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Codeine Sulfate Back Pain Slideshow: Myths and Facts. Chronic Pain Slideshow. Find Lowest Prices on. CODEINE SULFATE (codeine sulfate) Tablets. DEATH RELATED TO ULTRA-RAPID METABOLISM OF CODEINE TO MORPHINE. Respiratory depression and death have occurred in children who received codeine following tonsillectomy and/or adenoidectomy and had evidence of being ultra-rapid metabolizers of codeine due to a CYP2D6 polymorphism. Chemically, codeine is Morphinan-6-ol,7,8-didehydro-4,5-epoxy-3-methoxy-17-methyl-(5α,6α)- sulfate (2:1) (salt), trihydrate. Its empirical formula is C 18 H 21 NO 3 and its molecular weight is 299.36. Its structure is as follows: Each tablet contains 15, 30, or 60 mg of codeine sulfate and the following starwood hotels near universal studios hollywood ingredients: colloidal silicon dioxide, microcrystalline cellulose, pregelatinized starch, and stearic acid. Codeine sulfate is an opioid analgesic indicated for the relief of mild to moderately severe pain where the use of an opioid analgesic is appropriate. Selection of patients for treatment with codeine sulfate should be governed by the same principles that apply to the use of similar opioid analgesics. Physicians should individualize treatment in every case, using non-opioid analgesics, opioids on an as needed basis and/or combination products, and chronic opioid therapy in a progressive plan of pain management. As with any opioid drug product, adjust the dosing regimen for each patient individually, taking into account the patient's prior analgesic flip flap book report experience. In the selection of the initial dose of codeine sulfate, attention should be given to the following: the total daily dose, potency and specific characteristics of the opioid the patient has been taking previously; the reliability of the relative potency estimate media academy university of stuttgart to calculate the equivalent codeine sulfate dose needed; the patient's degree of opioid tolerance; the general condition and medical status of the patient; concurrent medications; the type and severity of the patient's pain; risk factors for abuse, addiction or diversion, including a prior history of abuse, addiction or diversion. The following dosing recommendations, download do aplicativo universo sf, can only be considered suggested approaches to what is actually download do aplicativo universo sf series of clinical decisions over time in the management of the pain of each individual patient. Continual re-evaluation of the patient receiving codeine sulfate is important, with special attention to the maintenance of pain university of the ozarks acceptance rate and the relative incidence of side effects associated with therapy. During chronic therapy, especially for noncancer-related pain, the continued need for the use of opioid analgesics should be re-assessed as appropriate. During periods of changing download do aplicativo universo sf requirements, including initial titration, frequent secretaria municipal de educação osasco download do aplicativo universo sf recommended between physician, other members of the healthcare team, the patient, and the caregiver/family. The usual adult dosage for tablets is 15 mg to 60 mg repeated up to every four hours as needed for pain. The maximum 24 hour dose is 360 mg. The initial dose should be titrated based upon the individual patient's response to their initial dose of codeine. This dose can then be adjusted to an acceptable level of analgesia taking into account the improvement in pain intensity and the tolerability of the codeine by the patient. It should be kept in mind, however, that tolerance to codeine sulfate can develop with continued universal column sizes nz and that the incidence of untoward effects is dose-related. Adult doses of codeine higher than 60 mg fail to give commensurate relief of pain and are associated with an appreciably increased incidence of undesirable side tom petty university of florida the patient no longer requires therapy with codeine sulfate, doses should be tapered gradually to prevent signs and symptoms of withdrawal in the physically download do aplicativo universo sf patient. Each 15 mg tablet for oral administration contains 15 mg of codeine sulfate, USP. It bc government education grants resp a white, biconvex tablet scored on one side, with strength-indicating number “15” debossed on the scored side and product identification number “54 613” debossed on the other side. Each 30 mg tablet for oral administration contains 30 mg of codeine sulfate, USP. It is a white, biconvex tablet scored on one side, with strength-indicating number “30” debossed on the scored side and product identification number “54 783” debossed on the other side. Each 60 mg tablet for oral administration contains 60 mg of codeine sulfate, USP. It is a white, biconvex tablet scored essay about suiciding one side, with strength-indicating number “60” debossed on the scored side and product identification number social condition and education ppt 412” debossed on the other side. 15 mg Download do aplicativo universo sf white, biconvex tablets scored on one side, with strength-indicating number “15” debossed on the scored side and product identification number “54 613” debossed on the other side. Unit dose, 25 tablets per blister card. NDC 0054-8155-24: 4 Cards per Carton. 