Talk:Codeine/Archive 1

This is an archive of past discussions about Codeine. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page.

Archive 1

Codeine is BOTH an opiate and an opioid

This is an editor's quotation. However according to the Wikipedia articles opioid and opiate, codeine is an opiate because it derives from opium and an opioid because it binds to the opioid receptors. Do you mean that those Wikipedia articles are incorrect? --Jclerman 20:17, 10 August 2006 (UTC)

Codeine can be classified as either an "opioid" (a drug that binds to opioid receptors) or an "opiate" (opioid drug derived from opium). That particular editor is incorrect in saying that "opioids are synthetic" – the other articles are correct. -Techelf 10:11, 12 August 2006 (UTC)

Techelf is correct. "Opiate" is used to refer to a drug either found in opium or derived from opium, so it is used to refer to both "natural" and "synthetic" drugs. "Opioid" is a pharmacological term used to refer to drugs acting on the opioid receptor. The terms are not mutually exclusive. Generally, "opioid" includes "opiate" drugs but not vice-versa. For example, codeine is both an opiate and an opioid, however methadone is an opioid but not an opiate. ~~ unsigned

"didehydro" - unknown prefix

Please change "didehydro" in "dihydro" in the offered IUPAC name. Only "dihydro" makes sense. Thanks.

The name refers to di-dehydro, which is something different than dihydro. The name stated in the drugbox ("(5(,6()-7,8-didehydro-4,5-epoxy-3-methoxy-17-methylmorphinan-6-ol") is correct, see e.g. the drugbox entry (here). Hope this helps. --Dirk Beetstra ^{T C} 18:24, 4 March 2007 (UTC)

Australia has 15 mg over the counter

You can get panadeine 15 (500mg of paracetamol and 15 mg of codine) over the counter at a pharmacy.

Nurofen Plus is 13.8 mg...

Don't know if I am allowed to update the article.

As far as I have ever seen in Australia, OTC tablets come in 10mg and 8 mg codeine (with 500mg paracetamol). Nurofen Plus is 12.8 mg codeine (with 200mg ibuprofen). If anyone thinks that this is incorrect, please post below here. Otherwise I will be editing the page in about a week. Come to think of it, also post if you think my figures are correct. Of course I could be wrong, seeing as I am just going on what I have seen.Tmrussell 05:50, 25 April 2007 (UTC)

you CAN get panadeine 15 (15mg codeine) OTC in australia

however codeine linctus CANNOT be brought OTC. it isn't even S4 anymore, its S8, like morphine. rikodeine can be bought OTC but this is different.

thanks for the information about Panadeine-15 Lucky I posted here before editing the main page. Tmrussell 08:07, 13 May 2007 (UTC)

New pics from DOJ

Pictures taken from the Department of Justice's website.USDOJ Fuzzform 03:24, 3 May 2007 (UTC)

These might perhaps belong on co-codamol or similar. Fuzzform 03:26, 3 May 2007 (UTC)

Oddly, the ones on the far right (Tylenol 2-4) are mixed up. Tylenol 3 has 30 mg codeine and Tylenol 4 60. --Galaxiaad 03:08, 23 July 2007 (UTC)

UK Limits for OTC medicines

The law concerning the maximum allowable amount of codeine allowed in non-prescription medicines can be found in section 2.1 of this document on the Medicines and Healthcare products Regulatory Agency.

The strongest codeine-containing medicines available without a prescription contain 25.6mg of codeine per maximum single dose, ie Solpadeine Max (500mg Paracetamol/12.8mg Codeine per tablet, recommended dose 1-2 tablets) and Nurofen Plus (200mg Ibuprofen/12.8mg Codeine per tablet, recommended dose 1-2 tablets).80.229.137.187 20:56, 7 October 2006 (UTC)

That is somewhat wrong. According to the above statement, a single pill containing 25.6mg of codeine should be legal if marketed as "maximum single dose" but would have far more abuse potential than 2x 12.8mg containing tables. The general rule here is per 12.8mg of codeine there needs to be 500mg paracetamol or 200mg ibuprofen. In other words, per maximum single dose the requirements are 25.6mg of codeine with either 1g paracetamol or 400mg ibuprofen with a maximum of 12.8mg per pill. --87.194.3.52 02:00, 12 August 2007 (UTC)

Is Codeine/Tylenol 3 also an anti-inflamatory?

I have been perscribed Tylenol 3 for the occasional pains that occur as a result of an ongoing health problem, for use on an as-needed basis. For some time now I have not needed to take it, but I still keep it on-hand.

Last night, after nearly a month of an aching right leg, I took one tablet under the advice of my health nurse so that I would sleep better. The Tylenol 3 did indeed help the pain (as well as making me sleepy enough to spend all day in bed), and now almost 24 hours later, the pain is still very mild. Could the Tylenol 3 have had an anti-inflamatory effect and "cured" the problem with my leg? CG janitor 07:36, 21 December 2006 (UTC)

Tylenol is indeed an NSAID (anti-inflammatory). I don't think codeine has much effect on that. This isn't really an appropriate conversation for a wikipedia talk page though! Go ask a doctor, or talk to your nurse some more. Gigs 00:07, 3 January 2007 (UTC)

Actually, neither codeine nor acetaminophen is considered an anti-inflammatory. To quote the paracetamol (AKA acetaminophen) article, "Paracetamol, unlike other common analgesics such as aspirin and ibuprofen, has very little anti-inflammatory properties, and so it is not a member of the class of drugs known as non-steroidal anti-inflammatory drugs (NSAIDs)." --Galaxiaad 00:05, 4 January 2007 (UTC)

Galaxiaad is partly correct. Actually, acetaminophen has NO direct anti-inflammatory properties, so maybe someone should correct the other cited article. --87.194.3.52 16:25, 12 August 2007 (UTC)

cannot be attributed to non-medical use?

In the recreational use section it says: It is reported that in France, 95% of the consumption of Néo-codion cough preparation, containing codeine, cannot be attributed to non-medical use.

To me this implies that 95% is not recreational, and therefore only 5% is recreational. Is this really what is meant? If it is, then it could be worded in a less round-about way.

Because of the weasel words it is reported that...', I'd also like to see a citation for that 95% figure, whatever it claims to represent. Royhills 20:55, 4 August 2007 (UTC)

I believe it was a mistake. I changed it to "can be attributed to non-medical use". There is a reference for that figure, an article in French (ref 10). --Galaxiaad 21:35, 4 August 2007 (UTC)

Galaxiaad, thanks, I checked the source. --87.194.3.52 16:47, 12 August 2007 (UTC)

Diarrhea vs Diarrhoea

The on going battle of US English vs British English. The problem in this case is the article name is Diarrhea - [Diarrhoea] is a redirect page to Diarrhea. Dbiel ^(Talk) 00:47, 3 July 2007 (UTC)

The spelling seems to keep getting reverted. We should acknowledge the differences in spelling but the link itself should be to the actual page name it links to rather than to the alternate spelling that is a redirect page. Dbiel ^(Talk) 03:08, 23 July 2007 (UTC)

Since the origins of Wikipedia is in the US, and the encyclopaedia's English section first took popularity in the US, it is accepted to use US English over British English. --87.194.3.52 16:50, 12 August 2007 (UTC)

Death

"Some people may also have an allergic reaction to codeine, which may cause severe illness or even death" is a strong statement, and there is no citation or source to verify the claim. I have rephrased the sentence until a citation is available, if at all in existence: "Some people may also have an allergic reaction to codeine, which may cause severe allergic reactions such as the swelling of skin and rashes." The swelling and rash is typical and documented in any codeine medicine leaflet and generally accepted as a allergic reaction or signs off exceeding the ceiling effect within the medical community. However, death by an allergic reaction is absurd unless mixtures of other drugs were used resulting in respiratory depression, high dose codeine in infants or overdose in opioid naive people. A fatal overdose is different than claiming deaths from allergic reactions, which has never occurred in the case of codeine from the research I have done.--87.194.3.52 17:07, 12 August 2007 (UTC)

Expansion please - History, Financial and Statistical information

A little history on the who, when, how, and why the drug was discovered or created, and its use came to be would be a welcome addition to this article. Carlossuarez46 19:30, 17 July 2007 (UTC)

I agree, and have added history to this title. I have also moved this to the top for more attention. Although codeine has always been in raw opium, information needed are History about:

the discovery of codeine presence in opium
the discovery of converting morphine into codeine (who, where)
the extraction process of native codeine from raw opium

Also some financial data would be nice:

codeine sales
statistics on codeine usage over other pain killing medicines

Aswell as:

usage in modern entertainment and the fact that there is a music group who calls themselves "codeine" after the drug.

Definition of a drug- i.e. caffeine is a drug and certainly used more than codeine. Thus the statement referring to codeine being the most used drug is erroneous.

