Narcotic analgesics interact with opioid receptors in the CNS. The interactions result in the narcotic pharmacologic effects of analgesia, sedation and cough suppression. While significantly more effective against severe and acute pain than nonnarcotic analgesics they have the disadvantage of adverse effects such as sedation, respiratory depression and dependence.
Codeine is the most commonly prescribed narcotic for moderate to severe pain. It is absorbed well when taken orally and may be used for severe pain that is not responsive to acetaminophen, aspirin, and NSAIDS. Codeine is usually given in combination with non-narcotic analgesics, because the narcotic acts at a central site and the non-narcotic analgesic at a peripheral site providing enhanced analgesic activity. Codeine products are recommended only for acute dosing (3 days or less) as they can cause nausea, sedation, constipation and dependency with prolonged use.
Contraindications: Same as for acetaminophen plus hypersensitivity to codeine or any component of the formulation, significant respiratory depression, acute or severe bronchial asthma, hypercapnia, and paralytic ileus.
Warnings/Precautions: Same as acetaminophen plus use with caution in patients with hypersensitivity to other opioid agents. Use with caution in patients with hypotension, adrenocortical insufficiency, thyroid disorders, prostatic hyperplasia, urethral stricture, seizure disorder, CNS depression, head injury or increased intracranial pressure. Safety and efficacy in pediatric patients has not been established.
Children ≤ 44 kg: Oral
Codeine: 0.5-1 mg codeine/kg/dose every 4-6 hours
Acetaminophen: 10-15 mg/kg/dose every 4-6 hours up to 2.6 gm/day
Children > 44 kg and adults: Oral
Codeine: 30-60 mg/dose every 4-6 hours.
Acetaminophen: 325-650 mg/dose every 4-6 hours, up to 4g/day
Elixir, suspension: Acetaminophen 120 mg and codeine phosphate 12 mg per 5 ml