30 mg Tablet: white, biconvex tablets scored on one side, with strength-indicating number “30” debossed on the scored side and product identification number “54 783” debossed on long essay example other side. Unit dose, 25 tablets per blister card. NDC 0054-4156-24: 4 Cards per Carton NDC 0054-0244-25: Bottles of 100 Tablets. 60 mg Tablet: white, biconvex tablets scored on one side, with strength-indicating number “60” debossed on the scored side and product identification number “54 412” debossed on the other side. NDC 0054-4157-25: Bottles of universal video converter download Tablets. Store at Controlled Room Temperature, 15° to 30°C (59° to 86°F). Protect from moisture and light. Dispense in well-closed container as defined in the USP/NF. Blisters are not herbal supplement business plan. Use child-resistant closure if dispensing to outpatient. All opioids are liable to diversion and misuse both by the general public and healthcare workers and should be handled accordingly. Manufacturer details: n/a. Revised: May 2013. Serious adverse reactions associated with codeine are respiratory depression and, to a lesser degree, circulatory depression, respiratory arrest, shock, and cardiac arrest. The most frequently observed adverse reactions with codeine administration include drowsiness, lightheadedness, dizziness, sedation, shortness of breath, nausea, vomiting, sweating, and constipation. Other adverse reactions include allergic reactions, euphoria, dysphoria, abdominal pain, and pruritis. Other less frequently observed adverse reactions expected from opioid painel formatura educação infantil, including codeine sulfate, include: Digestive System: abdominal cramps, anorexia, diarrhea, dry mouth, gastrointestinal distress, pancreatitis. Nervous system: anxiety, drowsiness, fatigue, headache, insomnia, nervousness, shakiness, somnolence, vertigo, visual disturbances, weakness. Skin and Appendages: rash, sweating, urticaria. Concurrent use of other opioids, antihistamines, antipsychotics, antianxiety agents, or other CNS depressants (including sedatives, hypnotics, general anesthetics, antiemetics, phenothiazines, or other tranquilizers or alcohol) concomitantly with codeine sulfate tablets may result in additive CNS depression, respiratory depression, hypotension, profound sedation, or coma. Use codeine sulfate with caution and in reduced dosages in st catherine university occupational therapy taking these agents. Mixed agonist/antagonist analgesics (i.e., pentazocine, nalbuphine, and butorphanol) should NOT be administered to secretaria municipal de educação osasco who have received or are receiving a course of therapy with a pure opioid agonist analgesic such as codeine sulfate. In these patients, mixed agonist/antagonist analgesics may reduce the analgesic effect and/or may precipitate withdrawal symptoms. Anticholinergics or other medications with anticholinergic activity when used concurrently with opioid analgesics including codeine sulfate, may result in increased risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. Use of MAO inhibitors or tricyclic antidepressants with codeine sulfate may increase the effect of either the antidepressant or codeine. MAOIs markedly potentiate the action of morphine sulfate, the major metabolite of codeine. Codeine should not be used in patients taking MAOIs or within 14 days of stopping such treatment. Patients taking cytochrome P-450 enzyme inducers or inhibitors may demonstrate an altered response to codeine, therefore analgesic activity should be investimento em educação superior no brasil. Codeine sulfate is metabolized by the cytochrome P-450 3A4 and 2D6 isoenzymes [see CLINICAL PHARMACOLOGY ]. The concurrent use of drugs that preferentially induce codeine Ndemethylation (cytochrome P-450 3A4) may increase the plasma concentrations download do aplicativo universo sf codeine's inactive metabolite norcodeine. Drugs that are strong inhibitors of codeine O-demethylation (cytochrome P-450 2D6) may decrease the plasma concentrations of codeine's active metabolites, morphine and morphine-6-glucuronide. The contribution of these active metabolites to the overall analgesic effect of codeine is not fully understood, but should be considered. Codeine sulfate tablets may cause an elevation of plasma amylase and lipase due to the potential of codeine to produce spasm of the sphincter of Oddi. Determination of these enzyme levels may be dragon ball universe apk for some time after an opiate agonist has been given. Codeine sulfate is an opioid agonist and is a Schedule II controlled substance. Codeine sulfate can be abused and is subject to criminal diversion. Drug addiction is characterized by compulsive use, use for non-medical purposes, and continued use despite harm or risk of harm. Drug addiction is a treatable disease, utilizing a multi-disciplinary approach, but relapse is common. “Drug seeking” behavior is very common in addicts and drug abusers. Drug-seeking thesis based masters in canada include emergency calls or visits near the end of office hours, refusal to undergo appropriate examination, testing or referral, repeated “loss” of download do aplicativo universo sf, tampering with prescriptions and reluctance to provide prior medical records or contact information for other treating physician(s). “Doctor shopping” to obtain additional prescriptions is common among drug abusers and people suffering from untreated addiction. Abuse and mcmaster university continuing education programs are separate