Codeine

introduction

Codeine is an active ingredient that, like morphine, belongs to the group of opiates. Nowadays it is mainly taken as a substance to relieve dry coughs and as a pain reliever.

Three opiates - codeine, morphine and thebaine - occur naturally in opium, the dried milky sap of the opium poppy, and can be obtained from it. Codeine, however, is mainly produced synthetically. But it can also be made from other opiates. In Switzerland codeine is considered a narcotic, but only requires a prescription in high doses. In low doses it is not bound by any narcotics regulations and can be purchased without a prescription.
In Germany, on the other hand, codeine can only be purchased on presentation of a prescription.

It should not be used in children under 2 years of age.

Effect and commitment

Codeine can as tablet, capsule, drops, Effervescent tablet or juice swallowed when Suppositories introduced or as liquid given directly into the vein. Drops with a low content of active ingredients are common for children aged 2-12.

The maximum amount Codeine that one Adult eats should 200 mg or in exceptional cases 300 mg do not exceed.
At Children under 6 years is the maximum Daily dose 30 mg, at Children to 12 years 60 mg. Much higher doses can be life-threatening due to the side effects (see below).

All opioids basically work on certain Neurons in the brain and cause a Inhibition of forwarding of stimuli. That is why they work in general reassuring and inhibiting on the Sensation of pain and on the urge to to cough.

After the ingestion of codeine, approx. 10% the amount consumed Converted to morphine. This proportion of morphine mainly causes the analgesic effect. It's important, that Codeine in different people is converted to morphine to different degrees, from which different Potency can result. The reason for this are various genetically predisposed variants the substance that converts codeine to morphine. Approx. 10% of the white population convert codeine to a small extent into morphine, which is why it is less potent, and up to 5% it is more potent. In the latter case, the use of codeine should only take place under strict control and after clarification of the possible side effects, as one can quickly Overdose can occur.

The analgesic effect from Codeine is on average approx. 1/10 as strong as the analgesic effect of pure morphine the same dose. Codeine is therefore one of the so-called "weakly effective opioids". Compared to other substances in this group, however, it dissolves with less effect stronger side effects which is why it is not used as the first choice in pain therapy. Better alternatives from the group of Opioids are in severe pain Tramadol or Buprenorphine.

Mostly will Codeine as an addition to weaker painkillers such as Diclofenac, Acetylsalicylic acid (Aspirin) or Paracetamol for lighter pain utilizedwhen a so-called “non-steroidal” pain reliever - a weaker pain reliever that does not belong to the group of opiates - is no longer sufficient.

Codeine continues to work inhibiting on the Cough center („antitussive“) Of the brain. Because of this effect, it is especially at irritating cough at night used in which no mucus is coughed up. Here it is the first choice as there are no better alternatives to Cough relief gives. Basically, codeine should be Not taken to one Cough with sputum from mucus to inhibit. This can worsen the underlying disease by suppressing the natural defense process in the lungs.

Earlier has been Codeine happy to treat Diarrhea used because - like all opioids - it slows down stomach and intestinal movements and such a thing longer residence time from food allowed in the intestinal tube. In the meantime, however, it has been Loperamide replaced. The latter acts at the same point of attack in the gastrointestinal system as codeine, but cannot reach the brain and thus no longer trigger various side effects.

Earlier it was also at withdrawal from e.g. heroin used to relieve symptoms. this will today however Not done more.

Side effects

Since the Main effects of Codeins by a Impact on the brain arise, it is not surprising that this substance is diverse Side effects may have.

Very often (in up to 10%) occurs after ingestion due to the irritation of the Vomiting center in the brain and / or the effect on the Gastrointestinal tract a nausea one that for Vomit can lead. If the stomach and bowel movements slow down too much, a constipation triggered in the absence of bowel movements (also in up to 10% of cases). Often, because of this side effect, laxative drugs must be taken in addition to codeine.

Like any opiate, codeine can contribute to Overdose to a Inhibition of the respiratory drive to lead. This can cause lethal flattening and even slowing of breathing Apnea cause. Existing breathing problems such as in asthma or COPD can be intensified or newly provoked.

First Signs for one Overdose is a severe drowsinessthat extends up to the unconsciousness can express. In addition, you can usually narrow pupils, Vomit and a headache to be watched. In the event of these signs, a doctor should be consulted immediately in order to avoid a life-threatening situation. If breathing stops, the effect from Codeine With Naloxone cancel.

Furthermore, all opiates can become one temporary elation to lead. For this reason, codeine is called Intoxicants abused. It should be noted that if it is used too long and heavily, it can cause addiction.

possible side effects are also:

• sudden fainting
• sleepiness
• a headache and
• Drops in blood pressurethat to weakness and dizziness being able to lead.

Cramps can be triggered, especially in children.

Codeine can interact with many drugs that act on nerves in the brain. On taking alcohol should be used during treatment with opiates be waivedbecause the combination of these 2 substances affects consciousness even more and the likelihood of worsening breathing is further increased.

For questions about Interactions with certain drugs they look into that Leaflet or discuss the use of codeine with the prescribing doctor.

Use during pregnancy and breastfeeding

Basically can Codeine in the pregnancy can be used.
Since the drug is also on the child's organism damage cannot be ruled out.
Previous studies could, however no harmful effect from codeine to the Unborn determine.

Short in front of the Childbirth should be on Do without codeineas it is the normal breathing of Restrict newborns and one Apnea can trigger.

There Codeine or that of it to Morphine converted share also into the Breast milk If the child is breast-fed, codeine should only be used for Max. 2-3 Days be taken to avoid side effects in the child. However, it should be noted that the conversion speed of certain Enzymes such as. the CYP2D6 enzyme who work particularly quickly for a few percent of the population. Also others Genes can accelerate the conversion process and thus increase the morphine level extremely in a very short time, which in the worst case leads to death of the newborn due to the uptake of morphine via the Breast milk can lead. Therefore, when taking codeine and similar painkillers containing morphine, it should be weighed up in a medical consultation.