03/04/2009 19:45

Codeine phosphate

Pregnancy Category C (during pregnancy), Pregnancy Category D (during labor), C-II controlled substance

Drug classes: Narcotic agonist analgesic, Antitussive

Therapeutic actions

Acts at opioid receptors in the CNS to produce analgesia, euphoria, sedation; acts in medullary cough center to depress cough reflex.



· Relief of mild to moderate pain in adults and children

· Coughing induced by chemical or mechanical irritation of the respiratory system



· Contraindicated with hypersensitivity to narcotics, physical dependence on a narcotic analgesic (drug may precipitate withdrawal).


Adverse effects

Sedation, clamminess, sweating, headache, vertigo, floating feeling, dizziness, lethargy, confusion, light-headedness, nervousness, unusual dreams, agitation, euphoria, hallucinations, delirium, insomnia, anxiety, fear, disorientation, impaired mental and physical performance, coma, mood changes, weakness, headache, tremor, convulsions

Palpitation, increase or decrease in BP, circulatory depression, cardiac arrest, shock, tachycardia, bradycardia, arrhythmia, palpitations

Rash, hives, pruritus, flushing, warmth, sensitivity to cold

Diplopia, blurred vision

Nausea, vomiting, dry mouth, anorexia, constipation, biliary tract spasm

Ureteral spasm, spasm of vesical sphincters, urinary retention or hesitancy, oliguria, antidiuretic effect, reduced libido or potency

Phlebitis following IV injection, pain at injection site; tissue irritation and induration (SC injection)

Slow, shallow respiration; apnea; suppression of cough reflex; laryngospasm; bronchospasm

Physical tolerance and dependence, psychological dependence



· Potentiation of effects of codeine with barbiturate anesthetics; decrease dose of codeine when coadministering

Nursing considerations


Name confusion has been reported between codeine and Cardene (nicardipine) and Lodine (etodolac); use caution.

· Give to nursing women 4–6 hr before scheduled feeding to minimize drug in milk.

· Provide narcotic antagonist, facilities for assisted or controlled respirations on standby during parenteral administration.

· Use caution when injecting SC into chilled body areas or in patients with hypotension or in shock; impaired perfusion may delay absorption; with repeated doses, an excessive amount may be absorbed when circulation is restored.

· Instruct postoperative patients in pulmonary toilet; drug suppresses cough reflex.

· Monitor bowel function, arrange for laxatives (especially senna compounds--approximate dose of 187 mg senna concentrate per 120 mg codeine equivalent), bowel training program if severe constipation occurs.