Maximum Recommended Dosage of Codeine Per Day
The maximum daily dose of codeine is 360 mg per day, as indicated in clinical practice guidelines for pain management. 1
Codeine Dosing Guidelines
- Codeine is classified as a weak opioid (WHO step II analgesic) used for mild to moderate pain 1
- For adults, the recommended dosing is typically 15-60 mg every 4-6 hours 1, 2
- The FDA-approved dosing instructions indicate not to exceed 6 doses in 24 hours 2
- For immediate-release formulations, the maximum daily dose should not exceed 360 mg 1
Dosing Considerations Based on Formulation
Immediate-Release Codeine
- Typically administered every 4-6 hours 2
- Available in tablet forms of 15 mg, 30 mg, and 60 mg 1
- Often combined with acetaminophen or other non-opioid analgesics 3
- Maximum daily dose: 360 mg 1
Controlled-Release Codeine
- Modified-release tablets are typically dosed every 12 hours 4
- Available in strengths of 60 mg, 90 mg, and 120 mg 1
- Maximum daily dose: 240 mg 1
Codeine in Combination Products
- When codeine is combined with acetaminophen, the maximum daily dose may be limited by the acetaminophen component (maximum 4000 mg/day of acetaminophen) 1
- In studies of combination products, dosages of codeine/acetaminophen 30/500 mg administered every 4 hours (total daily codeine dose of 150 mg) have been shown to be effective for cancer-related pain 3
- For chronic non-cancer pain, controlled-release codeine has been used at daily doses ranging from 150 mg to 390 mg 5
Special Considerations and Cautions
- Codeine is metabolized to morphine in the liver, and individual genetic variations can affect metabolism and efficacy 6
- Lower doses should be considered for elderly patients and those with hepatic or renal dysfunction 7
- When converting from codeine to stronger opioids like oxycodone, the relative potency should be considered (codeine is approximately 0.17 times as potent as oral morphine) 1, 7
- If more than 4 breakthrough doses per day are necessary when using controlled-release formulations, the baseline opioid treatment should be adjusted 1
Monitoring and Safety
- Side effects of codeine include constipation, nausea, vomiting, dizziness, and dry mouth 3, 6
- Long-term use should be monitored for development of tolerance, though studies suggest stable dosing can be maintained for extended periods in patients with well-defined pain conditions 6
- For chronic pain management, regular assessment of pain relief, functional improvement, and adverse effects is recommended 1
Remember that while 360 mg is the maximum recommended daily dose, the goal should be to use the lowest effective dose that provides adequate pain relief with minimal side effects 1, 6.