paracetamol and codeine phosphate

CLINICAL USE

Analgesic

DOSE IN NORMAL RENAL FUNCTION

1–2 tablets up to 4 times a day

PHARMACOKINETICS

Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Paracetamol: 151.2; codeine: 317.4 (codeine phosphate 406.4)

%Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Paracetamol: 20–30; codeine: 7

%Excreted unchanged in urine &nbsp &nbsp : Paracetamol: <5; codeine: 0

Volume of distribution (L/kg) &nbsp &nbsp &nbsp :Paracetamol: 1–1.2; codeine: 3–4

half-life – normal/ESRD (hrs)&nbsp &nbsp &nbsp :Paracetamol: 1–4/Unchanged; codeine: 2.5–4/13

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 &nbsp &nbsp : Dose as in normal renal function

10 to 20 &nbsp &nbsp : Dose as in normal renal function

<10 &nbsp &nbsp &nbsp &nbsp &nbsp : Dose as in normal renal function

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp:Unlikely to be dialysed. Dose as in normal renal function

HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Not dialysed. Dose as in normal renal function

HDF/high flux &nbsp :Unknown dialysability. Dose as in normal renal function

CAV/VVHD &nbsp &nbsp &nbsp:Not dialysed. Dose as in normal renal function

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugsNone known

ADMINISTRATION

Reconstition

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Route

Oral

Rate of Administration

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Comments

Available in 2 strengths: (1) 8/500; 8 mg codeine phosphate/500 mg paracetamol, (2) 30/500; 30 mg codeine phosphate/500 mg paracetamol30/500 formulation: may cause drowsiness, due to increased cerebral sensitivity in patients with renal failure

OTHER INFORMATION

Effervescent formulations of Solpadol and Tylex (30/500) should be avoided in renal impairment. They contain 16.9 mmol and 13.6 mmol sodium per tablet respectivelyIn renal impairment, opioid analgesics may produce a prolonged effect with increased cerebral sensitivityIncreased risk of constipation in ERF especially with 30/500 preparation

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