Codeine Linctus BP
Codeine Phosphate BP 15mg/5ml dose.
Codeine is indicated in adults for relief of the symptoms of dry or irritating coughs.
One 5ml spoonful.
Use with caution, a reduced dose can be recommended by a doctor.
Codeine should not be used for the treatment of children under the age of 18 years.
The dose may be repeated after four hours if required, but not more than 4 doses in any 24 hours.
Suspected opiate abuse, known hypersensitivity to codeine or to any of the other ingredients.
In cases of liver failure, respiratory depression, or patients at risk of paralytic ileus.
In patients with raised intracranial pressure or head injury.
patients for whom it is known they are CYP2D6 ultra-rapid metabolisers.
During an acute asthmatic attack.
Children under 18 years of age.
In women during breastfeeding (see section 4.6)
Use with caution in patients with renal and hepatic impairment(but avoid if severe), patients suffering from asthma or other respiratory disorders, or patients with a history of asthma, hypotension, shock, myasthenia gravis, cardiac arrhythmias, acute abdomen, gallstones, prostatic hypertrophy, urethral stenosis, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders.
Administration of pethidine and possibly other opioid analgesics to patients taking a monoamine oxidase inhibitor (MAOI) has been associate with very severe and sometimes fatal reactions. If the use of codeine is considere essential then great care should take in patients taking MAOIs or within 14 days of stopping MAOIs. (See section 4.5).
Use with caution in the elderly, as codeine may induce faecal impaction, producing incontinence, spurious diarrhoea, abdominal pain and, rarely, colonic obstruction. Prolonged use could aggravate irritable bowel syndrome.
A reduce dose is recommende in elderly or debilitate patients, in hepatic and renal impairment (but avoid if severe), in hypothyroidism, and in adrenocortical insufficiency. Repeate use of opioid analgesics is associate with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advise if prescribing for patients with a history of drug dependence or in acute alcoholism.
Codeine Linctus and other cough suppressants may cause sputum retention and this may be harmful in patients with chronic bronchitis and bronchiectasis.
If symptoms persist consult your doctor.
Codeine is metabolise by the liver enzyme CYP2D6 into morphine, its active metabolite. If a patient has a deficiency or is completely lacking this enzyme an adequate analgesic effect will not be obtaine. Estimates indicate that up to 7% of the Caucasian population may have this deficiency. However, if the patient is an extensive or ultra-rapid metaboliser there is an increased risk of developing side effects of opioid toxicity even at commonly prescribed doses. General symptoms of opioid toxicity include nausea, vomiting, constipation, lack of appetite and somnolence. In severe cases this may include symptoms of circulatory and respiratory depression. These patients convert codeine into morphine rapidly resulting in higher than expected serum morphine levels.