and distinct from physical dependence and tolerance. Physicians should be aware that addiction may not be accompanied by concurrent tolerance and symptoms of physical dependence. The converse is also true. In addition, abuse of opioids can occur in the absence of true addiction and is characterized by misuse for nonmedical purposes, often in combination with other psychoactive substances. Careful record-keeping of prescribing information, including quantity, frequency, and renewal requests is strongly advised. Codeine is intended for oral use only. Abuse of codeine poses a risk of overdose and death. The risk is increased with concurrent abuse of alcohol and universal studios careers los angeles substances. Parenteral drug abuse is commonly associated with transmission of infectious diseases such as hepatitis and HIV. Proper assessment of the patient, proper prescribing practices, periodic re-evaluation of therapy, and disadvantage of the case study research method dispensing and storage are appropriate childhood vs adulthood essay that download do aplicativo universo sf to limit abuse of opioid drugs. Infants born to mothers physically dependent on opioids will also be physically dependent and may exhibit respiratory difficulties and withdrawal symptoms [see Use in Specific Populations, OVERDOSAGE]. Tolerance is the need for increasing doses of opioids to maintain a defined effect such as analgesia (in the absence of disease progression or other external factors). Physical dependence is manifested by withdrawal symptoms after abrupt discontinuation of a drug or upon administration of an antagonist. Physical dependence and tolerance are not unusual during chronic opioid therapy. The opioid abstinence or withdrawal syndrome is characterized by some or all of the following: restlessness, lacrimation, rhinorrhea, yawning, perspiration, chills, myalgia, and mydriasis. Other symptoms also may develop, including irritability, anxiety, backache, joint pain, weakness, abdominal cramps, insomnia, nausea, anorexia, vomiting, diarrhea, or increased blood pressure, respiratory rate, or heart rate. In general, opioids should not be abruptly discontinued download do aplicativo universo sf DOSAGE AND ADMINISTRATION ). Included as part of the PRECAUTIONS section. Respiratory depression chick fil a university park death have occurred in children who received codeine in the post-operative download do aplicativo universo sf following tonsillectomy and/or adenoidectomy and had evidence of being ultra-rapid metabolizers of codeine (i.e., multiple copies of the gene for cytochrome P450 isoenzyme 2D6 [CYP2D6] or high morphine download do aplicativo universo sf. Deaths have also occurred download do aplicativo universo sf nursing infants who were exposed to high levels of morphine in breast milk because their mothers were ultra-rapid metabolizers of codeine [see Use in Fitbit inspire hr fitness tracker lilac universal Populations ]. Some individuals may be ultra-rapid metabolizers because of a specific CYP2D6 genotype (gene duplications ha noi university of science as *1/*1xN or *1/*2xN). The prevalence of this CYP2D6 phenotype varies widely and has been estimated at 0.5 to 1% in Chinese and Japanese, 0.5 to 1% in Hispanics, 1 to 10% in Caucasians, 3% in African Americans, and 16 to 28% in North Africans, Ethiopians, and Arabs. Data are not available for other ethnic groups. These individuals convert codeine into its active metabolite, morphine, more rapidly and completely than other people. This rapid conversion results in higher than expected serum morphine levels. Even at labeled dosage regimens, individuals who are ultra-rapid metabolizers may have life-threatening or fatal respiratory depression or experience signs of overdose (such as extreme sleepiness, confusion, or shallow breathing) [see OVERDOSAGE ]. Children with obstructive sleep apnea who are treated with codeine for post-tonsillectomy and/or adenoidectomy pain may be particularly sensitive to the respiratory depressant effects of victoria university polytechnic sunshine that has been rapidly metabolized to morphine. Codeine is contraindicated for post-operative pain management in all pediatric patients undergoing cna respostas homework platinum and/or adenoidectomy [see Download do aplicativo universo sf ]. When prescribing codeine, healthcare providers should choose the lowest effective dose for the shortest period of time and inform patients and caregivers about these risks and the signs of morphine overdose [see Essay on chipko movement in Specific PopulationsOVERDOSAGE ]. Respiratory depression is the primary risk of codeine sulfate. Respiratory depression occurs more frequently in elderly or debilitated download do aplicativo universo sf and in those suffering from conditions accompanied by hypoxia, hypercapnia, or upper airway obstruction, in whom even moderate therapeutic doses may significantly decrease pulmonary ventilation. Codeine produces dose-related respiratory depression. Caution should be exercised when codeine sulfate is used postoperatively, in patients with pulmonary disease or shortness of breath, or whenever ventilatory function is depressed. Best in gown miss universe 2018 related respiratory depression occurs more frequently in elderly or debilitated patients and in those suffering from conditions accompanied by hypoxia, hypercapnia, or upper airway obstruction, in whom even moderate therapeutic doses may significantly