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Codeine Sulfate
Overview
What is Codeine Sulfate?
Chemically, codeine is
Morphinan-6-ol,7,8-didehydro-4,5-epoxy-3-methoxy-17-methyl-(5α,6α)-, sulfate
(2:1) (salt), trihydrate. Its empirical formula is CHNO and its
molecular weight is 299.36.
Its structure is as follows:
Each tablet contains 15, 30, or 60 mg of codeine sulfate and the following
inactive ingredients: colloidal silicon dioxide, microcrystalline cellulose,
pregelatinized starch, and stearic acid.
What does Codeine Sulfate look like?




What are the available doses of Codeine Sulfate?
Each 15 mg tablet for oral administration contains 15 mg of
codeine sulfate. It is a white, biconvex tablet scored on one side, with
strength-indicating number “15” debossed on the scored side and product
identification number “54 613” debossed on the other side.
Each 30 mg tablet for oral administration contains 30 mg of codeine sulfate.
It is a white, biconvex tablet scored on one side, with strength-indicating
number “30” debossed on the scored side and product identification number “54
783” debossed on the other side.
Each 60 mg tablet for oral administration contains 60 mg of codeine sulfate.
It is a white, biconvex tablet scored on one side, with strength-indicating
number “60” debossed on the scored side and product identification number “54
412” debossed on the other side.
What should I talk to my health care provider before I take Codeine Sulfate?
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How should I use Codeine Sulfate?
Codeine sulfate is an opioid analgesic indicated for the relief of mild to
moderately severe pain where the use of an opioid analgesic is appropriate.
Selection of patients for treatment with codeine sulfate should
be governed by the same principles that apply to the use of similar opioid
analgesics. Physicians should individualize treatment in every case, using
non-opioid analgesics, opioids on an as needed basis and/or combination
products, and chronic opioid therapy in a progressive plan of pain
management.
As with any opioid drug product, adjust the dosing regimen for
each patient individually, taking into account the patient’s prior analgesic
treatment experience. In the selection of the initial dose of codeine sulfate,
attention should be given to the following:
• the total daily dose, potency and specific characteristics of the opioid
the patient has been taking previously;
• the reliability of the relative potency estimate used to calculate the
equivalent codeine sulfate dose needed;
• the patient’s degree of opioid tolerance;
• the general condition and medical status of the patient;
• concurrent medications;
• the type and severity of the patient’s pain;
• risk factors for abuse, addiction or diversion, including a prior history
of abuse, addiction or diversion.
The following dosing recommendations, therefore, can only be considered
suggested approaches to what is actually a series of clinical decisions over
time in the management of the pain of each individual patient.
Continual re-evaluation of the patient receiving codeine sulfate is
important, with special attention to the maintenance of pain control and the
relative incidence of side effects associated with therapy. During chronic
therapy, especially for noncancer-related pain, the continued need for the use
of opioid analgesics should be re-assessed as appropriate.
During periods of changing analgesic requirements, including initial
titration, frequent contact is recommended between physician, other members of
the healthcare team, the patient, and the caregiver/family.
The usual adult dosage for tablets is 15 mg to 60 mg repeated up
to every four hours as needed for pain. The maximum 24 hour dose is 360 mg.
The initial dose should be titrated based upon the individual patient’s
response to their initial dose of codeine. This dose can then be adjusted to an
acceptable level of analgesia taking into account the improvement in pain
intensity and the tolerability of the codeine by the patient.
It should be kept in mind, however, that tolerance to codeine sulfate can
develop with continued use and that the incidence of untoward effects is
dose-related. Adult doses of codeine higher than 60 mg fail to give commensurate
relief of pain and are associated with an appreciably increased incidence of
undesirable side effects.
When the patient no longer requires therapy with codeine sulfate,
doses should be tapered gradually to prevent signs and symptoms of withdrawal
in the physically dependent patient.
