Codeine Suspension

Codeine Suspension
Usage
Codeine suspension is an oral liquid formulation of an opioid analgesic used for the relief of mild to moderate pain. It may also be used for the suppression of cough in certain clinical situations.
This formulation is particularly useful for patients who require individualised dosing or have difficulty swallowing tablets.
It may be prescribed for:
• Mild to moderate pain (e.g., musculoskeletal pain, postoperative pain)
• Cough suppression (as directed by a healthcare professional)
• Situations where a liquid dosage form is preferred
Use should be under the supervision of a qualified healthcare professional, and in accordance with local prescribing regulations.

Dosage
Dosage should be determined by the prescribing practitioner based on the patient’s age, weight, condition, and response to treatment.
Typical dosing considerations include:
• Administered every 4–6 hours as needed for pain, or as directed
• Paediatric dosing (where appropriate) is typically weight-based and requires careful supervision
• The suspension should be shaken well before use
• May be taken with or without food
The lowest effective dose for the shortest duration should be used.

Mechanisms of Action
Codeine is an opioid analgesic that exerts its effects through the central nervous system.
Its mechanisms include:
Conversion to morphine
Codeine is metabolised in the liver (via CYP2D6) to morphine, its active form.
Activation of opioid receptors
Morphine binds to mu-opioid receptors in the brain and spinal cord, altering the perception of pain.
Cough suppression
Codeine also acts on the cough centre in the brain, reducing the urge to cough.

Contraindications
Codeine should not be used in patients with:
• Hypersensitivity to codeine or other opioids
• Severe respiratory depression
• Acute asthma or significant respiratory disease
• Children under a certain age (as per local guidelines)
• Known ultra-rapid CYP2D6 metabolisers, due to risk of toxicity
• Breastfeeding, in certain circumstances due to risk to the infant

Precautions
Codeine should be used with caution in patients with:
• Respiratory conditions
• Hepatic or renal impairment
• History of substance misuse or dependence
• Elderly patients, who may be more sensitive to effects
• Concurrent use of CNS depressants (e.g., benzodiazepines, alcohol)
Additional considerations include:
• Risk of sedation, dizziness, and impaired alertness
• Potential for dependence, misuse, and tolerance with prolonged use
• May cause constipation, nausea, or vomiting
• Avoid alcohol while taking codeine
• Patients should seek medical advice if they experience difficulty breathing, excessive drowsiness, or confusion

Storage
• Store below 25°C unless otherwise directed
• Keep the suspension in a tightly closed container
• Shake well before use
• Protect from heat, moisture, and direct light
• Store securely due to the controlled nature of the medication
• Keep out of reach of children and pets
Patients should follow the specific storage and legal requirements provided on the dispensing label supplied by the pharmacy.