From the Guidelines
Codeine and codone are not comparable terms, as "codone" is not a recognized medication, and therefore, codeine is the only valid opioid medication to consider for pain management. When considering codeine for pain management, it's essential to understand its potency and potential side effects. According to the CDC clinical practice guideline for prescribing opioids for pain - United States, 2022 1, codeine has a conversion factor of 0.15, indicating its relatively low potency compared to other opioids like hydrocodone or oxycodone. Some key points to consider when prescribing codeine include:
- Codeine is metabolized in the liver to morphine, which provides most of its pain-relieving effects
- Common side effects include drowsiness, constipation, and nausea
- Codeine is a controlled substance due to its potential for dependence and abuse, though it has a lower abuse potential than stronger opioids
- When converting opioids, the new opioid is typically dosed at a substantially lower dose than the calculated MME dose to avoid overdose because of incomplete cross-tolerance and individual variability in opioid pharmacokinetics 1. It's crucial to consult with a healthcare provider to determine appropriate dosing and duration based on your specific condition, as equianalgesic dose conversions are only estimates and cannot account for individual variability in genetics and pharmacokinetics 1.
From the Research
Difference between Codeine and Codone
There is no direct comparison between Codeine and Codone in the provided studies, as Codone is not mentioned. However, the studies provide information on Codeine and other opioids.
Codeine
- Codeine is a "weak" opioid analgesic, often used to treat severe pain or when paracetamol or a nonsteroidal anti-inflammatory drug (NSAID) proves inadequate 2.
- The potency of codeine is strongly influenced by the cytochrome P450 isoenzyme CYP2D6 genotype, which varies widely from one person to another 2.
- Codeine can have the same dose-dependent adverse effects as morphine, including respiratory depression, and there is no evidence that it carries a lower risk of addiction than low-dose morphine 2.
- In adolescents, the incidence of opioid-related adverse events per 10 000 person-years of opioid exposure was 91.2 for codeine 3.
Other Opioids
- Hydrocodone, oxycodone, and tramadol are frequently prescribed to adolescents for moderate pain, and their pharmacokinetic and pharmacodynamic differences can affect their relative safety 3.
- Tramadol has a higher incidence of opioid-related adverse events compared to hydrocodone, and its use is associated with a higher risk of serious events, including opioid-related escalation of care, hospitalization, or death 3.
- Oxycodone and buprenorphine are metabolized by the CYP450 2D6 and 3A4 enzymes, respectively, and are not prodrugs like codeine and dihydrocodeine 4.
Clinical Implications
- Clinicians should be aware of the potential pharmacokinetic drug interactions with codeine and other opioids, and choose the proper dosages for analgesia and anticipate potential drug-drug interactions 5, 4.
- The CDC Guideline for Prescribing Opioids for Chronic Pain has led to changes in prescribing patterns, with decreases in new prescriptions for Schedule II opioids like codeine, hydrocodone, and oxycodone, and increases in tramadol prescribing in certain specialties 6.