codeine phosphate Nursing Considerations & Management

Drug Name

Generic Name :codeine phosphate

Classification: Opioid agonist analgesic, Antitussive

Pregnancy Category C (during pregnancy)
Pregnancy Category D (during labor)
Controlled Substance C-II

Dosage & Route


  • 15–60 mg PO, IM, IV or subcutaneously q 4–6 hr; do not exceed 360 mg/24 hr.


  • 10–20 mg PO q 4–6 hr; do not exceed 120 mg/24 hr.
Pediatric Patients
  • Contraindicated in premature infants.


  • >1 yr: 0.5 mg/kg or 15 mg/m2 IM or subcutaneously q 4–6 hr.


  • 2–6 yr: 2.5–5 mg PO q 4–6 hr; do not exceed 30 mg/24 hr.
  • 6–12 yr: 5–10 mg PO q 4–6 hr; do not exceed 60 mg/24 hr.
Geriatric Patients or Impaired Adults
  • Use caution; respiratory depression may occur in elderly, the very ill, those with respiratory problems. Reduced dosage may be necessary.
Therapeutic actions
  • Codeine provides relief by blocking the ascending pain pathways by binding to opiate receptors found in the CNS. It also helps suppress cough by direct action in the medulla.
  • Relief of mild to moderate pain in adults and children
  • Suppression of coughing induced by chemical or mechanical irritation of the respiratory system
Adverse effects
  • Dependence, withdrawal symptoms; nausea, vomiting, constipation; drowsiness, confusion; difficulty in micturition, ureteric or biliary spasms, urinary retention; dry mouth, dizziness, sweating, facial flushing, headache, vertigo, bradycardia, tachycardia, palpitations, orthostatic hypotension, hypothermia, restlessness, mood changes, decreased libido or potency, hallucination, miosis; raised intracranial pressure, muscle rigidity.
  • Potentially Fatal: Respiratory depression and hypotension, with circulatory failure and deepening coma (larger doses). Convulsions (especially in children and infants). Rhabdomyolysis.
  • Respiratory depression, obstructive airway disease, asthma. Acute alcoholism, convulsive disorders, head injuries, comatose patients, raised intracranial pressure. Pregnancy (prolonged use or high doses at term).
Nursing considerations

CLINICAL ALERT! Name confusion has occurred between codeine and Cardene (nicardipine) and Lodine (etodolac); use caution.

  • History: Hypersensitivity to codeine, physical dependence on an opioid analgesic, pregnancy, labor, lactation, bronchial asthma, COPD, increased intracranial pressure, acute MI, ventricular failure, coronary insufficiency, hypertension, biliary tract surgery, renal or hepatic impairment
  • Physical: Orientation, reflexes, bilateral grip strength, affect; pupil size, vision; pulse, auscultation, BP; R, adventitious sounds; bowel sounds, normal output; LFTs, renal function tests
  • Give to nursing women 4–6 hr before scheduled feeding to minimize drug in milk.
  • WARNING: During parenteral administration, ensure that opioid antagonist and facilities for assisted or controlled respirations are readily available.
  • Use caution when injecting subcutaneously into chilled body areas or in patients with hypotension or in shock; impaired perfusion may delay absorption; with repeated doses, an excessive amount may be absorbed when circulation is restored.
  • WARNING: Do not use IV in children.
  • Instruct postoperative patients in pulmonary toilet; drug suppresses cough reflex.
  • Monitor bowel function, arrange for laxatives (especially senna compounds—approximate dose of 187 mg senna concentrate per 120 mg codeine equivalent), bowel training program if severe constipation occurs.
Teaching points
  • Take drug exactly as prescribed.
  • Do not take any leftover medication for other disorders, and do not let anyone else take it.
  • You may experience these side effects: Dizziness, sedation, drowsiness, impaired visual acuity (avoid driving and performing other tasks that require alertness); nausea, loss of appetite (lie quietly; eat frequent small meals); constipation (use a laxative).
  • Report severe nausea, vomiting, palpitations, shortness of breath or difficulty breathing.