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Look Up > Drugs > Aspirin and Codeine
Aspirin and Codeine
Pronunciation
U.S. Brand Names
Generic Available
Canadian Brand Names
Synonyms
Pharmacological Index
Use
Restrictions
Pregnancy Risk Factor
Contraindications
Warnings/Precautions
Adverse Reactions
Drug Interactions
Mechanism of Action
Pharmacodynamics/Kinetics
Usual Dosage
Dietary Considerations
Administration
Mental Health: Effects on Mental Status
Mental Health: Effects on Psychiatric Treatment
Dental Health: Local Anesthetic/Vasoconstrictor Precautions
Dental Health: Effects on Dental Treatment
Patient Information
Nursing Implications
Dosage Forms
References

Pronunciation
(AS pir in & KOE deen)

U.S. Brand Names
Empirin® With Codeine

Generic Available

Yes


Canadian Brand Names
Coryphen® Codeine; 222® Tablets; 282® Tablets; 292® Tablets

Synonyms
Codeine and Aspirin

Pharmacological Index

Analgesic, Narcotic


Use

Dental: Treatment of postoperative pain

Medical: Relief of mild to moderate pain


Restrictions

C-III


Pregnancy Risk Factor

D


Contraindications

Hypersensitivity to aspirin, codeine, or any component; premature infants or during labor for delivery of a premature infant


Warnings/Precautions

Use with caution in patients with impaired renal function, erosive gastritis, or peptic ulcer disease


Adverse Reactions

>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


Drug Interactions

Refer to individual monographs for Aspirin and Codeine


Mechanism of Action

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


Pharmacodynamics/Kinetics

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


Usual Dosage

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


Dietary Considerations

May be taken with food or milk to minimize GI distress; food decreases rate but not extent of absorption (oral)


Administration

Administer with food or a full glass of water to minimize GI distress


Mental Health: Effects on Mental Status

Sedation is common; may produce euphoria or dysphoria


Mental Health: Effects on Psychiatric Treatment

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


Dental Health: Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions


Dental Health: Effects on Dental Treatment

<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.


Patient Information

See individual agents. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to be pregnant. Consult prescriber if breast-feeding.


Nursing Implications

Administer with food or a full glass of water to minimize GI distress

Observe patient for excessive sedation, respiratory depression


Dosage Forms

Tablet:

#3: Aspirin 325 mg and codeine phosphate 30 mg

#4: Aspirin 325 mg and codeine phosphate 60 mg


References

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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