What interacts with Codeine Sulfate?
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What are the warnings of Codeine Sulfate?
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What are the precautions of Codeine Sulfate?
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What are the side effects of Codeine Sulfate?
Sorry No records found
What should I look out for while using Codeine Sulfate?
Codeine sulfate is contraindicated in patients with known
hypersensitivity to codeine or any components of the product. Persons known to
be hypersensitive to certain other opioids may exhibit cross-sensitivity to
codeine.
Codeine sulfate is contraindicated in patients with respiratory depression in
the absence of resuscitative equipment.
Codeine sulfate is contraindicated in patients with acute or severe bronchial
asthma or hypercarbia.
Codeine sulfate is contraindicated in any patient who has or is suspected of
having paralytic ileus.
What might happen if I take too much Codeine Sulfate?
Acute overdose of codeine is characterized by respiratory
depression (a decrease in respiratory rate and/or tidal volume, Cheyne-Stokes
respiration, cyanosis), extreme somnolence progressing to stupor or coma, miosis
(mydriasis may occur in terminal narcosis or severe hypoxia), skeletal muscle
flaccidity, cold and clammy skin, and sometimes bradycardia and hypotension. In
severe overdosage, apnea, circulatory collapse, cardiac arrest, and death may
occur.
Codeine sulfate may cause miosis, even in total darkness. Pinpoint pupils are
a sign of opioid overdose but are not pathognomonic (e.g., pontine lesions of
hemorrhagic or ischemic origin may produce similar findings). Marked mydriasis
rather than miosis may be seen with hypoxia in overdose situations.
Primary attention should be given to the re-establishment of
adequate respiratory exchange through provision of a patent airway and
institution of assisted or controlled ventilation as necessary. Supportive
measures (including oxygen and vasopressors) should be employed in the
management of circulatory shock and pulmonary edema accompanying overdose as
indicated. Cardiac arrest or arrhythmias may require cardiac massage or
defibrillation. Induction of emesis is not recommended because of the potential
for CNS depression and seizures. Activated charcoal is recommended if the
patient is awake and able to protect his/her airway. In persons who are at risk
for abrupt onset of seizures or mental status depression, activated charcoal
should be administered by medical or paramedical personnel capable of airway
management to prevent aspiration in the event of spontaneous emesis. Severe
agitation or seizures should be treated with an intravenous benzodiazepine.
The opioid antagonist naloxone hydrochloride is a specific antidote against
respiratory depression resulting from overdosage or unusual sensitivity to
opiate agonists, including codeine. Therefore, an appropriate dose of naloxone
hydrochloride (see prescribing information for naloxone hydrochloride) should be
administered, preferably by the intravenous route, simultaneously with efforts
at respiratory resuscitation. Since the duration of action of codeine may exceed
that of the antagonist, the patient should be kept under continued surveillance
and repeated doses of the antagonist should be administered as needed to
maintain adequate respiration. A narcotic antagonist should not be administered
in the absence of clinically significant respiratory or cardiovascular
depression secondary to codeine sulfate overdose.
In an individual physically dependent on opioids, administration of the usual
dose of the antagonist will precipitate an acute withdrawal syndrome. The
severity of the withdrawal symptoms experienced will depend on the degree of
physical dependence and the dose of the antagonist administered. Use of an
opioid antagonist should be reserved for cases where such treatment is clearly
needed. If it is necessary to treat serious respiratory depression in the
physically dependent patient, administration of the antagonist should be
initiated with care and titrated with smaller than usual doses.
How should I store and handle Codeine Sulfate?
