From the Guidelines
Pholcodine can be metabolized to morphine, an active opioid, in the body, making it a potential source of opioid activity [ 1 ].
Key Points
- Pholcodine is used as a cough suppressant and can be found in various over-the-counter medications [ 1 ].
- The metabolism of pholcodine to morphine can occur with doses of 10 mL qid, as indicated in the treatment guidelines for cough management [ 1 ].
- The resulting morphine levels from pholcodine metabolism can be substantial, with potential therapeutic effects comparable to morphine sulfate [ 1 ].
- However, the exact mechanisms and efficacy of pholcodine's conversion to morphine in humans are not well-studied and may vary depending on individual factors [ 1 ].
Clinical Implications
- Clinicians should be aware of the potential for pholcodine to contribute to opioid activity, particularly in patients with a history of opioid use or those who are sensitive to opioids [ 1 ].
- The use of pholcodine should be carefully considered in patients with lung cancer, as it may interact with other medications or exacerbate underlying conditions [ 1 ].
- Further research is needed to fully understand the effects of pholcodine metabolism on opioid activity and its implications for clinical practice [ 1 ].
From the Research
Pholcodine Conversion to Active Opioid
- There is no direct evidence in the provided studies to suggest that pholcodine converts to an active opioid.
- However, a related opioid, codeine, is known to be biotransformed to morphine, a strong opioid, as mentioned in the study 2.
- The biotransformation of codeine to morphine is catalysed by CYP2D6, which may imply that other opioids or opioid-like substances could undergo similar conversions, but this is not explicitly stated for pholcodine.
- The provided studies focus on various aspects of opioid use, non-opioid substances, and their interactions, but do not specifically address pholcodine or its conversion to an active opioid 3, 4, 5, 6.