If anyone else has anything to add, please feel free to edit the above. Once the relevant information is added, either remove the bullet point or add "check" or "done" in italic next to the bullet point. --87.194.3.52 18:04, 12 August 2007 (UTC)

Expansion please - History, Financial and Statistical information

A little history on the who, when, how, and why the drug was discovered or created, and its use came to be would be a welcome addition to this article. Carlossuarez46 19:30, 17 July 2007 (UTC)

I agree, and have added history to this title. I have also moved this to the top for more attention. Although codeine has always been in raw opium, information needed are History about:

the discovery of codeine presence in opium
the discovery of converting morphine into codeine (who, where)
the extraction process of native codeine from raw opium

Also some financial data would be nice:

codeine sales
statistics on codeine usage over other pain killing medicines

Aswell as:

usage in modern entertainment and the fact that there is a music group who calls themselves "codeine" after the drug.

If anyone else has anything to add, please feel free to edit the above. Once the relevant information is added, either remove the bullet point or add "check" or "done" in italic next to the bullet point. --87.194.3.52 18:04, 12 August 2007 (UTC)

Lean

I do believe that codeine is what is used in the drink "Lean". Its a drink most common amongst youth in Texas. Some mention should be made to that.--Jaysscholar 05:22, 23 September 2005 (UTC)

That is true to an extent. Lean is actually just the nickname of the codeine syrup that kids drink. They make mix it with drinks or coat blunts with it.

Codeine is mixed with soda such as sprite,not alcohol, to create "lean". Made popular by early pioneers of screwed music like DJ screw, Big Moe Fat Pat and LIl' Flip; they were the ones to bring codeine to the drug culture as lean. (unsigned)

This had been in the article before, and then removed, presumably for lack of verifiability. However, the reference links in Purple drank seem to check out, so I'm going to put a brief mention of this back into the article. - Pacula 16:39, 27 September 2007 (UTC)

Paracetmaol helping with withdrawals

A heroin addict may use paracetamol to ward off the effects of a withdrawal

Methadone and perhaps codeine (both opioids) may be used to ease withdrawal - but paracetamol is a different type of analgesic and I have never heard of it being used in this way.

I was addicted to Methadone for 6 months and paracetamol has no effect what so ever on withdrawls. Paracetamol contains no opiates thus has no effect on the opoid receptors craving opiates. The opiate withdrawls, being very similar to the flu (fever, cold sweets, discomfort, nausea, etc.), one would think since those are some of the uses for paracetamol that they would theoreticly work; but the causes of symptoms are manifested for completely different reasons.

Paracetamol has no reversible effects on the withdrawal symptoms, but DOES help with withdrawal symptoms. Paracetamol lowers the body temperature (anti-pyretic) and also helps with very mild pain. Since withdrawal symptoms can include fluctuations in body temperature and also pain, it can easily be argued that paracetamol might help with withdrawal symptoms. But whether it can reverse the withdrawal symptoms, No, since it is not an opioid. It's a tricky sentence, but whoever wrote it was theoretically right, but wrong in practice. --87.194.3.52 16:39, 12 August 2007 (UTC)

CAN ANYONE FIND A SOURCE FOR THE SENTENCE ABOUT GETTING CODEINE IN NEW JERSEY WITHOUT A PRESCRIPTION? —The preceding unsigned comment was added by 63.145.150.3 (talk • contribs) .

I agree with the above concerning Paracetamol, I also was addicted to morphine, heroin and pentazocine, paracetamol is of no use for withdrawals

Not sure where this would fit in, but when I was really young I had quite unpleasant hallucinations associated with the withdrawal. (Thank heavens I can't remember any of it.) Is that already in the article? I couldn't find it. 71.213.127.231 22:53, 17 October 2007 (UTC)

Original Research

The amount of original research and unverified (or sourced) claims must be heavily edited from the recreational use section. If a statement cannot be backed up with verifiable and valid source then it does not belong in an encyclopedia, especially statements like this: " In Texas, codeine in syrup form is called Lean. It is commonly mixed with a soft drink such as Sprite (to make a drink called purple drank)."

Information like that adds nothing to the article, and unless there are valid and verifiable sources to backup the statement it must be truncated entirely. Nja247 (talk • contribs) 21:41, 24 July 2007 (UTC)

A simple statement stating that the recreational use of codeine does exist, and a little description is enough. --87.194.3.52 16:46, 12 August 2007 (UTC)

Are you sure the phrase "truncated entirely" is the one you are looking for? —Preceding unsigned comment added by 154.5.12.245 (talk) 17:19, 15 November 2007 (UTC) british english is the ONLY english. americans were speaking tribal indian before it was taken over by europeans. wherever wiki originatrd, english is ...ENGLISH.

Funny brackets

Broken links because of funny brackets under Rec. use section, para 4. Deliberate? --81.105.243.17 (talk) 18:13, 10 February 2008 (UTC)

Promethazine is a cyp 2d6 booster?

Unless I'm reading this wrong but isn't promethazine (Phenergan) a CYP 2D6 inhibitor? I.E taking it before/during codeine ingestion will reduce the amount of codeine that gets converted to methyl-morphine.

It does boost the effect if a nod (sedation) is what you're after, if taken when the effects of the codeine really start to kick in.

Albeit it is a slightly weak inhibitor of 2D6, but to say that it doubles the conversion rate of codeine to morphine (the job of CYP-2D6) isn't quite right.

info: http://www.bluelight.ru/vb/archive/index.php/t-255945.html

http://www.umm.edu/altmed/drugs/promethazine-107100.htm#Drug%20Interactions —Preceding unsigned comment added by 121.221.245.12 (talk) 19:34, 27 July 2008 (UTC)

What does this sentence mean???

The article states in the opening paragraph:

"[Codeine] is one of the most effective orally-administered opioid analgesics and has a wide safety margin. It is from 8 to 12 percent of the strength of morphine in most people; differences in metabolism can change this figure as can other medications."

What does the "It" in the second sentence mean??? Is it the safety margin? Is it codeine? Is it the effectiveness of codeine? In case it is the effectiveness, is this as an analgesic (painkiller) ? If so, then in comparing it to morphine, is this by mass? By volume? Per standard dosages? If standard dosages, then what are these dosages? Etc.

The sentence desparately needs clarification.Daqu (talk) 19:36, 11 October 2008 (UTC)

"it" is...8-12% of codeine "supposivly" gets converted into morphine...AKA 1/10 of your codeine dose will get motabolized, and turn into morphine once it passes thru the liver, thus, the "high" or pain relief one gets is really from morphine. GET IT? not that hard to understand

EXAMPLE: 200mg of codeine=20mgs of morphine (estimate)...400mg of codeine=40mg of codeine (estimate). This is based off a 10% conversion, which is the average.

Wrong structure in 3D gif

I believe the methoxy on the benzene ring is reversed in the space filling model, making it an alcohol when it should be an ether. Zombiejesus (talk) 22:00, 4 October 2008 (UTC)

This is correct.60.229.232.109 (talk) 06:36, 13 November 2008 (UTC)

India has unaccountable rate of OTC misuse

Recreational Use or State of Euphoria are terms which I find are misleading.The proper term would be the use of Codeine based (phospahtes/sulphates dissolved with chlorophenaramine maleate and acetominophenes)for the alteration in the brain's ability to perceive the surrounding environment.I do not if I am allowed to disclose the "Brand Names"of the 2 leading pharma companies whose products are among the highest misused drugs otc.However some states like Punjab,Most of the N.E. region states and New Delhi do not sell these cough syrups without a prescription ;but still its usage stands at 75% of the most common mind altering drugs in liquid form second only to alcohal among the youth age group of late teens-35 years.
In the year 1992-94;the use of codeine based syrups reached an all time high.At that time ;the codeine based cough syrups also had among its contents :Ephedrine and Phenargan's base;which was the (IMHO though I'm not sure)trigger activating the feeling of an overflow of adrenaline and heightened sense of visuals and aural elements ;almost like the ones describes by Huxley in his book "The Doors Of Perception".Since it (still)is OTC drug along with cheap cost;and ignorance of populace about it led it to being the most sold/bought cough syrups by youngsters.Although in late 1997-99 the manufacturers to withdraw all stocks from the shelf and then released altered formula base containing only "Codeine with Chlorophenaramine Maleate and SunsetYellow with flavoured base.However ,it was still used in the same way by external intake of tablets of ephidrine HCL 10mg and Phenargan and Spasmoproxywan capsules.Of course ;hot filtering. Side effects: Dryness,loss of natural moisture like tear in eyes,lips,swollen tongue,bitterness and loss of taste,tightenign of jaws,problems in speaking fluently,constricted pupil,delusion,paranoid and self pity.--asydwaters 14:30, 12 April 2007 (UTC)

Does a tobacco user abuse/misuse tobacco? Does a marijuana smoker abuse/misuse marijuana? Does a coffee user abuse/misuse coffee? Does a drinker abuse/misuse alcohol?? Codeine is a euphoria inducing drug, if the use of codeine recreationally is "misuse", then many other substances we use daily to relax/feel better can also bear the term "misuse". If codeine could not alleviate pain, but still had euphoric properties, i bet any money the term misuse would be used farless. Also remember, OPIUM (containing codeine) was used as a recreational drug many years before it was used medicinally, giving the recreational use a far more natural human behavior than that of medicinal use. --87.194.3.52 16:45, 12 August 2007 (UTC)

