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Introduction
  • Codeine is considered a prodrug, since it is metabolised in vivo to the primary active compounds morphine and codeine-6-glucuronide (C6G). Roughly 5-10% of codeine will be converted to morphine, with the remainder either free, conjugated to form codeine-6-glucuronide (~70%), or converted to norcodeine (~10%) and hydromorphone (~1%).
Indications
  • Moderate to strong pain
  • See NSAID indications
Contraindications
  • Known hypersensitivity to codeine, aspirin or ibuprofen
  • Asthmatic that is aspirin or NSAID sensitive
  • Active gastrointestinal bleeding or peptic ulceration
  • Pregnant patients
  • Need to drive, operate heavy machinery, or work at heights
  • Constipated patients
Precautions / Notes
Management

Give tablets orally, with water to swallow

Aspirin and Codeine (Aspalgin)

  • 2 tablets every 4 hours to a maximum of 8 tablets per day
  • Dissolve the tablets in a little water before swallowing them
  • Aspalgin can be taken with or without food
  • Not recommended for children under 12 years of age

Ibuprofen 200mg + Codeine 12.8mg (Nurofen Plus)

Adults and children from 12 years:

  • 2 tablets, then 1 or 2 tablets every 4 hours as necessary (maximum 6 tablets in 24 hours).
  • Not for children under 12 years.
Special Considerations

References
References
Presentation
  • Aspalgin (Aspirin 300mg, Codeine 8mg; see Aspirin guideline as well)
  • Ibuprofen 200mg + Codeine 12.8mg (See NSAID guideline as well)

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