▶With parenteral useDysuria
lBREAST FEEDINGAvoid—although amount usually too
small to be harmful, mothers vary considerably in their
capacity to metabolise codeine—risk of morphine overdose
in infant.
lRENAL IMPAIRMENTAvoid use or reduce dose; opioid
effects increased and prolonged and increased cerebral
sensitivity occurs.
lPRESCRIBING AND DISPENSING INFORMATIONBP directs
that when Diabetic Codeine Linctus is prescribed, Codeine
Linctus formulated with a vehicle appropriate for
administration to diabetics, whether or not labelled
‘Diabetic Codeine Linctus’, shall be dispensed or supplied.
lPATIENT AND CARER ADVICE
Medicines for Children leaflet: Codeine phosphate for pain
http://www.medicinesforchildren.org.uk/codeine-phosphate-pain- 0
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension, oral solution, solution
for injection
Tablet
CAUTIONARY AND ADVISORY LABELS 2
▶Codeine phosphate (Non-proprietary)
Codeine phosphate 15 mgCodeine 15 mg tablets| 28 tabletP
£ 1. 40 DT = £ 0. 65 m| 100 tabletP£ 2. 32 DT = £ 2. 32 m
Codeine phosphate 30 mgCodeine 30 mg tablets| 28 tabletP
£ 1. 59 DT = £ 0. 76 m| 100 tabletP£ 5. 68 DT = £ 2. 71 m
Codeine phosphate 60 mgCodeine 60 mg tablets| 28 tabletP
£ 5. 95 DT = £ 1. 32 m
Solution for injection
▶Codeine phosphate (Non-proprietary)
Codeine phosphate 60 mg per 1 mlCodeine 60 mg/ 1 ml solution for
injection ampoules| 10 ampouleP£ 24. 10 – £ 24. 18 DT =
£ 24. 18 b
Oral solution
CAUTIONARY AND ADVISORY LABELS 2
▶Codeine phosphate (Non-proprietary)
Codeine phosphate 3 mg per 1 mlCodeine 15 mg/ 5 ml linctus sugar
free sugar-free| 200 mlp£ 1. 90 DT = £ 1. 62 msugar-free|
2000 mlp£ 16. 20 m
Codeine 15 mg/ 5 ml linctus| 200 mlp£ 1. 90 DT = £ 1. 90 m
Codeine phosphate 5 mg per 1 mlCodeine 25 mg/ 5 ml oral solution
| 500 mlP£ 6. 46 DT = £ 6. 46 m
▶Galcodine(Thornton & Ross Ltd)
Codeine phosphate 3 mg per 1 mlGalcodine 15 mg/ 5 ml linctus
sugar-free| 2000 mlp£ 9. 90 m
eiiiiF 273Diamorphine hydrochloride 10-Jun-2016
(Heroin hydrochloride)
lINDICATIONS AND DOSE
Acute or chronic pain
▶BY MOUTH
▶Child 1 month–11 years: 100 – 200 micrograms/kg every
4 hours (max. per dose 10 mg), adjusted according to
response
▶Child 12–17 years: 5 – 10 mg every 4 hours, adjusted
according to response
▶BY CONTINUOUS INTRAVENOUS INFUSION
▶Child 1 month–11 years: 12. 5 – 25 micrograms/kg/hour,
adjusted according to response
▶BY INTRAVENOUS INJECTION
▶Child 1–2 months: 20 micrograms/kg every 6 hours,
adjusted according to response
▶Child 3–5 months: 25 – 50 micrograms/kg every 6 hours,
adjusted according to response
▶Child 6–11 months: 75 micrograms/kg every 4 hours,
adjusted according to response
▶Child 1–11 years: 75 – 100 micrograms/kg every 4 hours
(max. per dose 5 mg), adjusted according to response▶Child 12–17 years: 2. 5 – 5 mg every 4 hours, adjusted
according to response
▶BY INTRAMUSCULAR INJECTION, OR BY SUBCUTANEOUS
INJECTION
▶Child 12–17 years: 5 mg every 4 hours, adjusted
according to response
Acute or chronic pain in ventilated neonates
▶INITIALLY BY INTRAVENOUS INJECTION
▶Neonate:Initially 50 micrograms/kg, dose to be
administered over 30 minutes, followed by (by
continuous intravenous infusion)
15 micrograms/kg/hour, adjusted according to response.Acute or chronic pain in non-ventilated neonates
▶BY CONTINUOUS INTRAVENOUS INFUSION
▶Neonate: 2. 5 – 7 micrograms/kg/hour, adjusted according
to response.Acute severe nociceptive pain in an emergency setting
(specialist supervision in hospital)
▶BY INTRANASAL ADMINISTRATION
▶Child 2–15 years (body-weight 12–17 kg): 1. 44 mg for
1 dose, spray into alternate nostrils
▶Child 2–15 years (body-weight 18–23 kg): 2. 16 mg for
1 dose, spray into alternate nostrils
▶Child 2–15 years (body-weight 24–29 kg): 2. 88 mg for
1 dose, spray into alternate nostrils
▶Child 2–15 years (body-weight 30–39 kg): 3. 2 mg for
1 dose, spray into alternate nostrils
▶Child 2–15 years (body-weight 40–50 kg): 4. 8 mg for
1 dose, spray into alternate nostrilslCONTRA-INDICATIONSDelayed gastric emptying.
phaeochromocytoma
lCAUTIONSCNS depression.severe cor pulmonale.severe
diarrhoea.toxic psychosis
lINTERACTIONS→Appendix 1 : opioids
lSIDE-EFFECTS
▶Common or very common
▶With intranasal useHaemorrhage.laryngitis.nasal
complaints.procedural pain.taste altered
▶Uncommon
▶With intranasal useAbdominal pain.anxiety.conjunctivitis
.eye pruritus.feeling hot.fever.hiccups.hypoxia.level
of consciousness decreased.pallor.paraesthesia
▶Frequency not known
▶With parenteral useBiliary spasm.circulatory depression.
intracranial pressure increased.mood altered.postural
hypotension
lBREAST FEEDINGTherapeutic doses unlikely to affect
infant; withdrawal symptoms in infants of dependent
mothers; breast-feeding not best method of treating
dependence in offspring.
lRENAL IMPAIRMENTAvoid use or reduce dose; opioid
effects increased and prolonged; increased cerebral
sensitivity.
lMONITORING REQUIREMENTS
▶With intranasal useManufacturer advises monitor for at
least 30 minutes following administration.
lDIRECTIONS FOR ADMINISTRATION
▶With intravenous useForintravenous infusion, dilute in
Glucose 5 % or Sodium Chloride 0. 9 %; Glucose 5 %is
preferable as an infusionfluid.
▶With intranasal useManufacturer advises spray should be
directed at the nasal side wall whilst the patient is in a
semi-recumbent position.
lPRESCRIBING AND DISPENSING INFORMATIONIntranasal
administration of diamorphine hydrochloride injection has
been used [unlicensed]—no dose recommendation.BNFC 2018 – 2019 Pain 277
Nervous system4