Adult Dosing

Mild to moderate pain

• 15–60 mg IM/IV/SC q4–6 hrs PRN

Pediatric Dosing

Mild to moderate pain

• Child 1 yr: 0.5 mg/kg (15 mg/m²) q4–6 hrs PRN

• Mild to moderate pain

• Hypersensitivity to any of the ingredients of the product
• Upper airway obstruction
• Respiratory compromise
• Acute asthma
• Diarrhea caused by poisoning or toxins

• N/A

Renal Dose Adjustment (Based on CrCl)

• 40-50 mL/min: Decrease dose to 25%
• < 10 mL/min : Decrease dose to 50%

Hepatic Dose Adjustment

• Hepatic impairment: Use lower doses or increase dosing intervals

• It may cause respiratory depression in elderly, debilitated patients, those suffering from conditions accompanied by hypoxia, hypercapnia, or upper airway obstruction
• Similar to other opioids it is a Schedule II controlled substance with an abuse liability
• If used in conjunction with alcohol, other opioids, or illicit drugs it may result in additive CNS depressive effects, including respiratory depression, hypotension, profound sedation, coma, or death
• Avoid use in head injury or other intracranial lesions as it may exaggerate elevation of ICP
• Restrict use in patients whose ability to maintain blood pressure has already been compromised, as therapy may cause severe hypotension
• Avoid administration in patients with gastrointestinal obstruction, especially paralytic ileus because it diminishes propulsive peristaltic waves in the gastrointestinal tract and may prolong the obstruction
• Use with caution in patients with biliary tract disease, including acute pancreatitis, as it may cause spasm of the Sphincter of Oddi and diminish biliary and pancreatic secretions
• Administration may result in higher than expected morphine levels and overdose symptoms due to its ultra-rapid conversion into its active metabolite, morphine
• Caution must be used with potentially hazardous activities such as driving and operating machinery

Cautions: Use cautiously in

• Severe renal impairment
• Severe hepatic impairment
• Elderly or debilitated pts
• GI obstruction
• Hypothyroidism
• Seizure disorder
• CNS depression
• Asthma
• COPD
• IBD
• Urethral stricture
• Seudomembranous colitis
• Biliary disease
• Ultra-rapid CYP2D6 metabolizer

Pregnancy Category:C

Breastfeeding: Safety conditional. Breastfeeding can cause infant drowsiness. Newborn infants seem to be particularly sensitive to the effects of even small dosages, particularly in the first week of life. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 9 December 2010). Maternal medication usually compatible with breastfeeding, no observable change was seen in the nursing infant while the mother was ingesting the compound. This information is based upon data from AAP Policy Guidelines (available at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776/T6 last accessed 9 December 2010 ).

• CNS: Agitation, anxiety, insomnia, lethargy, lightheadedness, convulsions, disorientation, dizziness, drowsiness, dysphoria, euphoria, fear, headache, mental clouding, mood changes, psychic dependence, impaired mental and physical performance, , reduced libido, sedation, weakness
• CV: Circulatory depression, fainting, orthostatic hypotension, bradycardia, cardiac arrest, palpitation, shock, syncope, tachycardia
• RESP: Respiratory depression, suppressed cough reflex
• DERM: Pruritus, rash, sweating, urticaria, flushing, hemorrhagic urticaria
• EENT: Visual disturbances, miosis
• GI: Nausea, vomiting, anorexia, constipation, dry mouth, increased biliary tract pressure and spasm
• GU: Antidiuretic effect, reduced libido or potency, spasm of vesicle sphincter, ureteral spasm, urinary retention or hesitancy
• MISC: Allergic reactions, edema

• Opioid agonist; produces analgesia and sedation by binding to various opioid receptors
• Completely absorbed from IM sites
• Primarily metabolized by liver; CYP450: 2D6 substrate
• Excreted in urine (5-15% unchanged)
• Half life: 2.5–4 hrs

US Trade Name(s)

• N/A

US Availability

• N/A

Canadian Availability

codeine phosphate (generic)

• INJ: 30, 60 mg/mL

UK Trade Name(s)

• N/A

UK Availability

• N/A

Australian Trade Name(s)

• N/A

Australian Availability

• N/A

Analgesics

Opioid Analgesics

Opioid Agonists