I disagree. Misuse is exactly the word for the two pack a day smoker, the alcoholic, the caffeine junkie, the pothead. I've been all those things and I'm familiar with the rationalizations, the myths of ancient lotus-eaters, the us-against-them. The problem with opiates is that they are addictive, and create a tolerance. The more they are used for pleasure, the less they are effective for pain. Why is the question of what's "natural" behavior relevant to society's attitude to what is in effect a biological, psychological form of gambling? Isn't murder natural behavior? Did the British have nature on their side when they started the Opium Wars? Should we abandon civilization to nod-out in the jungle, only to build our tolerance sky-high until euphoria is impossible to reach and we need ridiculous amounts just to feel semi-normal? When I was a junkie, it took about six months. That's the truth about opiates: you only have fun in the beginning. Then the only pleasure is in warding off the sickness. You lose your veins, money, everything . . . even the pleasure. It happens FAST. And god forbid you're in a car wreck or grow cancers . . . even if they can get it in you, no amount of anything is gonna breach your tolerance. Nothing will kill your pain. Trust me . . . every ounce of pleasure you wring from that plant, you'll pay back twice in pain. MISUSE is an understatement, believe me. 76.115.59.36 (talk) 01:03, 16 January 2009 (UTC)

Sorry to hear about your hardtime, but this is not about how bad a drug is. I could come up with thousand tails about why alcohol is equally detrimental, from saying my neighbour died by a drunk driver, to my cousin choking on her vomit after drinking too much, to George Best needing a liver transplant, to my friends granddad getting Jaundice, to my other cousin, dying whilst withdrawing from alcohol after a convulsion. Alcohol withdrawal is 10 times worst, so you got off lightly my friend. Misuse is used when something is used for other than intended. So if a kitchen knife is used to kill someone instead of cutting food, its called misuse or abuse. So your understanding is perhaps tainted. But thanks for sharing your worries about a drug, which perhaps has helped more people than it has not helped. To use opium or opioids for pain, whether physical or emotional is certainly not misuse or abuse. To use opium to feel good is not misuse neither. If you use opium to play football with it, or create figurines, then its misuse. Your problem is no one gave you advice about opium dose management, and the fact that you never tried reducing your dose is a good indicator why you hate it so much. I know many in Iran, who smoke it monthly, or even yearly at weddings etc. all well-off people from doctors to business men. My grandad was given oxycontin prescription, even though he had to take it daily, he took it only when he needed it. It is not addictive at all, unlike Crack, it only becomes an addiction when people think they know better or give them selves excuses for repeated daily use. The truth is, some people end up using something more, because they are a child inside, given access to chocolate or have addictive personalities. Also, some end up also over using their drug, because it happens to be a drug of their choice. People all across the world are looking for something to give them a break, for some its opium, alcohol and for some its marijuana, but all have bad side effects, and most of them, end up addicts, because its what works for them. Thousands of people every month are given morphine in hospitals, not by mouth, but by injection, most of them never think of it again. So your persistence that its very addictive, is perhaps self-proclaimed and not general. Stop judging something that is also good, God forbid if you get shot or stabbed, and about to die of pain, and be neglected pain relief by paramedics. Pain alone can kill, and morphine has helped many soldiers and people fight that extra length to stop from letting go. Yes it has created addicts, just like all those homeless people in central London, smelling of alcoholic piss sitting with extra strength beer cans in their hand, and their hat on the floor begging for coins. By the way, murder is not natural, since its circumstantial... you might aswell say pedophilia and sexual and child abuse is natural too. Sick indeed. --93.97.181.187 (talk) 01:33, 30 March 2009 (UTC)

Grammar

It's spelt 'PER CENT', not 'PERCENT'. -Preceding unsigned comment added by 194.82.129.62 (talk) 19:31, 30 March 2009 (UTC)

Both are acceptable spellings, although the prominence of each varies by country. Someguy1221 (talk) 19:34, 30 March 2009 (UTC)

As noted either is acceptable. Though for consistency percent is likely the best option. Though we should be flexible and let it go to avoid any long term non-sense edit conflicts. Nja²⁴⁷ 19:36, 30 March 2009 (UTC)

Weird wording

The second paragraph of the History section hardly makes any sense.

Until the beginning of the 19th century, raw opium was used in diverse preparations known as laudanum (see Thomas de Quincey's "Confessions of an English Opium-Eater", 1821), paregoric elixirs (a number of them, very popular in England since the beginning of the 18th century; the original preparation seems to have been elaborated in Leyden,Holland around 1715 by a chemist named Lemort; in 1721 the London Pharmocopeia mentions an Elixir Asthmaticum, replaced by the term Elixir Paregoricum ("pain soother") in 1746)

Ignoring the parenthesis (and the parenthesis-inside-the-parenthesis), the sentence doesn't really finish itself "...diverse preparations known as laudanum, paragoric elixers" There should at least be a period. —Preceding unsigned comment added by 99.178.133.194 (talk) 05:43, 11 March 2010 (UTC)

Scheduling change in Australia

Codeine products are being moved behind the counter in Australia, costing pharmacists $84 million and annoying customers: [1], [2]. Probably not significant enough to be mentioned in the article, but it is big news over here. Factsontheground (talk) 15:02, 28 March 2010 (UTC)

Canada

"In Australia and Canada, codeine is regulated, however it is available without prescription in combination preparations from licensed pharmacists in doses up to 12.5 mg/table"

Health Canada regulations allow for codeine in combination with at least 2 other medicinal ingredients to a maximum of 8mg per tablet or per 5ml available without a presciption in the pharmacist access area (Tylenol #1, 222's, combination cough liquids, Robaxacet with codeine are examples)208.38.3.162 14:24, 8 June 2007 (UTC)

I am looking for the source of this information. I have heard many times that codeine is available without a prescription in Canada, but can not locate any references to reputable websites, such as Health Canada.

In Australia Codeine is available up to 15mg per tablet without presecription. I have updated the article.

Mystic eye 16:23, 19 December 2005 (UTC)

Also: I would like to point out that codeine is available without prescription in the UK coupled with ibuprofen in 12.8mg/tablet doses. Perhaps the article should be modified slightly to reflect this? 82.4.43.239 00:06, 9 March 2006 (UTC)

I live in Canada, and the most I can buy 8mg codeine/325mg paracetemol/15mg caffeine Over the counter. Next time I go to buy some, Ill ask if they have higher amounts of codeine, but I doubt you can get it without a prescription.Peoplez1k 02:30, 19 May 2007 (UTC)

I'm in Ireland, sopadeine is available in pharmacies over the counter. There's a UK site for it.

Just go to any Canadian pharmacy and ask for generic Tylenol 1: 8mg codiene/300mg acetaminophen/15mg caffeine. The "reference" here is personal experience (Alberta in particular, but I'm sure its true anywhere) Sometimes you have to sign something, sometimes they ask no questions at all. —Preceding unsigned comment added by 68.150.52.70 (talk) 12:44, August 26, 2007 (UTC)

Yes, the limit in Canada is 8mg, roughly 1/8th of a grain, and equivalent to (and includes!) Tylenol 1. I can't find a site that properly references this fact but numerous pharmacists have asserted this to me, and if you are willing to spend the time, a query of all the codeine products available in Canada (which may be done at http://webprod.hc-sc.gc.ca/dpd-bdpp/index-eng.jsp ), will affirm the fact that nothing above 8mg is available OTC. Emjaymj (talk) 05:13, 9 March 2010 (UTC)

Why isn't there anything about OTC availability in Mexico? Just wondering. —Preceding unsigned comment added by 71.140.89.27 (talk) 15:49, 7 May 2010 (UTC)

Greece

Hello,

you should distinguish "illegal" vs "controlled".

I live in Greece and I am in possession of a drug which contains codeine in particular Lonarid N (paracetamol + caffeine + codeine phosphate 10mg) and it was LEGALLY prescribed and purchased..

One can't prescribe more than 20 pills a time (and it's risky to make more than 1 prescription a month) using a simple prescription but for people who need it frequently, one can acquire a special "narcotic"-prescription which is heavily controlled for as many pills as are needed.

source : http://www.islasithiou.gr/download.php?file=76 (PDF - in Greek)

[f20g.xyker.no-ip.be/ bicycle handlebar moustache] Thanks P4n0z (talk) 08:24, 3 June 2010 (UTC)

Codeine and fertility in women?

I read in the nurofen plus booklet that codeine phosphate belongs to a group of medicines that can impair fertility, but usual fertility is resumed once the medicine has left the system- does anyone know anything more about this? I've google searched high and low to find evidence/details of clinical trials etc but found nothing. —Preceding unsigned comment added by 62.49.221.26 (talk) 14:13, 10 September 2010 (UTC)

French Article

The article regarding codeine use in France says that codeine is not a euphoriant; it also claims 95% of the syrups use in not medicinal. Is the author credible?

I'm french and I can certify that codeine pills such as "neo codion" can be bought without any prescription in a drugstore.

