UNCONTROLLED WHEN PRINTED
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
- See Non-Steroidal and Anti-Inflammatory Drugs (NSAIDs) and Aspirin precautions
- Can develop dependency with long term use.
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
- Respiratory depression in large enough doses
- Constipation
- Nausea
- Euphoria
- Drowsiness
- Dry mouth
- Miosis
- See side effects of Aspirin and Non-Steroidal and Anti-Inflammatory Drugs (NSAIDs)
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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