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Palliative care
Published in Peter Hoskin, Peter Ostler, Clinical Oncology, 2020
When level I analgesics are no longer effective, the next step is to use regular level II analgesics. These drugs are weak opioids, i.e. they act by binding to the same opioid receptors as morphine but are less potent. Because of this, however, they tend to have a similar side-effect profile, in particular being associated with nausea and constipation. The drugs available in this group are: Codeine, given as codeine phosphate 4–6 hourlyDihydrocodeine, a derivative of codeineCombination formulations of the aforementioned with paracetamol (co-codamol or codydramol)Tramadol, a synthetic opioid
Criteria For Evaluating Physical And Psychic Dependence And Overall Abuse Potential Of Drugs In Man
Published in S.J. Mulé, Henry Brill, Chemical and Biological Aspects of Drug Dependence, 2019
The abuse potential of a drug often is influenced significantly by subtle characteristics other than physical and psychic dependence. Questions which may play a part, for instance, are whether the compound is soluble in water, so that it may be readily injected intravenously, and whether the quality of the subjective effects upon injection resembles that of morphine or heroin. For example, codeine has a pattern typical of morphine when injected intravenously, with the exception that it releases considerably more histamine. While a moderate amount of histamine release is desired by the addict (that is, the induction of a flush), an excessive release is disliked. Furthermore, when injected rapidly or in doses that are sufficient to produce the desired subjective effect, codeine has the capacity for inducing postural hypotension and even fainting, a characteristic not observed when either morphine or heroin is injected intravenously. In addition, since codeine phosphate is relatively insoluble, the addict has difficulty getting a large enough dose in his 2 or 5 cc syringe. The precipitate frequently blocks a small needle.
Drug Therapy in Laryngology and Head and Neck Surgery
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
These are divided into cough suppressants and the expectorant and demulcent cough preparations. After excluding an underlying cause of a cough, such as asthma and gastro-oesophageal reflux, cough suppressants may be used. It is thought that these drugs act by an ill-defined central action in the nervous system and may depress the ‘cough centre’ in the brain stem. The narcotic analgesics are effective as antitussives in subanalgesic doses. Codeine phosphate is useful for dry or painful coughs but it also inhibits the secretion and mucociliary clearance of sputum, is constipating and dependence can develop. Pholcodine (related to codeine) and dextromethorphan (a non-narcotic, nonanalgesic) have lesser side effects. Over the counter preparations include sedating antihistamines, such as diphenhydramine, and may work by causing drowsiness.
Analgesic efficacy of naproxen sodium versus hydrocodone/acetaminophen in acute postsurgical dental pain: a randomized, double-blind, placebo-controlled trial
Published in Postgraduate Medicine, 2022
Stephen A. Cooper, Paul J Desjardins, Todd Bertoch, Alberto Paredes-Diaz, Emanuel Troullos, Azita Tajaddini, Robert Centofanti, Robert An, Donna Morella
NapS 440 mg has previously been compared to codeine phosphate (60 mg) plus APAP (600 mg) and was found to provide superior and longer-lasting pain relief for postsurgical dental pain [32]. Our study extends the finding to another commonly prescribed oral opioid combination, HYD+APAP. Taken together, the evidence indicates that NapS is preferable to opioid medication to relieve postsurgical dental pain. While NapS (440 mg) has not been studied in other postsurgical pain models, the findings from dental impaction studies should be applicable to other postoperative pain states. A review comparing analgesic efficacy in various pain models found no consistent differences between dental and other postsurgical pain (e.g. episiotomy, cesarean section, gynecologic, urologic, inguinal hernia, etc.) in single or two-dose trials [16]. Additionally, findings from the dental impaction pain model have been reported to be similar to those from general surgery, obstetrics-gynecology surgery, and bunionectomy [15].
Pharmacotherapeutic Options for Chronic Refractory Cough
Published in Expert Opinion on Pharmacotherapy, 2020
Although codeine is widely used, its efficacy is not fully supported by clinical trials. There are a few randomized placebo-controlled trials for cough in patients with chronic bronchitis or chronic obstructive pulmonary disease (COPD), but they are outdated in terms of cough measurements, and the population criteria are not matched to the current indications (for CRC) [22–24]. More recent clinical trials, although not conducted in patients with CRC, did not find any significant benefits with the use of codeine over the placebo in different patient groups with cough [25–27]. In a sophisticated study by Smith and colleagues, 60 mg of codeine phosphate per day was not more effective than the placebo in reducing either objective cough frequency or subjective cough severity among patients with stable COPD and cough [27] (Table 1). As these findings are not directly related to CRC, they do not refute the potential benefits of using codeine for the management of patients with CRC; however, the discrepancy between practice and evidence strongly indicates the need to reevaluate the effectiveness of codeine in patients with CRC.
The utility of universal urinary drug screening in chronic pain management
Published in Canadian Journal of Pain, 2018
Luke K. Wiseman, Mary E. Lynch
Currently in Nova Scotia, acetaminophen with codeine preparations do not require a prescription if the preparation contains no more than 8 mg or its equivalent of codeine per solid dosage unit or more than 20 mg or its equivalent of codeine phosphate per 30 ml in a liquid preparation.35 The readily available access to codeine may have contributed to it being the most common unexpected drug on UDS. Patients may feel that it is not important to disclose nonprescription medications to their health care provider. One study showed that physicians ask about over-the-counter drug use in 37% of patient encounters and only 58% of patients told their physicians about their over-the-counter use.36