirin or acetaminophen (paracetamol/Tylenol)
it is listed as Schedule III or V, depending on formula.
Preparations for cough or diarrhoea containing small amounts of
codeine in combination with two or more other active ingredients are
Schedule V in the US, and may be dispensed in amounts up to 4 fl.
oz. per 48 hours without a prescription.
Common adverse drug reactions associated with the use of codeine
include
euphoria,
itching,
nausea,
vomiting,
drowsiness,
dry mouth,
miosis,
orthostatic hypotension,
urinary retention
and
constipation.
Tolerance to many of the effects of codeine develops with prolonged
use, including therapeutic effects. The rate at which this occurs
develops at different rates for different effects, with tolerance to
the constipation-inducing effects developing particularly slowly for
instance.
A potentially serious adverse drug reaction, as with other opioids,
is
respiratory depression. This
depression is dose-related and is the mechanism for the potentially
fatal consequences of overdose.
Another side effect commonly noticed is the lack of sexual drive.
* page last updated 5/18/2008
Source:
National Institute on Drug
Abuse (NIDA), various other sources
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