Store at controlled room temperature 20° to 25°C (68° to 77°F) [see USP] .Codeine SulfateNDC 54868-2541-0: Bottles of 10 TabletsNDC 54868-2541-1: Bottles of 30 TabletsNDC 54868-2541-2: Bottles of 60 Tablets StorageStore at Controlled Room Temperature, 15º to 30ºC (59º to 86ºF). Protect from moisture and light. Dispense in well-closed container as defined in the USP/NF.All opioids are liable to diversion and misuse both by the general public and healthcare workers and should be handled accordingly.Codeine SulfateNDC 54868-2541-0: Bottles of 10 TabletsNDC 54868-2541-1: Bottles of 30 TabletsNDC 54868-2541-2: Bottles of 60 Tablets StorageStore at Controlled Room Temperature, 15º to 30ºC (59º to 86ºF). Protect from moisture and light. Dispense in well-closed container as defined in the USP/NF.All opioids are liable to diversion and misuse both by the general public and healthcare workers and should be handled accordingly.Codeine SulfateNDC 54868-2541-0: Bottles of 10 TabletsNDC 54868-2541-1: Bottles of 30 TabletsNDC 54868-2541-2: Bottles of 60 Tablets StorageStore at Controlled Room Temperature, 15º to 30ºC (59º to 86ºF). Protect from moisture and light. Dispense in well-closed container as defined in the USP/NF.All opioids are liable to diversion and misuse both by the general public and healthcare workers and should be handled accordingly.Codeine SulfateNDC 54868-2541-0: Bottles of 10 TabletsNDC 54868-2541-1: Bottles of 30 TabletsNDC 54868-2541-2: Bottles of 60 Tablets StorageStore at Controlled Room Temperature, 15º to 30ºC (59º to 86ºF). Protect from moisture and light. Dispense in well-closed container as defined in the USP/NF.All opioids are liable to diversion and misuse both by the general public and healthcare workers and should be handled accordingly.Codeine SulfateNDC 54868-2541-0: Bottles of 10 TabletsNDC 54868-2541-1: Bottles of 30 TabletsNDC 54868-2541-2: Bottles of 60 Tablets StorageStore at Controlled Room Temperature, 15º to 30ºC (59º to 86ºF). Protect from moisture and light. Dispense in well-closed container as defined in the USP/NF.All opioids are liable to diversion and misuse both by the general public and healthcare workers and should be handled accordingly.Codeine SulfateNDC 54868-2541-0: Bottles of 10 TabletsNDC 54868-2541-1: Bottles of 30 TabletsNDC 54868-2541-2: Bottles of 60 Tablets StorageStore at Controlled Room Temperature, 15º to 30ºC (59º to 86ºF). Protect from moisture and light. Dispense in well-closed container as defined in the USP/NF.All opioids are liable to diversion and misuse both by the general public and healthcare workers and should be handled accordingly.Codeine SulfateNDC 54868-2541-0: Bottles of 10 TabletsNDC 54868-2541-1: Bottles of 30 TabletsNDC 54868-2541-2: Bottles of 60 Tablets StorageStore at Controlled Room Temperature, 15º to 30ºC (59º to 86ºF). Protect from moisture and light. Dispense in well-closed container as defined in the USP/NF.All opioids are liable to diversion and misuse both by the general public and healthcare workers and should be handled accordingly.Codeine SulfateNDC 54868-2541-0: Bottles of 10 TabletsNDC 54868-2541-1: Bottles of 30 TabletsNDC 54868-2541-2: Bottles of 60 Tablets StorageStore at Controlled Room Temperature, 15º to 30ºC (59º to 86ºF). Protect from moisture and light. Dispense in well-closed container as defined in the USP/NF.All opioids are liable to diversion and misuse both by the general public and healthcare workers and should be handled accordingly.Codeine SulfateNDC 54868-2541-0: Bottles of 10 TabletsNDC 54868-2541-1: Bottles of 30 TabletsNDC 54868-2541-2: Bottles of 60 Tablets StorageStore at Controlled Room Temperature, 15º to 30ºC (59º to 86ºF). Protect from moisture and light. Dispense in well-closed container as defined in the USP/NF.All opioids are liable to diversion and misuse both by the general public and healthcare workers and should be handled accordingly.