In fact, codeine is often used by drug addicts in need, or those who try to wean off other drugs. It is a kind of bulwark to prevent theft and smuggling of products more potent as methadone or subutex. So, the article needs to be changed concerning the case of France.93.21.121.146 (talk) 10:52, 8 March 2011 (UTC)

Naming Compendium Notes

Codeine is NOT an INN name. It is a USP name, meaning the monohydrate. (see USP DICTIONARY 2010) It is a (former) BAN name, meaning the anhydrous substance. (see link below) It may be a USAN name, but it has not been verified.

http://books.google.com/books?id=zruxjioUFngC&lpg=PR11&ots=zg_P6x-9iv&dq=BRITIsh%20approved%20name%20list&pg=PA68#v=onepage&q=BRITIsh%20approved%20name%20list&f=false —Preceding unsigned comment added by Peryeat (talk • contribs) 15:41, 29 April 2011 (UTC)

Australia in North America

Austalia is currently listed as # 9.1.3 Australia, as a subsection of North America. It is not. —Preceding unsigned comment added by 78.105.212.184 (talk) 15:27, 5 November 2010 (UTC)

lol — Preceding unsigned comment added by 210.48.101.90 (talk) 22:10, 11 July 2011 (UTC)

Lead

I suggest editing the lead to remove the stricken text, as follows:

Codeine (INN) or methylmorphine is an opiate used for its analgesic, antitussive, and antidiarrheal properties, ~~and is useful for numbing back pain, and is frequently purchased under this pretence.~~

Obviously codeine (or medication with codeine) is prescribed for back pain. But, is there any source that its used especially for this, versus other types of pain? The lead is supposed to be a summary of the article body, but the text "back pain" only appears in the lead sentence. If something's worth mentioning in the lead, it's always worth elaborating in the body. Since

Next, the use of the word "pretence" seems wrong. Of course, in some cases, complaining of pain is literally a pretence to get the drug. But, it seems reasonable to assume that in most cases it's prescribed for back pain (or other pain) it really is used for that, and there's no "pretence".

On a separate note, I suggest using common words (in addition to the current terms), such as "painkiller" and "cough medicine". I particularly object to the use of piping for "[[Cough medicine|antitussive]]". If a term is good enough for an article title, it's good enough for text linking to it. --Rob (talk) 04:33, 15 July 2009 (UTC)

It is used for broken bones from personal experience - recieved a prescrip. of codeine phosphate 30mg tablets after breaking my ankle. — Preceding unsigned comment added by 109.157.231.75 (talk) 22:30, 6 March 2012 (UTC)

Codeine/Venlafaxine contraindication claim

I've marked a {{Fact}} tag on this claim in the article as I can find no relevant info to back it up, and I myself am on venlafaxine and have no issues with codeine. Timeshift 07:55, 19 May 2007 (UTC)

Its not a contraindication (as far as I know, but i'm not a doctor), it is metabolized by the same enzymes. What this means is your venlafaxine may be using up some of the enzymes, causing decreased codeine effect (as this interferes with its conversion to morphine). However, if your CYP2D6 function is normal, then you should have no problem taking a normal prescribed dose of venlafaxine, and a normal prescribed dose of codeine. You may notice stronger codeine effect if you were to stop taking your venlafaxine for a couple days, that's all. —Preceding unsigned comment added by 143.166.255.41 (talk) 02:18, 9 September 2007 (UTC)

Yup. Fluoxetine and paroxetine are also metabolized by that enzyme (see CYP2D6 for a longer list). I've taken a significant amount of codeine to no effect while on fluoxetine. --Galaxiaad 02:40, 9 September 2007 (UTC)

I have serious problems with Codeine and Venlafaxine Xr. I came across the article while trying to locate a reason for the reaction I am experiencing. I take a fairly large dose of Venlafaxine, 300mg daily. But the codeine I am taking is very small, only 8mg of codeine phosphate, which is available over the counter in Cananda. My doctor suggests that one of teh drugs uses up the enzyme and causes the blood level of the other to increase abnormally. -ellethekitty in Canada

In my opinion, you just need to let your body get used to Venlafaxine during a few weeks and once there you can start small with codeine and increase it each time according to your body. I am on 150 mg Venlafaxine daily and i still manage to metabolise up to 300-400 mg max codeine (this mainly depends on the weight and tolerance of the person), codeine's red line (overdose) is somewhere after 800 mgs on an average (LD50s). The key is to ingest Venlafaxine at least 6 hours away from your codeine, in order to leave time the enzymes. As for the people on 300 mg Venlafaxine, they may have to wait longer and experiment even smaller. In the same class of substances, only the serotonergic opiates/opioids (ex. Tramadol) are dangerous when combined with Venlafaxine (serotonin syndrome). — Preceding unsigned comment added by 178.83.124.54 (talk) 14:46, 25 March 2012 (UTC)

Codeine and Papaver bracteatum

"Codeine is the second-most predominant alkaloid in opium, at up to three percent; it is much more prevalent in the Iranian poppy (Papaver bracteatum), and codeine is extracted from this species in some places although the below-mentioned morphine methylation process is still much more common."

This line appears in the opening paragraph. However, Papaver Bracteatum does not contain codeine or morphine. Only thebaine is present as an alkaloid in Papaver Bracteatum. Codeine and morphine can be synthesized from thebaine, but they are not present as alkaloids. — Preceding unsigned comment added by 207.203.238.6 (talk) 14:03, 14 January 2013 (UTC)

I agree and have reworded the statement accordingly. Is the new wording acceptable to you? -- Ed (Edgar181) 15:07, 14 January 2013 (UTC)

Perfect — Preceding unsigned comment added by 207.203.238.6 (talk) 16:41, 14 January 2013 (UTC)

Recreational use - Ilicit synthesis of morphine from codeine

The method described in the article of synthesising morphine via demethylation of codeine with pyridine is incorrect. In fact what should be used is pyridinium hydrochloride.

In the hands of an inexperienced chemist, the resulting product would likely be heavily contaminated with pyridine, resulting in a foul smell which would likely deter even a hardened addict from using it. There are much easier and cheaper ways to obtain morphine than this.

Should this be deleted from the article? The section is about recreational use, not ilicit drug synthesis.

Bobby charriot 23:46, 5 January 2007 (UTC)

Absolutely this should NOT be deleted from the article. The article should just tell the truth, which is that an amateur chemists can convert codeine to morphine, but are complete idiots to do so because of the toxic (and possibly carcinogenic) by-products. The public needs to know that there are silly people doing this. Tmrussell 10:30, 29 April 2007 (UTC)

No, leave the morphine synthesis in the article. Tmrussell, there are no cited information or reports as far as I know about anyone in the public synthesizing codeine into morphine except 1 case many years ago in New Zealand. It is inefficient, highly undesirable and uncommon to synthesize morphine from codeine using pyridine. The only reason this was included in the article is to tell the public it is Possible to synthesize codeine into morphine, but that is a very uncommon practice. It is far more cheaper and easier to buy illicit heroin than the procedure required to synthesize morphine from codeine. --87.194.3.52 16:29, 12 August 2007 (UTC)

In any case, Pyridine is neither toxic nor carcinogenic, as can be easily seen in the related article. This should be corrected as hysteria on chemicals is already large enough and to spare. —Preceding unsigned comment added by 88.71.177.210 (talk) 13:35, 11 December 2008 (UTC)

Bobby charriot's point is somewhat moot. It is not at all incorrect to say that pyridine is used in the synthesis of morphine from codeine because pyridine IS being used, simply with an acid being added. Also, as far as I remember, pyridine plus hydrochloric acid (i.e. pyridinium hydrochloride) is not sufficient for aryl-alkyl ether cleavage. What's required is pyridine plus hydrobromic acid (i.e. pyridinium hydrobromide). To the above, pyridine IS toxic. According to the Hazardous Substances Database (HSDB), pyridine is a known carcinogen in animals. ~~ unsigned — Preceding unsigned comment added by 184.145.50.110 (talk) 03:59, 12 June 2013 (UTC)

The information about codeine's ceiling dose come from nowhere. Please see: Armstrong, SC. and Cozza, KL. Pharmacokinetic drug interactions of morphine, codeine, and their derivatives: theory and clinical reality, Part II. Psychosomatics. 44, pp. 515 - 520. (2003) There is absolutely no direct evidence that a one time dose of codeine is subject to a ceiling due to CYP2D6 saturation. Most codeine is not metabolized by CYP2D6 anyway. The evidence, suggests that saturation of CYP2D6 by codeine may not have an effect on codeine's analgesic and euphorigenic effects. About 85% of codeine is metabolized by uridine diphosphate glucuronosyl transferase 2B7 (UGT2B7). Further, why don't you just ask people who have taken over 400 mg of codeine phosphate at once whether or not they notice a difference between, for example 400 mg and 640 mg. The reference I have listed above is freely available online.

Recreational Use

"people will frequently purchase it from multiple pharmacies so as not to incur suspicion" is generalizing that all people in some countries purchase it from multiple pharmacies. I have rephrased it so it only implies to people likely to recreationally use codeine, and not just "people". This also ties in with the source far more than the present phrase. It now reads "some potential recreational users are reported to buy the aforementioned from multiple pharmacies as to not incur any suspicion." --87.194.3.52 02:37, 12 August 2007 (UTC)

This shit is totally wrong. Who in the fuck wrote that the liver can't metabolize more than 400 mg at once? Where is the evidence for this? Any peer reviewed journal? Next time someone brings up unsubstantiated claims about the "ceiling dose" of codeine, please cite some primary, peer-reviewed literature. The evidence simply does not agree with the bullshit I have seen on this page about morphine being the main active metabolite and the limit to codeine metabolism.

