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Pronunciation |
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(AS
pir in & KOE
deen) |
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U.S. Brand
Names |
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Empirin® With
Codeine |
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Generic
Available |
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Yes |
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Canadian Brand
Names |
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Coryphen® Codeine; 222® Tablets;
282® Tablets; 292®
Tablets |
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Synonyms |
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Codeine and Aspirin |
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Pharmacological Index |
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Analgesic, Narcotic |
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Use |
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Dental: Treatment of postoperative pain
Medical: Relief of mild to moderate pain |
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Restrictions |
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C-III |
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Pregnancy Risk
Factor |
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D |
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Contraindications |
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Hypersensitivity to aspirin, codeine, or any component; premature infants or
during labor for delivery of a premature infant |
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Warnings/Precautions |
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Use with caution in patients with impaired renal function, erosive gastritis,
or peptic ulcer disease |
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Adverse
Reactions |
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>10%:
Central nervous system: Lightheadedness, dizziness, sedation
Gastrointestinal: Nausea, heartburn, stomach pains, dyspepsia, epigastric
discomfort, vomiting
Respiratory: Shortness of breath
1% to 10%:
Central nervous system: Fatigue, euphoria, dysphoria
Dermatologic: Rash, pruritus
Gastrointestinal: Gastrointestinal ulceration, constipation
Hematologic: Hemolytic anemia
Neuromuscular & skeletal: Weakness
Respiratory: Dyspnea
Miscellaneous: Anaphylactic shock |
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Drug
Interactions |
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Refer to individual monographs for Aspirin and Codeine |
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Mechanism of
Action |
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Aspirin inhibits prostaglandin synthesis, acts on the hypothalamus
heat-regulating center to reduce fever, blocks prostaglandin synthetase action
which prevents formation of the platelet-aggregating substance thromboxane
A2; codeine binds to opiate receptors (mu and kappa subtypes) in the
CNS causing inhibition of ascending pain pathways, altering the perception of
and response to pain |
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Pharmacodynamics/Kinetics |
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Aspirin:
Absorption: Rapid
Serum half-life:
Parent drug: 15-20 minutes
Salicylates (dose-dependent): From 3 hours at lower doses (300-600 mg), to
5-6 hours (after 1 g) to 10 hours with higher doses
Time to peak serum concentration: ~1-2 hours
Codeine:
Onset of effect: 0.5-1 hour
Duration of effect: 4-6 hours
Serum half-life: 2.5-3.5 hours
Time to peak serum concentration: 1-1.5 hours |
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Usual Dosage |
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Oral:
Aspirin: 10 mg/kg/dose every 4 hours
Codeine: 0.5-1 mg/kg/dose every 4 hours
Adults: 1-2 tablets every 4-6 hours as needed for pain
Dosing adjustment in renal impairment:
Clcr 10-50 mL/minute: Administer 75% of dose
Clcr <10 mL/minute: Avoid use
Dosing interval in hepatic disease: Avoid use in severe liver disease
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Dietary
Considerations |
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May be taken with food or milk to minimize GI distress; food decreases rate
but not extent of absorption (oral) |
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Administration |
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Administer with food or a full glass of water to minimize GI
distress |
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Mental Health: Effects
on Mental Status |
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Sedation is common; may produce euphoria or dysphoria |
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Mental Health:
Effects on Psychiatric
Treatment |
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May cause leukopenia; use caution with clozapine and carbamazepine; may
displace valproic acid from binding sites resulting in an increase of unbound
drug; monitor for toxicity; codeine is a CNS depressant; monitor for additive
effects with concurrent psychotropic use |
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Dental Health: Local
Anesthetic/Vasoconstrictor
Precautions |
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No information available to require special precautions |
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Dental Health:
Effects on Dental Treatment |
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<1% of patients may experience dry mouth; avoid aspirin, if possible, for
1 week prior to surgery because of the possibility of postoperative bleeding
Avoid aspirin, if possible, for 1 week prior to surgery because of the
possibility of postoperative bleeding
Elderly are a high-risk population for adverse effects from nonsteroidal
anti-inflammatory agents. As much as 60% of elderly with GI complications to
NSAIDs can develop peptic ulceration and/or hemorrhage asymptomatically. Also,
concomitant disease and drug use contribute to the risk for GI adverse effects.
Use lowest effective dose for shortest period possible. Consider renal function
decline with age. Use with caution in patients with history of asthma.
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Patient
Information |
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See individual agents. Pregnancy/breast-feeding precautions: Inform
prescriber if you are or intend to be pregnant. Consult prescriber if
breast-feeding. |
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Nursing
Implications |
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Administer with food or a full glass of water to minimize GI distress
Observe patient for excessive sedation, respiratory depression
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Dosage Forms |
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Tablet:
#3: Aspirin 325 mg and codeine phosphate 30 mg
#4: Aspirin 325 mg and codeine phosphate 60 mg |
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References |
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Dionne RA, "New Approaches to Preventing and Treating Postoperative Pain,"
J Am Dent Assoc, 1992, 123(6):26-34.
Gobetti JP, "Controlling Dental Pain," J Am Dent Assoc, 1992,
123(6):47-52. |
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