From the Guidelines
Codeine should be prescribed at a dose of 30-60 mg orally every 4-6 hours as needed for cough in adults, as suggested by the Chest guideline and expert panel report 1. When considering the use of codeine for cough, it is essential to weigh the potential benefits against the risks of dependence, respiratory depression, and other side effects. The medication works by suppressing the cough reflex in the brain, and its effectiveness has been demonstrated in various studies, including a double-blind randomized trial with positive results from using codeine 30 mg twice a day with phenyltoloxamine 10 mg 1.
Key Considerations
- The dose of codeine may vary depending on the patient's previous exposure to opioids, and the patient's response to the medication should be closely monitored 1.
- Codeine is less preferred compared to other opioids, such as pholcodine or hydrocodone, due to its greater side effect profile 1.
- Treatment duration should be limited to 3-7 days due to the risks associated with codeine use 1.
- Patients should be aware of the potential side effects of codeine, including drowsiness, constipation, and nausea, and should avoid alcohol and driving while taking it 1.
Alternative Options
- Other cough suppressants, such as dextromethorphan, may be preferred by some clinicians due to their lower risk of dependence and respiratory depression 1.
- Non-pharmacological approaches, such as demulcents and topical anesthetics, may also be effective in managing cough and should be considered as alternative options 1.
From the FDA Drug Label
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. The dose of codeine PO for cough is:
- 2 tsp (10 mL) every 4 hours for adults and children 12 years of age and over
- 1 tsp (5 mL) every 4 hours for children 6 to under 12 years of age
- For children under 6 years of age: consult a doctor 2
From the Research
Codeine PO for Cough Dose
- The dose of codeine for cough suppression is not explicitly stated in the provided studies, but its efficacy and comparison with other antitussives are discussed 3, 4, 5, 6.
- Codeine is a centrally acting narcotic opioid approved for use as an antitussive, and its effects are related to plasma morphine concentrations 3.
- Studies have compared the antitussive effects of codeine with dextromethorphan, another common cough suppressant, with varying results:
- One study found that dextromethorphan lowered cough intensity to a greater degree than codeine 4.
- Another study found that codeine 20 mg had a greater antitussive action than placebo, but dextromethorphan 30 mg did not differ from codeine 20 mg 5.
- A comparison of plasma kinetics and antitussive effects found that 30 mg codeine phosphate and 60 mg dextromethorphan hydrobromide did not differ significantly in their antitussive effects 6.
- The American Academy of Pediatrics recommends caution when using codeine- and dextromethorphan-containing cough remedies in children due to potential risks and lack of proven antitussive effects 7.