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  • Content
  • CPCRE
  • ACRRM
  • Content
    • Introduction
    • Responses to Patient FAQs
    • Treatment tree
      • Get Started
      • Mild to Moderate Pain
      • Moderate to Severe Pain
      • Breakthrough Pain
    • Precautions When Using Opioids
    • Difficult Pain Control
    • Equianalgesic Dosing
    • Incident Pain
    • Mode of Action
    • Morphine Myths and Facts
    • Route of Delivery
  • Opioids
    • Choosing an Opioid
    • Opioid Comparative Information Table
    • Opioid Formulation Table
    • Opioids in Special Populations
    • Opioids to Avoid
  • Individual Opioids
    • Buprenorphine
    • Codeine
    • Fentanyl
    • Hydromorphone
    • Methadone
    • Morphine
    • Oxycodone
    • Tramadol
    • Tapentadol

Codeine

Indications#

  • Mild to moderate pain (includes fixed-dose combinations with aspirin, ibuprofen, paracetamol)
  • Cough suppression
  • Diarrhoea

Precautions#

  • Renal – avoid use in renal impairment
  • Breastfeeding – avoid use
  • See precautions from Opioid Analgesics

Dose#

  • Oral, 30–60 mg every 4 hours if needed; maximum 240 mg in 24 hours.

Fixed-dose combination with aspirin#

  • 1–2 tablets every 4 hours if needed, up to a maximum of 8 tablets daily.

Fixed-dose combination with ibuprofen#

  • 1–2 tablets (of ibuprofen 200 mg and codeine 12.8 mg) every 4 hours if needed, up to a maximum of 6 tablets daily.

Fixed-dose combination with paracetamol#

  • 1–2 tablets (of paracetamol 500 mg and codeine 8, 15 or 30 mg) every 4–6 hours if needed, up to a maximum of 8 tablets daily.

Practice considerations#

  • codeine is not recommended for the management of severe pain

  • codeine (a prodrug) is metabolised to morphine; people with normal codeine metabolism metabolise 30 mg of codeine to approximately 4.5 mg of morphine

  • codeine is metabolised by CYP2D6:

    • some people are unlikely to obtain analgesia with codeine due to a genetic lack of CYP2D6, e.g. 6–10% of Caucasians and 1–2% of Asians
    • some people are ultra-rapid metabolisers, e.g. up to 10% of Caucasians, 1–2% of Asians and 29% of Ethiopians, and may achieve higher morphine concentrations, increasing their risk of toxicity

  • beware of the potential for misuse leading to dependence and over-use of OTC codeine fixed-dose combinations; this has resulted in toxicity from the non-opioid analgesic, e.g. acute renal failure and GI perforation from ibuprofen

  • there is no conclusive evidence that products containing 8–15 mg of codeine per tablet with paracetamol, aspirin or ibuprofen have any benefits over these non-opioids alone

Available brands#

  • Codeine phosphate 30 mg – tablet
  • Aspirin 300 mg + codeine phosphate 8 mg - tablet
  • Paracetamol 500 mg + codeine phosphate 30 mg – tablet
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  • Indications
  • Precautions
  • Dose
    • Fixed-dose combination with aspirin
    • Fixed-dose combination with ibuprofen
    • Fixed-dose combination with paracetamol
  • Practice considerations
  • Available brands
Copyright ©2021
Built by ACRRM on behalf of CPCRE

    Welcome

    Welcome to the GP Pain Help App, to help GPs manage cancer pain in their patients.

    General principles

    Opioids are the only pharmacological class of drug with the ability to control severe pain.

    Use oral route first line where possible.

    Dose regularly with controlled-release (CR) preparations, with as required (prn) immediate-release (IR) doses (1/6 daily dose) to assess analgesic requirements.

    Titrate dose against effect and toxicity – consider switching to another class of opioid if toxicity becomes dose-limiting.

    Disclaimer

    The information within this app is presented by the Centre for Palliative Care Research and Education (CPCRE) for the purpose of disseminating health information free of charge and for the benefit of the healthcare professional.

    While CPCRE has exercised due care in ensuring the accuracy of the material herein, the information provided should be treated as a guide only to appropriate practice, to be followed subject to the clinician’s judgment and the patient’s preference in each individual case.

    CPCRE does not accept any liability for any injury, loss or damage incurred by use of or reliance on the information contained herein.

    Acknowledgement

    CPCRE acknowledges the work of Professor Janet Hardy, Associate Professor Phillip Good and the Australian College of Rural and Remote Medicine (ACRRM) in development of this pain aid for GPs.