a. Action and Uses. Codeine, also derived from opium, exerts a narcotic
action similar to that of morphine, though far less potent. When codeine is given
concurrently with aspirin, its analgesic effect is greatly enhanced. Besides its analgesic
activity, codeine has a selective action on the cough center and is often used as an
antitussive, especially for the relief of nonproductive coughs.
b. Administration. For analgesia, codeine is given in a dose of 30 to 60 mg
orally every 4 to 6 hours. As an antitussive, it is used in a dose of 15 to 30 mg orally
every 4 to 6 hours.
c. Untoward Effects. Toxic reactions that occur with the use of codeine and
with over dosage of codeine are the same as those that occur with morphine, but they
are less severe. The treatment of such reactions is as described for the treatment of
d. Cautions and Contraindications. Codeine is an addicting drug, though it is
less addicting than morphine. The same cautions and contraindications should be
observed as those observed with the use of morphine.
e. Supply. Both codeine phosphate and codeine sulfate are supplied in
injection and solution forms. Further, codeine is marketed in combination with aspirin
as Empirin with Codeine #2, #3, and #4. Codeine is also combined with Tylenol in the
products Tylenol with Codeine #1, #2, #3, and #4.
3-24. MEPERIDINE HYDROCHLORIDE
a. Action and Uses. Meperidine (Demerol) is a synthetic narcotic analgesic
drug. Its analgesic properties are excellent, but it is not useful for the treatment of
cough. It has a shorter duration of action than morphine, and this feature makes it
preferable to morphine in certain clinical situations. These include certain diagnostic
procedures, such as cystoscopy, retrograde pyelography, and gastroscopy. In addition,
meperidine may be used as a preanesthetic medication, and in obstetrical analgesia. It
is generally not used as an antidiarrheal or antitussive.
b. Administration. The usual dose of meperidine is 50 to 100 mg, given orally
or by intramuscular injection, 4 to 6 times daily.
c. Untoward Effects. Some untoward effects that may occur after therapeutic
doses of meperidine include dizziness, sweating, flushing of the skin, dryness of the
mouth, constipation, and nausea and vomiting. Over dosage with this drug may result
in severe respiratory depression and coma, or it may produce tremors and convulsions;
the treatment is that described for treatment of over dosage with morphine.