^ ceiling dose varies, everyone is different

i start getting hives at about 400mgs

then again, i know someone who takes 900mgs of codeine and loves it

"ceiling dose" is basicly once u start getting negative effects, IMO

but i read and heard, scientifically, 350mg-450mg is the ceiling dose, based upon weight. —Preceding unsigned comment added by 69.125.136.239 (talk) 01:15, 5 January 2009 (UTC)

Could you be ANY less vague? You read it "scientifically?" What does that mean? Can you give an actual source for that claim? If all you mean is that you heard that approximately 400 mg is the "ceiling dose" and that is supposed to be 'scientifically correct' then I think you should be able to find a source for that claim. It's pretty common for people to hear nonsense and believe that it's "scientific" just because someone says it's "scientific." It it really is "scientific" then there should be published evidence available for skeptical people to look at. Saying the "ceiling doe" is one you start getting negative effects is also totally gibberish. Some people get negative effects at small doses. At higher doses, the negative effects might be due to the increased amount of the drug. I still haven't seen one, single published source supported the often repeated claim that 400 mg is a "ceiling dose" of codeine. 184.145.50.110 (talk) 04:26, 12 June 2013 (UTC) unsigned

euphoria an adverse reaction?

Anyone find this a bit funny?

Common adverse drug reactions associated with the use of codeine include euphoria, …

Yes, it is a side-effect of normal medical treatment not exactly what I would call adverse :p 68.45.219.63 (talk) 19:53, 6 June 2008 (UTC)

Not everyone considers euphoria or getting high to be a positive thing, thus it's adverse since it's a reaction from the medicine which can adversely affect the user. Personal opinion doesn't really come into play here. Nja247 (talk • contribs) 10:09, 7 June 2008 (UTC)

By definition, everyone considers euphoria per se to be a positive thing.

On the other hand, if a comcomitant effect is *impairment* of the ability to perform desired tasks, then not everyone considers this to be a positive thing -- probably very few would.Daqu (talk) 19:36, 11 October 2008 (UTC)

^ if someone doesn't like euphoria or getting high, then they are retarded, for real

By definition, euphoria means 'feeling good' so I don't see how it can be called an 'adverse reaction.' Calling something an 'adverse reaction' should not be considered the same thing as a 'side effect.' 184.145.50.110 (talk) 04:33, 12 June 2013 (UTC) unsigned

"Adverse reactions" is newspeak for "side effects". As to the effect in question being adverse ... Some of us take pain-relieving medications to relieve our pain, and not to muck with our brains. Euphoria can be nice, especially if it's coming after you've been in pain for some time, but surely we can all understand why not everyone would feel comfortable having their emotional state taken out of their hands? In my case, I had adverse reactions to a cardiac drug once: I would get up in the morning feeling as if I hadn't slept at all, though I'd been out like a light for 12 hours, and then I'd spend the whole day on the couch dozing, lacking the energy to do anything so taxing as getting up to raid the fridge (my university studies sure suffered)--but another of the side effects was euphoria, and that meant that I just didn't care that I was sleeping, yawning, and dozing my life away. I spent weeks longer on that drug than I should have because I was incapable of feeling unhappy about its effects. I knew I could barely make the walk between the living room couch and my bedroom, but I didn't seem to mind at all. It took a family member to drag me along to the doctor to discuss changing to a different drug. I still remember that stuff fondly, though I'd never willingly take it again. Your mileage may vary, but I can assure you that a bit of chemically-induced euphoria isn't always a good thing. (As far as codeine's 'euphoria' goes, however, I would much rather have that than the horrible 'head-rush' of IV morphine. Shudder.) I think the current wording (title of Adverse Reactions, then sentence beginning "Common effects other than analgesia") does the trick nicely. The Gilly (talk) 12:26, 12 May 2009 (UTC)

If someone does not like the feeling caused by a particular drug then this feeling cannot be called 'euphoric'. They are in fact experiencing 'adverse' and 'negative' effects of the drug.

eu·pho·ri·a (y-fôr-, -fr-) n. A feeling of great happiness or well-being.

Euphoria or the state of feeling 'euphoric' is a happy state. One cannot dislike feeling good, it's a contradiction. 86.147.239.207 (talk) 13:29, 1 February 2013 (UTC)

Active metabolite

The article states rather strongly that the main active metabolite isn't actually morphine, while the article cited indicates that the research on the subject is rather lacking. It would be a good idea to re-write that part for a more balanced view on the active metabolites especially since it's generally accepted (whether correct or incorrect) that morphine is the most important metabolite. —Preceding unsigned comment added by 212.149.136.62 (talk) 20:42, 29 March 2011 (UTC)

Here. Vree, T. B.; Van Dongen, R. T.; Koopman-Kimenai, P. M. (2000). "Codeine analgesia is due to codeine-6-glucuronide, not morphine". International journal of clinical practice 54 (6): 395–398. PMID 11092114.

^ Armstrong, S. C.; Cozza, K. L. (2003). "Pharmacokinetic Drug Interactions of Morphine, Codeine, and Their Derivatives: Theory and Clinical Reality, Part II". Psychosomatics 44 (6): 515–520. doi:10.1176/appi.psy.44.6.515. PMID 14597688. 184.145.50.110 (talk) 04:37, 12 June 2013 (UTC) unsigned

Link on extracting codine from tablets

Is this really necessary? It seems to me that it doesn't contribute anything to the article, and it seems quite unencyclopedic 203.5.70.1 11:08, 5 November 2006 (UTC)

Is also really stupid dumb ass!!!

Well, at the least people will not damage their livers with the paracetamol.

See the discussion page for cold water extraction for the justification of why it is here. It's encyclopedic, and is a standard procedure in chemistry. Tmrussell 10:30, 29 April 2007 (UTC)

It not totally correct either. Hot water extraction would remove the paracetamol, not the codeine as is implied.

Bobby charriot 23:52, 5 January 2007 (UTC)

Is cold water extraction , not hot. And is paracetamol that damages the liver (can cause death) , not the codeine

Not so. Codeine CAN (in high doses) cause Hepatic damage.) —Preceding unsigned comment added by 92.22.3.47 (talk) 19:05, 2 August 2008 (UTC)

I think the above is bullshit. Can you cite a source for your claim that codeine can cause damage to the liver? Codeine is metabolized quite easily and I'd like to know via what mechanism codeine allegedly damages the liver. I don't believe you know what you're talking about. ~~ unsigned — Preceding unsigned comment added by 184.145.50.110 (talk) 03:50, 12 June 2013 (UTC) 184.145.50.110 (talk) 04:38, 12 June 2013 (UTC) unsigned

The section describing recreational dose is completely bogus

While I can't speak to the actual recreational and therapeutic dose ranges, the ranges listed here seem high. Consult the Physicians Desk Reference or "PDR" for the legit answer on therapeutic range. Anyone who has ever taken codiene can tell you that the therapeutic doses certainly have a recreational aspect to them, so the idea that you have to take so much more to get into the "fun" range is just logically false.

Most innaccurate, however, is the idea that the effects of the drug are limited by your liver's ability to metabolize it. The liver breaks things down. Therefore, a higher capacity for metabolization would mean less effect, not more. These is one of the most glaring errors I have ever seen on Wikipedia. This is why people without scientific backgrounds cannot be allowed to write this type of article. There are tons of "experts" out there on recreational drugs that espose nothing more than myths - whoever wrote this is one of them. Also, as for the opiate/opioid debate, both are acceptable. —The preceding unsigned comment was added by Soszai (talk • contribs) 21:50, 31 January 2007 (UTC).

