This opioid analgesic works by activating mu opioid receptors in the CNS and periphery, producing pain relief, sedation, and respiratory depression.
Codeine is intended to relieve mild to moderate pain. Because this medication is classified as a moderate to strong opioid, pain relief is less than that of other strong opioid agonist medications such as morphine.
Opioids act in the medulla to suppress coughing. Though the antitussive effect may be a desired outcome of codeine therapy, lack of coughing can cause secretions to accumulate in the airway. Patients should be instructed to induce coughing at regular intervals to maintain a clear airway.
Use of codeine can cause sedation, and should be used with discretion.
Opioids can decrease GI peristalsis, and reduce secretion of fluids into the intestines, causing constipation. Laxatives or stool softeners can be used to prevent constipation.
Codeine can cause constriction of pupils, leading to impaired visual acuity. Patients should keep lights on during the day to reduce the risk of injury associated with impaired vision.
Women who are breastfeeding should use caution when taking codeine. This medication can cause unsafe levels of morphine in breast milk. Babies who become intoxicated may be lethargic, more sleepy than usual, disinterested in eating, or have difficulty breathing.
Codeine is often combined with non-opioid analgesics such as acetaminophen or aspirin. Because the medications have different mechanisms of action, when combined, they can relieve pain better than any of the medications alone.
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