Recommended Dosage of Codeine Linctus for Cough
The recommended dose of codeine linctus for cough management is 30-60 mg four times daily (qid), though codeine is actually less preferred among opioid antitussives due to its greater side effect profile compared to alternatives like pholcodine, hydrocodone, or morphine. 1
Specific Dosing Parameters
- Standard adult dosing: 30-60 mg every 4-6 hours, with a maximum of 240 mg in 24 hours 2
- FDA-labeled formulation: 10 mL (containing codeine) every 4 hours for adults and children ≥12 years, not exceeding 6 doses in 24 hours 3
- Guideline-recommended frequency: Four times daily (qid) at 30-60 mg per dose 1
Clinical Context and Positioning
When to Use Codeine
- Second-line therapy: Codeine should be considered only after demulcents (simple linctus, glycerol-based preparations) have failed 1
- Short-term use only: Limit to 5-7 days with reassessment if symptoms persist 2
- Specific indications: Most evidence supports use in cancer-related cough and refractory chronic cough rather than acute respiratory infections 4
Important Limitations
Codeine is explicitly noted as "less preferred" despite being the most researched opioid antitussive because palliative medicine experts consistently report it has a greater side effect profile than other opioid derivatives 1. A well-designed study demonstrated that codeine (30 mg single dose or 120 mg daily) was no more effective than placebo syrup for acute upper respiratory tract infection cough 4.
Preferred Alternatives to Consider First
If opioid therapy is indicated, the CHEST guidelines recommend this hierarchy 1:
- Pholcodine (10 mL qid) - where available
- Hydrocodone (5 mg bid initially) - where available 5
- Dihydrocodeine (10 mg tid)
- Morphine (5 mg single-dose trial; if effective, 5-10 mg slow-release bid) 1
Critical Safety Considerations
- Respiratory depression risk: Particularly at higher doses, with potential for dependence and overdose 2
- Constipation and drowsiness: Common side effects that may be beneficial if cough disturbs sleep 6
- Contraindication: Avoid in chronic bronchitis and bronchiectasis as cough suppressants cause sputum retention 2
- Pediatric caution: Children under 6 years require physician consultation; use is limited due to safety concerns 3, 7
Special Dosing Scenarios
Bedtime dosing strategy: For palliative patients with nonspecific cough, a single bedtime dose of codeine may help suppress cough and induce undisturbed sleep, though this is based on clinical experience rather than evidence 1
Patients already on opioids: If already receiving morphine for other symptoms, increasing the morphine dose by 20% may be more effective than adding codeine 1
Common Pitfall to Avoid
Do not use codeine as first-line therapy for cough. The algorithmic approach should be: demulcents first → then opioid derivatives (preferably pholcodine/hydrocodone/morphine over codeine) → then peripherally-acting antitussives if opioid-resistant → finally nebulized local anesthetics for intractable cases 1.