Arthritis
Hugh McGavock, Dennis Johnston in Treating Common Diseases, 2017
OA cannot be cured or its progress much slowed by any drugs. The aim is to maintain function and relieve pain. The nature of pain, its nerve pathways and the actions of analgesic drugs (pain-relievers) are explained in How Drugs Work,Chapter 14. Pain relief in OA should begin with oral paracetamol, raising the dose as required to 1 gram, four times daily. Codeine phosphate 30 mg, four times daily, may be added when paracetamol alone gives inadequate relief. The most troublesome side-effect of this drug is constipation, and laxatives are sometimes needed. The combination of paracetamol 500 mg and codeine phosphate 30 mg (co-codamol 30/500) is often prescribed. Always remember that about 10% of each dose of codeine is metabolized to morphine, and that long-term use of co-codamol may cause dependence and tolerance (see How Drugs Work, Chapter 19).
Palliative care
Peter Hoskin, Peter Ostler in 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
The patient is constipated
Wesley C Finegan in Being a Cancer Patient’s Carer, 2018
Have you bought the patient any medication over the counter or from the pharmacist? One of the commonly sold pain-killing tablets is cocodamol (a combination of paracetamol and codeine), which is sold under a variety of trade names. Codeine is well known as a cause of constipation. Check and see if you have bought anything containing codeine and let the nurse or doctor know about this, or any other medication you purchased. You never know; it could be something as simple as that! Make a note of anything you buy for future reference.
A spotlight on the role, use, and availability of codeine and the implications faced
Published in Expert Review of Clinical Pharmacology, 2018
Emma M Y Tay, Darren M Roberts
Overall, until more data are available, we believe that codeine has a limited role in the treatment of pain because there appear to be more concerns than benefits. Codeine–paracetamol preparations may have a role in acute pain for patients unable to use nonsteroidal anti-inflammatory drugs. An argument could also be made for prescribing codeine when the CYP2D6 genotype is known. The Clinical Pharmacogenetics Implementation Consortium advises that codeine should not be used in poor and ultrarapid CYP2D6 metabolizers which is somewhat practical, but this means that 2–27% of population (depending on the demographics [2]) are advised against codeine use solely on the basis of genotyping. Currently, most people do not know their CYP genotype, so laboratory testing is required which will delay the initiation of treatment. However, in many countries consumers can self-initiate CYP genotyping, so genotype may be increasingly known in the future at the time that treatment is initiated. We are not aware of dosage guidelines for codeine based on genotype and this degree of consideration may simply increase complexity with codeine use. Of course, a patient’s CYP2D6 genotype is non-contributory if that patient is taking a drug that inhibits CYP2D6, so a medication review should always be performed.
Cold water extraction of codeine/paracetamol combination products: a case series and literature review
Published in Clinical Toxicology, 2020
James T. Harnett, Alison M. Dines, David M. Wood, John R. H. Archer, Paul I. Dargan
Three papers investigated the technique of cold-water extraction [18,21,25], developing standardized laboratory procedures from varying information sources online. Fleming et al. first duplicated water extraction techniques using methods discovered on Internet forums and applied these to a range of different over-the-counter codeine containing analgesics [25]. They reported recovery of codeine in the solution ranging from 42-100% and paracetamol ranging from 1–84%. However, they applied a cold-water technique to only one of eight paracetamol/codeine products tested (co-codamol 8/500 effervescent tablets) and filtered the remaining seven products at room temperature. Specifically, the cold-water experiments produced 100% recovery of the codeine, with only 8% of the paracetamol remaining.
Designing safer analgesics: a focus on μ-opioid receptor pathways
Published in Expert Opinion on Drug Discovery, 2018
Joseph V. Pergolizzi, Jo Ann LeQuang, Robert Taylor, Michael H. Ossipov, Daniel Colucci, Robert B. Raffa
In a study of 50 hip-fracture patients randomized to receive transdermal buprenorphine (10 µg/h) or oral tramadol 50 mg three times a day, transdermal buprenorphine patients had significantly lower pain intensity starting from 24 h postoperatively and for the next 7 consecutive days; vomiting rates were significantly lower for the buprenorphine patch patients (66%) than the tramadol patients (79%) [43]. In an observational study of 966 patients with chronic pain associated with knee or hip osteoarthritis, patients with transdermal buprenorphine patches reported significantly higher satisfaction scores with their pain treatment than the other groups [44]. In a randomized trial of osteoarthritis patients, 7-day buprenorphine patches with oral acetaminophen were found noninferior to co-codamol (codeine plus acetaminophen) in terms of pain relief with a comparable rate of adverse events (86.4% of buprenorphine patients reported adverse events compared to 81.7% with co-codamol) [45]. In a retrospective study of 16 placebo-controlled, active-controlled, and uncontrolled clinical trials (n = 6566), the incidence of adverse events was similar in older patients (≥65 years) than in younger patients (<65 years): 63.8% vs. 61.0%, respectively [46]. It should be noted, though, that in general transdermal opioids are relatively better tolerated than are oral opioids, so some of the comparisons might reflect the contribution of benefits of the route of administration rather than solely to the drug itself.
Related Knowledge Centers
- Rash
- Paracetamol
- Codeine
- Pain
- Aspirin
- Ibuprofen
- Compound Analgesic
- NONsteroidal Anti-Inflammatory Drug
- Naproxen
- Hemoptysis