It is essential to caution the patients in this regard and to institute an appropriate regimen of bowel management at the start of prolonged opioid therapy. Stimulant laxatives, stool softeners and other appropriate measures should be used as required. Less Frequently Observed with Opioid Analgesics: Dysphoria, euphoria, weakness, headache, agitation, tremor, uncoordinated muscle movements, alterations of mood nervousness, apprehension, depression, floating feelings, dreams , muscle rigidity, paresthesia, muscle tremor, blurred vision, nystagmus, diplopia and miosis, transient hallucinations and disorientation, visual disturbances, insomnia and increased intracranial pressure may occur.

Physical dependence with or without psychological dependence tends to occur on chronic administration of opioids. An abstinence syndrome may be precipitated when opioid administration is discontinued or opioid antagonists administered.

The following withdrawal symptoms may be observed after opioids are discontinued: In patients who are appropriately treated with opioid analgesics and who undergo gradual withdrawal from the drug, these symptoms are usually mild. Symptoms And Treatment Of Overdose: In severe overdosage, apnea, circulatory collapse, cardiac arrest and death may occur. Primary attention should be given to the establishment of adequate respiratory exchange through the provision of a patent airway and controlled or assisted ventilation.

The opioid antagonist naloxone HCl is a specific antidote against respiratory depression due to overdosage or as a result of unusual sensitivity to opioids. An appropriate dose of the antagonist should therefore be administered, preferably by the i. The usual initial i. Concomitant efforts at respiratory resuscitation should be carried out. Since the duration of action of opioids, particularly sustained release formulations, may exceed that of the antagonist, the patient should be under continued surveillance and doses of the antagonist should be repeated as needed to maintain adequate respiration.

An antagonist should not be administered in the absence of clinically significant respiratory or cardiovascular depression. In individuals physically dependent on opioids, the administration of the usual dose of opioid antagonist will precipitate an acute withdrawal syndrome. The severity of this syndrome will depend on the degree of physical dependence and the dose of antagonist administered.

The use of opioid antagonists in such individuals should be avoided if possible. Evacuation of gastric contents may be useful in removing unabsorbed drug, particularly when a sustained release formulation has been taken. Doses of Codeine Contin are expressed as codeine base. Having determined the total daily dosage of the present analgesic, Table II can be used to calculate the approximate daily oral codeine phosphate dosage that should provide equivalent analgesia. Codeine Contin tablets should not be chewed or crushed but may be halved.

Dose titration is the key to success with opioid analgesic therapy. Add mg of powder to a mL beaker. Mix for 10 minutes while adding Ora-Sweet to make mL; transfer to a calibrated bottle.

Stable 98 days at room temperature. Administer with an accurate measuring device calibrated oral syringe or measuring cup ; do not use a household teaspoon or tablespoon to measure dose overdosage may occur. Tablets should be swallowed whole; do not chew, dissolve, or crush.

All strengths may be halved, except the 50 mg tablets; half tablets should also be swallowed intact. May be administered by IM or SubQ injection. Storage Immediate release tablet, oral solution: Protect from moisture and light.

Controlled release tablet [Canadian product]: Do not use if more than slightly discolored or contains a precipitate. Drug Interactions Abiraterone Acetate: Avoid concurrent use of abiraterone with CYP2D6 substrates that have a narrow therapeutic index whenever possible.

Consider therapy modification Ajmaline: This is most notable for patients receiving long-term i. Alvimopan is contraindicated in patients receiving therapeutic doses of opioids for more than 7 consecutive days immediately prior to alvimopan initiation.

Consider therapy modification Amphetamines: May enhance the analgesic effect of Opioid Analgesics. Monitor therapy Anticholinergic Agents: Specifically, the risk for constipation and urinary retention may be increased with this combination. Consider therapy modification Azelastine Nasal: Consider therapy modification Brimonidine Topical: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used.

Consider therapy modification Chlorphenesin Carbamate: Monitor therapy CNS Depressants: Avoid concomitant use of opioid analgesics and benzodiazepines or other CNS depressants when possible.

These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Consider therapy modification Cobicistat: May diminish the therapeutic effect of Codeine. These CYP2D6 inhibitors may prevent the metabolic conversion of codeine to its active metabolite morphine. May decrease serum concentrations of the active metabolite s of Codeine. May increase serum concentrations of the active metabolite s of Codeine.

Monitor therapy Dimethindene Topical: Opioid Analgesics may diminish the therapeutic effect of Diuretics. Consider dose reductions of droperidol or of other CNS agents e. Consider therapy modification Eluxadoline: Opioid Analgesics may enhance the constipating effect of Eluxadoline.

Consider therapy modification Gastrointestinal Agents Prokinetic: Opioid Analgesics may diminish the therapeutic effect of Gastrointestinal Agents Prokinetic.

Avoid concomitant use of hydrocodone and benzodiazepines or other CNS depressants when possible. Consider therapy modification Imatinib: Monitor therapy Kava Kava: Monitor therapy Magnesium Sulfate: Further CNS depressant dosage adjustments should be initiated only after clinically effective methotrimeprazine dose is established.

Monitor therapy Monoamine Oxidase Inhibitors: May diminish the therapeutic effect of Opioid Analgesics. Avoid the concomitant use of nalmefene and opioid analgesics. Discontinue nalmefene 1 week prior to any anticipated use of opioid analgesics. If combined, larger doses of opioid analgesics will likely be required. Consider therapy modification Naltrexone: Seek therapeutic alternatives to opioids.

See full drug interaction monograph for detailed recommendations. Consider therapy modification Opioid Analgesics: May diminish the analgesic effect of Opioid Analgesics. Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible.

Consider therapy modification Panobinostat: Avoid concurrent use of sensitive CYP2D6 substrates when possible, particularly those substrates with a narrow therapeutic index. Consider therapy modification Paraldehyde: Avoid combination Peginterferon Alfa-2b: Opioid Analgesics may diminish the therapeutic effect of Pegvisomant.

Patients taking perampanel with any other drug that has CNS depressant activities should avoid complex and high-risk activities, particularly those such as driving that require alertness and coordination, until they have experience using the combination. The doctor will convert the dose of short-acting analgesics to an equivalent dose of codeine controlled release.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

Codeine controlled release tablets should be taken every 12 hours in order to maintain pain relief. To preserve the long-acting activity of the medication, the tablets should be swallowed whole and should not be chewed or crushed. Half tablets should also be swallowed intact. Over time, this medication may produce tolerance and physical dependence as your body becomes used to the drug. Tolerance occurs when a dose that used to provide acceptable pain relief is no longer effective, and higher doses are required to achieve the same level of pain relief.

Physical dependence is a state where the body will go into withdrawal if the medication is stopped suddenly. If you have been taking codeine on a regular basis for a long period of time, talk to your doctor before stopping the drug, as withdrawal effects can occur. Follow the instructions on the label. Do not use more of this product, or more often, than prescribed. This medication should be swallowed whole. It should not be split, crushed or chewed. It is not advisable to stop using this product suddenly, particularly if you have been on it for several weeks.

If you are considering stopping the medication, talk to your doctor or pharmacist first. This medication may be taken with or without food. Consuming alcohol may intensify the effect of this product.

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