I don't claim any special knowledge of the subject matter of the article, but reading it verified the obvious inference that the liver metabolises codeine to its active form. This indicates, rather poetically, that the comments above seem to apply well to the author of the comments. Elroch 10:39, 24 August 2007 (UTC)

"Therefore, a higher capacity for metabolization would mean less effect, not more." This is absolutely false. First of all, the liver does not simply "break things down." Secondly, codeine is a prodrug of morphine and codeine-6-glucuronide. If MORE codeine is metabolized by CYP2D6 to morphine or by UGT2B7 to codeine-6-glucuronide then increased metabolism would mean MORE effective, not less. Elroch pointed out the irony of the user's comments. 184.145.50.110 (talk) 04:42, 12 June 2013 (UTC) unsigned

Codeine containing products will typically contain 8-60mg per unit. While an opiate naive person may find a therapuetic dose (~60mg) somewhat euphoric, a person with tolerance or experience with other opiates will likely choose a dose in the range listed for recreational use. Usually codeine use is limited by the fact that at around 400mg (for most people) a ceiling effect is reached due to saturation of CYP2D6. Beyond this area there will be little (if any) therapeutic or recreational value, while the side effects will increase to an unacceptable degree. The article is accurate. My phantom limb 12:11, 26 March 2007 (UTC)

Physicians Desk Reference only guides the GP on how much to prescribe for pain, not for the euphoria. Although codeine can have effective analgesia up to 90% of the ceiling effect, it is generally accepted that if a patient requires that much for pain control, it is better to switch to a stronger pain killer. Yes you are right, even 2mg dose of codeine can induce a liking in the user, but very subtly. Many codeine users we see are "addicted", notice the speech marks, to ridiculously low amounts which generally should only bring 1-2 days of very very mild discomfort upon cessation. However, most recreational users take larger amounts of codeine simply because the euphoria intensifies. Yes therapeutic doses do induce euphoria, above 15mg I would say noticeable, but above therapeutic doses also carry a stronger more intense euphoria hence most recreational users tending to pass the therapeutic standards. The euphoric values generally increase until they slop off nearing the ceiling effect. In a frequent recreational codeine user with some tolerance, little doses such as 30-60mg will generally have little effect, although noticeable. However, since a recreational user is one that tends to dabble with codeine, tolerance is generally not present although mentally they could have made a familiarity with the low dose euphoria being left tempted to intensify the effects. I wrote this in the above discussion and it might be relevant to your question:

200-400 mg is an estimate and very inaccurate. If you want to know how much you can take before reaching the ceiling effect then read on which I hope will partly answer your question. Euphoria does intensify with increasing the dosage and drifts off nearing 75%-90% of the ceiling effect. Analgesic properties likewise. The ceiling effect is per dose and not over the 24 hours, however once the ceiling effect is met, any further codeine will have no effect until the previously given dose is fully processed by the liver (2-8 hours) (also note, subsequent codeine doses in the same day might have less euphoric properties, not because of the ceiling effect, but due to minimal tolerance). The real ceiling effect can be calculated by using the rule that 7mg of codeine per 1 kilo of bodyweight is the ceiling effect. So a 75kg male would be able to consume (7x75=525mg) with effective analgesia and euphoria at 75%, meaning a single dose 393mg will be near all efficient (this is not always the case, read on). Anything above 525mg will have no or little effect. Even that rule of thumb can be argued as every individual is different, and we see many people with unusually high CYP2D6 enzyme presence who can process more codeine and some with little CYP2D6. (CYP3A4, UGT2B7 also have part to play on this ceiling effect as also mentioned in this article). How long codeine is used, liver condition, and gender also play a part as well as age on the ceiling effect. Alcohol and usage of other medicines that put a burden on the liver can also affect the ceiling effect of codeine. But generally 7mg per 1kilo is the rule of thumb many of us GP's were taught, however when greater deal of pain management is required we normally prescribe stronger pain killers other than codeine. Please do not ask where this information is from as it was something we learned in Med school. If your bothered, have a look online i'm sure you will find a source so this can be added to the article. By the way, the weight generally takes into consideration the BMI, in other words a obese person would probably be no more able to process codeine than if he was his normal bodyweight. However, this is the theory, and in practice, everyones liver differs, some can take more some less, and please do not try to max out your dose, if you seriously want to enjoy the euphoria codeine brings as well as the pain killing effects, maintain a dose which works for you and do not increase as tolerance might develop. And as a personal note, codeine is a fairly safe opioid since the euphoric effects tend to be fairly unaffected by increased or prolonged use in most cases if the dose is maintained. Enjoy, but responsibly. Bye. --87.194.3.52 02:11, 12 August 2007 (UTC)

The statement that the quicker the liver metabolizes codiene, the less the effect is incorrect. This article is ablsolutely correct, as codiene is inactive until it is processed to morphine by the liver. Codiene itself has no therapeutic value, it MUST be metabolized. I thought the article already made that clear. There is also great variability in CYP2D6 function, which means there is great variability in peoples response to codeine. Some people can take 30mg, and get noticeable euphoria, and pain relief, and others might not get noticeable euphoria until 150-200. I have personally taken 400mg codeine (but had tolerance) with no ill effect, and if I am intolerant I don't notice euphoria or pain relief in doses below 150mg. I am pretty sure my CYP2D6 function is slower than average, as it also takes about 1 hour before I even notice any effects. So yes, although I am going against my doctors instructions, codeine is very much effective in doses greater than 60mg, but a doctor will not recommend this. People with mild or moderate pain don't need stronger pain killers anyway, the possible risks outweigh the benefits, and doctors won't give you morphine or Percocet just because you say 60mg codeine isn't working well enough, unless there is severe pain, and medical reason to do so. I am also assuming that the user is using codeine recreationally from prescription products. If the cold water extraction is used from a 300mg acet/15mg caff/8mg codiene tablets, then there is also the fact that 200mg of codiene extracted contains 375 mg caffeine as well (3 expressos). This alters the way the drug is subjectively felt, with that amount of caffeine entering the bloodstream (unless you are totally a caffeine addict). So yes... some people will require larger doses to get euphoric effects, some will get euphoric effects at prescribed doses, its just that no doctor will recommend that you take 200-300mg of codeine at once for any reason (even though you probably could take that much without damaging your body, you are just "over medicating" yourself). —Preceding unsigned comment added by 143.166.255.57 (talk) 23:25, 5 September 2007 (UTC)

Saying that a dose above 525 mg of codeine will have no additional effect due to CYP2D6 saturation is total, utter gibberish. Please explain to me how you know what does of codeine leads to "enzyme saturation?" Did you actually calculate the amount of codeine required for "saturation" based on how much CYP 2D6 is produced by the liver? I seriously doubt it. Yes, codeine needs to be metabolized, but much of codeine's activity is due to metabolism by UGT 2B7. Almost 70% of codeine is normally metabolized by UGT 2B7 into codeine-6-glucuronide. Can anyone claiming that taking approx. 525 mg of codeine or a similar dose leads to "enzyme saturation" and thus no further effect actually back up that claim with evidence? 184.145.50.110 (talk) 04:12, 12 June 2013 (UTC) unsigned

I think the previous statement was talking about people with no tolerance. And by recreational he/she meant "someone that dabbles", not a daily user. --78.86.117.164 15:25, 22 September 2007 (UTC)

FYI - I took 60mg (2x30mg Codeine Phosphate) for the first time last night, and it didn't do anything to me at all, it didn't even relieve my back pain which is the reason It was prescribed. I weigh around 12.5 stone (175lbs) and am 5'11" tall, 25 years old. I will try 120mg (4x 30mg). Whilst i've got them here I might as well see what all the fuss is about. —Preceding unsigned comment added by 195.110.73.118 (talk) 22:43, 17 June 2008 (UTC)

Be careful, the euphoric aspects of opioids only become noticeable once your endorphin system is disturbed, in other words, first few times it may come across as ineffective, or as having no euphoric effects. After you use codeine for a few times, you will certainly learn to identify its euphoria. If it is not helping your back pain, it could be you may need something stronger than codeine. Do not increase your dose, go back to your doctor, tell him the codeine is not helping as much as you thought, and let him provide something stronger. Refuse Tramadol if it is offered, Tramadol despite popular beleif is very addictive, mentally and physically, and will leave you extremely depressed upon cessation. Always opt for natural or semi-synthetic opioids, and not synthetic analogues. --78.86.159.199 (talk) 17:49, 31 August 2008 (UTC)

This is absolute gibberish. The euphoric aspect of codeine is not only noticeable "once your endorphin system is disturbed." Where are you getting this bullshit? I definitely found codeine euphoric the first time I took it and had never used an opioid before. Also, advising people to only opt for "natural" or "semi-synthetic" opioids and not "synthetic analogues" is so ignorant that it makes me sick. There is no good reason to think that a "natural" drug is inherently safer than a "synthetic" drug. 184.145.50.110 (talk) 04:12, 12 June 2013 (UTC) unsigned

==== Codeine Ceiling Effect is not supported by evidence and contradicts facts =====

Where is the information about codeine's ceiling dose coming from? It would be nice to at least see a reference if claims like this, along with calculations supporting them, are going to be made. Just read the wiki article and you'll see that the ceiling dose effect contradicts other facts mentioned in the article. At the start of the pharmacology section, there is mention that 70% of codeine is metabolized to codeine-6-glucuronide (C6G). Codeine is metabolized to C6G by uridine diphosphate glucuronosyl transferase (UGT) 2B7. Only about 5% of codeine is metabolized by CYP 2D6 (Armstrong and Cozza, 2003). The article cited states that C6G is responsible for codeine analgesia, not morphine via 2D6. The pharmacology section is directly contradicting itself. The claims I have ever seen about the codeine "ceiling effect" have not been backed up by evidence: they seem to lie on the assumption that codeine analgesia is due to CYP2D6 producing morphine, which is being refuted. I have never seen any good evidence to suggest that codeine has a ceiling effect and some who use codeine recreationally will tell you that their experience contradicts it. I suggest removing this nonsense from the article.

Armstrong SC and Cozza KL. (2003) Pharmacokinetic drug interactions of morphine, codeine, and their derivatives: theory and clinical reality, Part II. Psychosomatics. 44: 515 - 520.

