From the FDA Drug Label
Directions do not exceed 6 doses in 24 hours. Adults and children 12 years of age and over: 2 tsp (10 mL) every 4 hours, or as directed by a doctor.
Children 6 to under 12 years of age: 1 tsp (5 mL) every 4 hours, or as directed by a doctor.
Children under 6 years of age: Consult a doctor.
The FDA drug label does not answer the question.
From the Research
Introduction to Codeine Toxicity
Codeine is an opioid analgesic that is commonly used for the treatment of pain. However, it can be toxic in high doses, and the risk of toxicity is increased in certain individuals, such as those who are ultra-rapid metabolizers of the drug 1.
Factors Influencing Codeine Toxicity
The toxicity of codeine is influenced by several factors, including the dose taken, the individual's metabolic rate, and the presence of other medical conditions. For example, individuals who are ultra-rapid metabolizers of codeine may be at increased risk of toxicity due to higher levels of the active metabolite morphine in their system 1.
Dosing Guidelines and Toxicity Risk
While dosing guidelines for codeine are available, there is still a risk of toxicity even when these guidelines are followed. For example, a study found that three children died from codeine toxicity despite receiving doses within the recommended range 2. This highlights the importance of careful monitoring and caution when prescribing codeine, particularly in vulnerable populations such as children.
Treatment and Prevention of Codeine Toxicity
To prevent codeine toxicity, it is essential to follow dosing guidelines carefully and to monitor patients closely for signs of toxicity. Treatment for codeine toxicity typically involves supportive care, such as respiratory support and cardiac monitoring, as well as the administration of naloxone, an opioid antagonist.
Key Considerations for Healthcare Providers
When prescribing codeine, healthcare providers should consider the following key points:
- Be aware of the risk of toxicity, particularly in ultra-rapid metabolizers and vulnerable populations such as children
- Follow dosing guidelines carefully and monitor patients closely for signs of toxicity
- Consider alternative analgesics, such as paracetamol or NSAIDs, which may be safer and more effective in certain situations 3, 4
- Educate patients and caregivers about the risks associated with codeine and the importance of following dosing instructions carefully
Conclusion
In conclusion, codeine can be a toxic drug, particularly in high doses or in individuals who are ultra-rapid metabolizers. Healthcare providers should be aware of the risks associated with codeine and take steps to prevent toxicity, including careful monitoring and education of patients and caregivers. Alternative analgesics may be safer and more effective in certain situations, and should be considered as part of a comprehensive pain management plan 3, 4, 5.