- Mild to moderately severe pain:
- Adult: PO 15-60mg codeine/dose every 4-6 hours
- Max 360mg codeine/day or 4g acetaminophen/day
- Adult: PO 15-60mg codeine/dose every 4-6 hours
-
- ≥12 years: PO 0.5-1mg codeine/kg/dose every 4-6 hours (Max 5 doses/24 hours); PO 10-15mg acetaminophen/kg/dose every 4-6 hours (Max 4g/24 hours)
- Cough (Off-label):
- PO 15-30mg codeine/dose every 4-6 hours
- Max 360mg codeine/day or 4g acetaminophen/day
- PO 15-30mg codeine/dose every 4-6 hours
- Tablet:
- 60mg/1000mg
- 30mg/500mg
- 10mg/500mg
- Codeine doses >60mg rarely more effective or well-tolerated in opioid-naive patients
Codeine: Opioid agonist; analgesia. It blocks pain impulse generation and inhibits ascending pain pathways, thus altering the perception and response to pain. It also inhibits cough by acting centrally in the medulla and causes CNS depression
Paracetamol: Nonopioid, nonsalicylate analgesic. It inhibits prostaglandin synthesis in CNS and may block peripheral pain impulse generation. Antipyresis activity as it acts on the hypothalamus as well
- Drowsiness
- Lightheadedness
- Dizziness
- Sedation
- Nausea
- Vomiting
- Xerostomia
- Hyperhidrosis
- Headache
- Constipation
- Abdominal pain
- Rash
- Pruritus
- Urinary retention
- Euphoria
- Dysphoria
- Hypersensitivity to components
- Hypersensitivity to opioids
- MAO inhibitor use within 14 days
- Ultra-rapid CYP2D6 metabolizers
- Patients <12 years old
- Patients 12-18 years with respiratory depression risk
- Post-tonsillectomy or adenoidectomy use (patients <18 years)
- Severe respiratory depression
- Acute or severe asthma
- Known or suspected GI obstruction
- Paralytic ileus
- Hepatic impairment
- Acute alcohol intoxication
- Acute drug intoxication
- Suicidal ideation or behaviour
- History of addiction
- Circulatory shock
- Coma
- Impaired consciousness
- Abrupt withdrawal
WARNING
- Hepatotoxicity may occur with acetaminophen doses that exceed 4g/day
- Paracetamol associated with cases of acute liver failure, at times resulting in liver transplant and death
- Risk of opioid addiction, abuse and misuse, which can lead to overdose and death
- Serious, life-threatening or fatal respiratory depression may occur
- Prolonged use during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated
- Concomitant opioid use with benzodiazepines or other CNS depressants, including alcohol, may result in profound sedation, respiratory depression, coma and death
- Respiratory depression and death have occurred in children who received tramadol post-tonsillectomy and/or adenoidectomy and were ultra-rapid CYP2D6 metabolizers
- Isocarboxazid
- Isoniazid
- Lidocaine topical
- Linezolid
- Methylene
- Naltrexone
- Phenelzine
- Prilocaine topical
- Procarbazine
- Rasagiline
- Safinamide
- Samidorphan
- Selegiline
- Alvimopan
- Tranylcypromine
- Yohimbe
Drug Status
| Availability | Prescription only |
| Pregnancy | Category C; Weigh risk vs benefit |
| Breastfeeding | Contraindicated |
| Schedule | Controlled |
| BRAND NAME | STRENGTH | FORMULATION | PACK SIZE | MANUFACTURER | DISTRIBUTOR |
|---|---|---|---|---|---|
| ParaCo-Denk | 60mg/1g | Suppository | 10’s | Denk Pharma | Laborex Kenya |
| ParaCo-Denk | 30mg/500mg | Tablet | 20’s | Denk Pharma | Laborex Kenya |
| Parcoten | 10mg/500mg | Tablet | 20’s | Delorbis Pharma | Europa Healthcare |