========

Costa Rica

I have a vacation home in Costa Rica and I know for a fact that the following sentence is incorrect:

In some countries it is available without prescription in combination preparations from licensed pharmacists in doses up to 15 mg/tablet in Australia, New Zealand, Poland (Thiocodin) and Costa Rica, 12.8 mg/tablet in the United Kingdom, 10 mg/tablet in Israel and 8 mg/tablet in Canada and Estonia.

Codeine can be purchased in Costa Rica in combination with diclofenac in a formulation called "Oxa Forte", without a prescription, with a dosage of 50mg of codeine per pill (and 50mg diclofenac).

I'd edit the article myself but my experience on Wikipedia has generally been that people are overly protective of their content and just revert the changes. In addition, I'm having difficulty finding an online source to provide proof because a query on Google just returns tons of online pharmacies listing the product, which wouldn't be very reliable even if they explicitly mentioned that it's available without a prescription in Costa Rica. Perhaps somebody better at finding these things can dig something up for me, but I can promise you I am 100% sure that it is available in the formulation named, at 50mg, without a prescription. I'm not heavily familiar with the rules anyways, and it's not like every single fact in every single article is cited anyways, so maybe somebody who knows better will just edit it with the correct information. Or perhaps Costa Rica isn't really significant enough to distinctly mention in an English article (and I say that as someone who loves the country), as many other Latin American and/or developing nations doubtlessly have their own formulations available without a prescription as well... Emjaymj (talk) 05:06, 9 March 2010 (UTC)

This use is 100% correct as i just bought some in Costa Rica without a prescription, 50mg oxa-forte. — Preceding unsigned comment added by 201.191.255.156 (talk) 07:00, 31 July 2013 (UTC)

Non-existent reference

As far as I can tell, "The December 2008 issue of The Bulletin of the National Codeine OTC Lobby (Vol. XVIII, No. 4)" is a false reference - this organization does not seem to actually exist beyond Wikipedia and other websites that only seem to copy/paste what is in this paragraph regarding OTC access to Codeine. I've had a professional literature search done and come back with absolutely nothing. — Preceding unsigned comment added by 159.71.254.248 (talk) 15:22, 24 October 2013 (UTC)

UK Legal Section

I've given this section a bit of an overhaul and clean-up as some of the information in it actually seemed to be false. Hope I've got everything right now, please discuss any issues with the Misuse of Drugs Regulations 2001 bit, etc. Levelledout (talk) 00:07, 6 November 2013 (UTC)

GREECE

"Codeine is classed as an illegal drug in Greece, and individuals possessing it could conceivably be arrested......It is sold only with a doctor's prescription (Lonarid-N, Lonalgal)". So it's not illegal if you have a prescription. Jeez, make up your mind — Preceding unsigned comment added by 98.239.250.100 (talk) 03:26, 28 November 2013 (UTC)

reword please

Under 2.1 Withdrawal and dependence there is this sentence "Claims about the supposed "ceiling effect" of codeine doses are based on the assumption that high doses of codeine saturate CYP2D6, preventing further conversion of codeine to morphine, however it is now known that C6G is the main metabolite responsible for codeine's analgesia.[11]" < Something went wrong there around the first comma resulting in an incomplete sentence, running on to the last phrase. Whoever knows what was being said please fix. Thanks ◦◦derekbd◦◦my talk◦◦ 14:34, 17 December 2013 (UTC)

Codeine is found in concentrations of 10 to 3.0 per cent in opium

changed this to 1.0 to 3.0 percent. source = http://www.unodc.org/unodc/en/data-and-analysis/bulletin/bulletin_1953-01-01_3_page005.html

— Preceding unsigned comment added by 109.155.158.7 (talk) 12:29, 14 January 2014 (UTC)

Codeine & Hip-hop

I was wondering if it would be acceptable to the major contributors to this page if we added to the recreational use section about codeine's emergence into recent hip-hop culture, including Lil Wayne's huge popularization of the drug, and his addiction to it, through his music; along with many other notable artists. I would be glad to contribute this paragraph with citations. Let me know your thoughts. VisaBlack (talk) 12:54, 17 October 2014 (UTC)

Ireland OTC limit

Neither of the documents cited as references for a 12.8mg OTC limit actually say that. I have never been able to get more than 8mg over the counter. — Preceding unsigned comment added by 84.203.35.92 (talk) 06:49, 23 January 2015 (UTC)

Date of synthesization?

Does anyone know what year Codeine was first synthesized from Morphine? I was unable to find it on the DEA's Drug Information page. 19:27, August 15, 2006 BigSciZot

The same day morphine was synthesized into codeine. The procedure is reversible in the knowledge of any chemist. --87.194.3.52 16:35, 12 August 2007 (UTC)

Is your response supposed to be a joke. BigSciZot asked when codeine was first produced from morphine and you're answer is that it was when codeine was first produced from morphine. Your answer is basically like saying that it happened when it happened. ~~ unsigned — Preceding unsigned comment added by 184.145.50.110 (talk) 03:48, 12 June 2013 (UTC)

Opiates and Opioids!!! Is this then like saying all Tigers are cats, but all cats aren't Tigers? As I also was led to believe that opioids were synthetic whereas opiates were all derived from the opium poppy (papaver somniferum)?

Astro86.140.123.103 (talk) 02:26, 20 June 2015 (UTC)

Greece, clarification needed

The entry on Greece seems contradictory [[3]]. It says you cannot have it even with a prescription and then, that you can have it with a prescription. Clarification is needed, for instance, it might be the case that you cannot have it under a foreign prescription but you can with a local one. Politis (talk) 14:29, 6 January 2016 (UTC)

Please fix this tiny mistake, someone

At the bottom of the page, there are two "Opioidergics" templates, one on top and one at the bottom (with the others in-between), so probably it was forgotten there by someone who edited it, I don't edit pages so often to do it smoothly and more of can't be bothered to, so just putting it out there - look at the bottom of the page and you'll see it there - twice. Thanks if anyone bothers. — Preceding unsigned comment added by 84.109.37.236 (talk) 23:22, 11 October 2014 (UTC)

Also this mistake. "Evidence does not support its use for cough suppression" Allanana79 (talk) 17:26, 16 March 2016 (UTC)

syrup

When used to relieve dry coughs, codeine is used in doses ranging from 5-15 mg and is usually mixed as a syrup with other drugs such as promethazine[9] which is an antihistamine/antipsychotic with strong sedative activity (some formulations come with different types of antihistamines),[10] guaifenesin which is an expectorant,[11] and other drugs.

In Belgium, seven syrups containing codeine are approved for sale in pharmacies, none of them contain any other active ingredient: BROMOPHAR (Qualiphar),BRONCHODINE (Pharmacobel),BRONCHOSEDAL CODEINE (Johnson & Johnson Consumer), BRONCHO-PECTORALIS CODEINE (Medgenix), GLOTTYL (Meda Pharma), TOULARYNX (Qualiphar),TOUX-SAN CODEINE (Nycomed) (source: official list)

So in which countries apart from the US are those mixtures sold, or even legal? Ssscienccce (talk) 23:17, 28 June 2012 (UTC)

In Denmark we have AFAIK only one cough syrup that contains codeine (only it's considered codeine in liquid form and is primarily sold as a painkiller, but it contains ethanol like most our efficient cough syrups do). Ref: [4] (article is in Danish, but from the most trustworthy medicinal website we have). It's however typically only prescribed for severe and painful cough, or to use the codeine's effect to suppress the cough (it works for some people I guess), and only rarely so. Typically efficient cough syrups here, both OTC and prescription, contain ephedrine instead for the pain relief. From personal experience, the codeine based cough syrup is inefficient while the ephedrine works almost instantly and has fewer side effects (whether or not that's relevant for the article I cannot say). --Metalbunny (talk) 00:10, 26 July 2016 (UTC)

Regarding references to codeine legality in Denmark

Noticed that the article says the reference is missing so went digging around, but the only openly available and valid reference articles about "Kodimagnyl" are all in Danish, with no English counterparts. The thing is that this is a purely Danish product, produced here and only sold here, and thus doesn't have available documentation in other languages. As such, editing to add the references is problematic, and I'm far from an expert on neither pharmacology or chemistry, so would rather leave it up to someone who is.

As to the actual drug, "Kodimagnyl" is the brand name, and it contains 150 mg acetalic (sp?) acid ASA, 9.6 mg codeine, and 150 mg magnesium oxide.

As for relevant references:

From the National Health Department's section for control with legal drugs: [5] (these are Word documents, in Danish - the pharmacological legal documentation for the products as I understand it).
From netdoktor.dk (most trustworthy medical site we have, as it's independent and run by doctors): [6] (the common-man's description of the drug).

This remains the only codeine based OTC product available in Denmark. As of a legal change a couple years ago, no painkiller (no matter what it is) may be sold in amounts greater than 20 pills without prescription (although I've seen pharmacists willingly greater amounts, but I'm unsure if that's legal or not). --Metalbunny (talk) 00:46, 26 July 2016 (UTC)

Emprazil mention - kind of a leadon to a #5 formulation

Emprazil has been banned in the United States since the 80's but was under scrutiny in the 60's. I don't need to cite a source for that as it's on Wikipedia already. By mentioning an Emprazil formulation with codeine with versions of 1-5, it leads one on to believe it is legal. Further mentioning of a #5 being 90mg codeine mislieads many to think there may be a Tylenol 5.

