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<script type="text/javascript" src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.boots.min.js"> </script><title>Codeine - LiverTox - NCBI Bookshelf</title>
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<meta name="citation_inbook_title" content="LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]">
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<meta name="citation_title" content="Codeine">
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<meta name="citation_publisher" content="National Institute of Diabetes and Digestive and Kidney Diseases">
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<meta name="citation_date" content="2019/04/25">
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yet</button><a id="jr-fip-next" class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><div class="fm-sec"><h1 id="_NBK548359_"><span class="title" itemprop="name">Codeine</span></h1><p class="fm-aai"><a href="#_NBK548359_pubdet_">Publication Details</a></p></div></div><div class="body-content whole_rhythm" itemprop="text"><div id="Codeine.OVERVIEW"><h2 id="_Codeine_OVERVIEW_">OVERVIEW</h2><div id="Codeine.Introduction"><h3>Introduction</h3><p>Codeine is one of the natural plant alkaloids found in extracts of opium and is commonly used to treat mild-to-moderate pain and cough. Codeine, like other opioids, has not been linked to serum enzyme elevations during therapy or to clinically apparent liver injury.</p></div><div id="Codeine.Background"><h3>Background</h3><p>Codeine (koe’ deen) is a natural alkaloid derived from resin extracts from the seeds of the opium poppy, Papaver somniferum. Codeine has opiate-like analgesic effects, but is much less potent than morphine. Codeine, however, is well absorbed orally and is less likely to cause serious respiratory depression than morphine. Codeine has been used in clinical medicine for more than a century and is currently approved for use in the United States as an oral analgesic for mild-to-moderate pain and, in low doses, as an antitussive for suppression of nonproductive cough. Codeine is available in multiple formulations including oral tablets of 15, 30 and 60 mg, as well as oral solutions and solutions for injection (subcutaneously, intramuscularly, intravenously) in varying concentrations. The typical adult, oral dose of codeine for analgesia is 15 to 60 mg every 4 to 6 hours. In addition, multiple commercial products combining codeine with acetaminophen for therapy of mild-to-moderate pain are available generically and under brand names such as Codrix and Codet. Side effects of codeine include sedation, respiratory depression, mental clouding, euphoria, agitation, constipation, abdominal bloating, nausea, vomiting and constipation. Codeine is a controlled substance and classified as a Schedule III drug, indicating that it has medical usefulness, but also a potential for physical and psychological dependency and abuse. Codeine is also available in low concentrations (~12 mg/tablet) in combination with antihistamines, antitussants or sympathomimetic agents for symptomatic therapy of upper respiratory infections and cough. These products are typically available over-the-counter without prescription.</p></div><div id="Codeine.Hepatotoxicity"><h3>Hepatotoxicity</h3><p>Despite wide use for many years, codeine has not been linked to serum enzyme elevations during therapy and there have been no convincing cases of idiosyncratic acute, clinically apparent liver injury attributed to its use.</p><p>Liklihood score: E (unlikely cause of clinically apparent liver injury).</p><p>References on the safety and potential hepatotoxicity of codeine are given in the Overview section of the Opioids.</p><p>Drug Class: <a href="/books/n/livertox/Opioids/?report=reader">Opioids</a></p></div></div><div id="Codeine.PRODUCT_INFORMATION"><h2 id="_Codeine_PRODUCT_INFORMATION_">PRODUCT INFORMATION</h2><div id="Codeine.BPI" class="box boxed-text-box whole_rhythm hide-overflow"><p>
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<b>REPRESENTATIVE TRADE NAMES</b>
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</p><p>Codeine – Generic, Codrix®</p><p>
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<b>DRUG CLASS</b>
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</p><p>Opioids</p><p>
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<a href="https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=Codeine" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">COMPLETE LABELING</a>
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</p><p>Product labeling at DailyMed, National Library of Medicine, NIH</p></div></div><div id="Codeine.CHEMICAL_FORMULA_AND_STRUCTURE"><h2 id="_Codeine_CHEMICAL_FORMULA_AND_STRUCTURE_">CHEMICAL FORMULA AND STRUCTURE</h2><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figCodeineT1"><a href="/books/NBK548359/table/Codeine.T1/?report=objectonly" target="object" title="Table" class="img_link icnblk_img" rid-ob="figobCodeineT1"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="Codeine.T1"><a href="/books/NBK548359/table/Codeine.T1/?report=objectonly" target="object" rid-ob="figobCodeineT1">Table</a></h4></div></div></div><div id="bk_toc_contnr"></div></div></div><div class="fm-sec"><h2 id="_NBK548359_pubdet_">Publication Details</h2><h3>Publication History</h3><p class="small">Last Update: <span itemprop="dateModified">April 25, 2019</span>.</p><h3>Copyright</h3><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a></div></div><h3>Publisher</h3><p><a href="https://www.niddk.nih.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Institute of Diabetes and Digestive and Kidney Diseases</a>, Bethesda (MD)</p><h3>NLM Citation</h3><p>LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Codeine. [Updated 2019 Apr 25].<span class="bk_cite_avail"></span></p></div><div class="small-screen-prev"><a href="/books/n/livertox/Cocaine/?report=reader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M75,30 c-80,60 -80,0 0,60 c-30,-60 -30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Prev</text></svg></a></div><div class="small-screen-next"><a href="/books/n/livertox/CoQ10/?report=reader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M25,30c80,60 80,0 0,60 c30,-60 30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Next</text></svg></a></div></article><article data-type="boxed-text" id="figobCodeineBPI"><div id="Codeine.BPI" class="box boxed-text-box whole_rhythm hide-overflow"><p>
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<b>REPRESENTATIVE TRADE NAMES</b>
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</p><p>Codeine – Generic, Codrix®</p><p>
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<b>DRUG CLASS</b>
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</p><p>Opioids</p><p>
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<a href="https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=Codeine" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">COMPLETE LABELING</a>
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</p><p>Product labeling at DailyMed, National Library of Medicine, NIH</p></div></article><article data-type="table-wrap" id="figobCodeineT1"><div id="Codeine.T1" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK548359/table/Codeine.T1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__Codeine.T1_lrgtbl__"><table><thead><tr><th id="hd_h_Codeine.T1_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">DRUG</th><th id="hd_h_Codeine.T1_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;">CAS REGISTRY NO.</th><th id="hd_h_Codeine.T1_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;">MOLECULAR FORMULA</th><th id="hd_h_Codeine.T1_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;">STRUCTURE</th></tr></thead><tbody><tr><td headers="hd_h_Codeine.T1_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">Codeine</td><td headers="hd_h_Codeine.T1_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;">76-57-3</td><td headers="hd_h_Codeine.T1_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;">C18-H21-N-O3</td><td headers="hd_h_Codeine.T1_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;">
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<div class="graphic"><img src="/books/NBK548359/bin/Codeine_Structure.jpg" alt="Codeine Chemical Structure" /></div>
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