Analgesic effect and plasma concentrations of codeine and morphine after two dose levels of codeine following oral surgery

@article{Quiding2004AnalgesicEA,
  title={Analgesic effect and plasma concentrations of codeine and morphine after two dose levels of codeine following oral surgery},
  author={Hans Quiding and G Lundqvist and Lars O. Bor{\'e}us and U. G. Bondesson and John {\"O}hrvik},
  journal={European Journal of Clinical Pharmacology},
  year={2004},
  volume={44},
  pages={319-323}
}
SummaryA double blind randomised cross over investigation was carried out in 25 male patients undergoing two oral surgical extractions, one for each lower wisdom tooth. The two extractions were performed about 6 weeks apart and were carried out under local anaesthesia. One hour after each extraction the patients randomly received 90 or 45 mg codeine. During the following 5 h the patients rated the intensity of their pain on a visual analogue scale. Blood was simultaneously sampled and assayed… 

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Codeine analgesia is less reliable than morphine, but was not well correlated with either phenotype or plasma morphine in this study, suggesting reduced ability for codeine metabolism may be more common than previously reported.

Codeine and clinical impairment in samples in which morphine is not detected

Codeine appeared to have some dose-dependent effect on the central nervous system that may lead to impairment as judged from a CTD, independent of measurable blood morphine concentrations, which supports the view that some codeine effects do not seem to be mediated by morphine.

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It is argued, in this paper, that codeine phosphate is an unpredictable pro-drug that does not equate to a safe and effective method of providing analgesia post-craniotomy, and there is an explicit challenge to the neurosurgical community to re-evaluate their pain-management strategies.

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Pharmacokinetic drug interactions of morphine, codeine, and their derivatives: theory and clinical reality, Part II.

Understanding of this metabolism of codeine, dihydrocodeine, hydrocodone, oxycodone, and buprenorphine is important so that clinicians can choose the proper dosages for analgesia and anticipate potential drug-drug interactions.

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Post‐craniotomy analgesia: current practices in British neurosurgical centres ‐ a survey of post‐craniotomy analgesic practices

  • G. Roberts
  • Medicine
    European journal of anaesthesiology
  • 2005
It is proposed that patient controlled analgesia with morphine is an efficacious and safe alternative to codeine phosphate in post‐craniotomy analgesia.

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ANALGESIC ACTIVITY OF MORPHINE-6-GLUCURONIDE