I just think it should be mentioned that Emprazil is banned in the United States and many western nations. In particular, Emprazil doesn't even exist! Only its generic which is rare.

Kyle — Preceding unsigned comment added by 2602:306:CCB9:9F20:95C5:115D:D914:A969 (talk) 00:42, 15 August 2016 (UTC)

Schedule of codeine as a controlled substance needs revision

Codeine formulations over 90mg and by itself is Schedule 2 in the U.S. but formulations such as APAP are schedule 3 and cough syrups like promethazine with codeine are schedule V. (Five.) I think listing it only as a schedule two can be misleading. Similarly, Schedule 1 in Canada, not all formulations.

While it may be accurate when mentioning pure codeine, most users are researching formulations (particularly APAP/codeine) and often just look for codeine. Yet it is wide knowledge that most codeine is in a mixture with other prominent meds. Just think it needs revision in several areas to better note that — Preceding unsigned comment added by 2602:306:CCB9:9F20:95C5:115D:D914:A969 (talk) 00:47, 15 August 2016 (UTC)

unsourced content from US availabability

Moved here per WP:PRESERVE

Bulk codeine falls into two categories, where codeine itself is used as an active ingredient portioned into medicines which can be Schedule II, III, IV, or V depending on composition and concentration, and where codeine is used as a precursor in making other drugs. Both categories of bulk codeine are Schedule II controlled substances, sharing an ACSCN of 9050. Bulk codeine for sale has an aggregate annual manufacturing quota for the US of 49 506.25 kilos as of 2013. Bulk codeine for conversion has a quota of 81 250 kilos. Both quotas are unchanged from the prior year.

The narcotic content number in the US names of codeine tablets and combination products (i.e., Tylenol With Codeine No. 3, Emprin With Codeine No. 4, the former Emprazil With Codeine No. 5 and pure codeine tablets) are as follows: No. 1 – 7½ or 8 mg (1/8 grain), No. 2 – 15 or 16 mg (1/4 grain), No. 3 – 30 or 32 mg (1/2 grain), No. 4 – 60 or 64 mg (1 grain), No. 5 – 90 or 96 mg (1 1/2 grains). The Canadian "Frosst 222"^[1] series is identical to the above list: "222" contains 8 mg codeine, "282" 15 mg, "292" 30 mg, and "293" 60 mg. This system, which is also used at present in the trade names of some dihydrocodeine and ethylmorphine products both in and outside of North America, was inaugurated with the Pure Food and Drug Act of 1906 and related legislation and refined since. For example, the dihydrocodeine/aspirin/caffeine capsule Synalgos DC and its generic equivalents and paracetamol analogues are labelled as No. 2 (16 mg) or No. 3 (32 mg) in most cases; the No. 1 and 4 products disappeared decades ago, as did plain Synalgos without narcotic content.

Equivalent scales for labeling stronger opioids such as diacetylmorphine (heroin), morphine, opium salts mixtures, and others were in common use in the past, and on occasion one can find past references to brand names for hydrocodone (invented 1920, introduced in US 1943), hydromorphone (invented 1924), oxycodone (invented 1916), paregoric and similar drugs containing narcotic content numbers. For example. from circa 1900 to 1925, the most common cough medicine was terpin hydrate With Heroin Elixir No. 2.

Contrary to the advertising matter of some pharmacies, 60 mg is No. 4, not No. 6, and tablets with 45 mg of codeine are not No. 4 and would in all likelihood be classified as No. 3½ under that system. Whether the scale goes to No. 6 (presumably 2 grains or 120 or 128 mg) and higher is moot at this point, as in the United States and Canada single-dose-unit concentrations of more than 64 mg are no longer manufactured. The United States Controlled Substances Act of 1970 does place dosage unit strengths of 90 mg of codeine and higher in Schedule II, even if mixed with another active ingredient.

Oral tablets, hypodermic tablets, liquid forms, and capsules of less common doses are available in some cases the equivalent dihydrocodeine, dionine, benzylmorphine, and opium dosages were previously available in North America (and in most cases still are in other countries, particularly the 45 mg paracetamol/codeine and 50 and 100 mg single-ingredient codeine tablets).

Preparations for cough or diarrhea containing small amounts of codeine in combination with two or more other active ingredients are Schedule V in the US, and in some states may be dispensed in amounts up to 4 fl. oz. per 48 hours (one or two states set the limit at 4 fl. oz. per 72 hours) without a prescription. Schedule V specifically consigns the product to state and local regulation beyond certain required record-keeping requirements (a dispensary log must be maintained for two years in a ledger from which pages cannot easily be removed and/or are pre-numbered, and the pharmacist must ask for photo identification) and also maintain controlled substances in the closed system at the root of the régime intended by the Controlled Substances Act of 1970; the codeine in these products was a Schedule II substance when the company making the Schedule V product acquired it for mixing up the end-product.

In locales where dilute codeine preparations are non-prescription, anywhere from very few to perhaps a moderate percentage of pharmacists will sell these preparations without a prescription. However, many states have their own laws that do require a prescription for Schedule V drugs. The December 2008 issue of The Bulletin of the National Codeine OTC Lobby (Vol. XVIII, No. 4) listed 12 states with some kind of OTC access to codeine, noting that small independent pharmacies are the most likely to have it. This situation is roughly equivalent to that in February 1991, when the aforementioned organisation undertook its first comprehensive study of Schedule V and overall codeine, dihydrocodeine, ethylmorphine, and hydrocodone availability.

Other drugs that are present in Schedule V narcotic preparations like the codeine syrups are ethylmorphine and dihydrocodeine. Paregoric and hydrocodone were transferred to Schedule III from Schedule V even if the preparation contains two or more other active ingredients, and diphenoxylate is usually covered by state prescription laws even though this relative of pethidine is a Schedule V substance when adulterated with atropine to prevent abuse.

References

^ Business and History – Merck Frosst Canada Inc. | Western Libraries

The sourced bit there is actually not supported by the source provided. -- Jytdog (talk) 19:49, 17 September 2016 (UTC)

Duplicate References

References 4 and 14 are identical references, so are 5 and 15. The duplicates should be removed and the reference points in the article need to be updated with the remaining reference numbers. 96.30.196.23 (talk) 16:41, 27 December 2016 (UTC)

Missing Antecedent

Under pharmacokinetics it reads: "Srinivasan, Wielbo and Tebbett speculate that codeine-6-glucuronide is responsible for a large percentage of the analgesia of codeine, and, thus, these patients should experience some analgesia." But there is no reference to patients anywhere in the preceding paragraph. Who are these patients? — Preceding unsigned comment added by 128.187.112.7 (talk) 15:06, 19 July 2017 (UTC)

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Non-existent reference

As far as I can tell, "The December 2008 issue of The Bulletin of the National Codeine OTC Lobby (Vol. XVIII, No. 4)" is a false reference - this organization does not seem to actually exist beyond Wikipedia and other websites that only seem to copy/paste what is in this paragraph regarding OTC access to Codeine. I've had a professional literature search done and come back with absolutely nothing.

That, alas, is true for quite a few "references" on medical a/or 'recreational' drugs... -a form or error propagation typical for the digital age. Also: "Evidence does not support its use for acute cough suppression in children or adults.[5][6] In Europe, it is not recommended as a cough medicine in those under 12 years of age.[3] Some tentative evidence shows it can reduce a chronic cough in adults.[16]" can only be regarded as spurious at best, resp. methodologically questionable. - As _anyone_ who has suffered from a severe cough and thus been administered codeine will readily confirm [or a short proficient unbiased search of med. db will support]. — Preceding unsigned comment added by 84.63.140.105 (talk) 21:07, 30 November 2019 (UTC)

Kodeiin

Kodeiin on hea ravim olin sõltuvuses sellest neelasin päevast päeva peo täite kaupa neid tablette . 2001:1530:1018:FB57:8400:AE90:C29C:7124 (talk) 06:32, 23 April 2022 (UTC)

Source for recommendation "in Europe"

The fifth sentence of the article is: "In Europe, it is not recommended as a cough medicine in those under 12 years of age.[4]" The source is the American Society of Health-System Pharmacists. While that source does warn against pediatric use, I cannot find anything about Europe in particular. Nothing in that source indicates that these are recommendations "in Europe". It refers to the FDA, but does not seem to refer to the EMA or any other European agency.

--77.250.163.202 (talk) 09:01, 10 August 2022 (UTC)

±?

What does including such mixtures as aspirin + paracetamol + codeine ± caffeine ± antihistamines and other agents mean? How can you have negative caffeine or antihistamines? If this is a medical notation, is there a less WP:JARGONy way to say this? --Ahecht (TALK
PAGE) 00:57, 25 October 2019 (UTC)

I think this is saying "mixtures that definitely contain aspirin, paracetamol and codeine - and may also contain caffeine and/or antihistamines".

That is, aspirin AND paracetamol AND codeine AND/OR caffeine AND/OR antihistamines. 213.105.99.162 (talk) 16:00, 18 July 2023 (UTC)

[1] Business and History – Merck Frosst Canada Inc. | Western Libraries

[1]