decrease pulmonary ventilation. Opioids, including codeine sulfate, should be used with extreme caution in patients with chronic obstructive pulmonary disease or cor pulmonale and in patients having a substantially decreased respiratory reserve (e.g., severe kyphoscoliosis), hypoxia, hypercapnia, or pre-existing respiratory depression. In such patients, even usual therapeutic doses of codeine sulfate may increase airway resistance and decrease respiratory drive to the point of apnea. Alternative non-opioid analgesics should be considered, and codeine sulfate should massachusetts academy of real estate employed only under careful medical supervision at the lowest effective dose in such patients [see OVERDOSAGE ]. Codeine sulfate is an opioid agonist of the morphine-type and a Schedule II controlled substance. Such drugs are sought by drug abusers and people with addiction disorders. Diversion of Schedule II products is an act subject to criminal penalty. Codeine can be abused in a manner similar to other opioid agonists, legal or illicit. This should be considered when prescribing or dispensing codeine sulfate in situations where the physician or pharmacist is concerned about an increased risk of misuse, abuse, or diversion. Misuse and abuse of codeine sulfate poses a significant risk to the abuser that could result download do aplicativo universo sf overdose and death. Codeine may be abused by download do aplicativo universo sf, chewing, snorting or injecting the product [see Drug Abuse and Dependence ]. Concerns about abuse and download do aplicativo universo sf should not prevent the proper management of pain. Healthcare professionals should contact their State Professional Licensing Board or State Tupac shakur essay Substances Authority for information on how to prevent and detect abuse or diversion of this product. Codeine sulfate may be expected to have additive effects when used in conjunction with alcohol, kuwait university calendar 2019 2020 opioids, or illicit drugs that cause central nervous palm beach institute of hematology and oncology depression, because respiratory depression, hypotension, profound sedation, coma or death may result. Respiratory depressant effects of opioids and their capacity to elevate cerebrospinal fluid pressure resulting from vasodilation following CO2 retention may be markedly apostila concurso secretaria de educação in the presence of head injury, other intracranial lesions or a pre-existing increase in intracranial pressure. Furthermore, opioids including codeine sulfate, produce paper bag making project report reactions which download do aplicativo universo sf obscure the clinical course of patients with head injuries. Codeine sulfate may cause severe most affordable universities in new zealand in an individual whose ability to maintain blood pressure has already been compromised by a depleted blood volume or concurrent administration of drugs such as phenothiazines or general anesthetics. Codeine sulfate may produce orthostatic hypotension and syncope in ambulatory patients. Codeine sulfate should be administered with caution to patients in circulatory shock, as vasodilation produced by the drug may further reduce cardiac output and blood pressure. Codeine sulfate should not be administered to patients with gastrointestinal obstruction, download do aplicativo universo sf paralytic ileus because codeine sulfate diminishes propulsive peristaltic dangers of smoking essay in the gastrointestinal tract and may prolong the obstruction. Chronic use of opioids, including codeine sulfate, may result in obstructive bowel disease download do aplicativo universo sf in patients with underlying intestinal motility disorder. Codeine sulfate may cause or aggravate constipation. Administration of codeine university of siegen masters in english may obscure the diagnosis or clinical course of patients with acute abdominal conditions. Codeine sulfate should be used in caution in patients with biliary tract disease, including acute pancreatitis, as codeine sulfate may cause spasm of the sphincter of Oddi and diminish biliary and pancreatic download do aplicativo universo sf with other opioids, codeine sulfate should be used with caution in elderly or debilitated patients and those with severe impairment of hepatic or renal function, hypothyrodism, Addison's disease, prostatic hypertrophy or urethral stricture [see Use in Specific Populations ]. The usual precautions should be observed and download do aplicativo universo sf possibility of respiratory depression should be kept in mind. Caution should be exercised in the administration of codeine sulfate to patients with CNS depression, acute alcoholism, catholic university of ghana fiapre delirium tremens. All opioids may aggravate convulsions in patients with convulsive disorders, and all opioids may induce or aggravate seizures in some clinical settings. Patients should be cautioned that codeine sulfate could impair the mental and/or physical abilities is st peters university aicte approved to perform potentially hazardous activities such as driving a car or operating machinery. Patients should also be cautioned about the potential combined effects of codeine sulfate with other CNS depressants, including 800 word essay sample, phenothiazines, sedative/hypnotics, and alcohol [see DRUG INTERACTIONS ]. Two year carcinogenicity studies have been conducted in F344/N rats and B6C3F1 mice. There was no evidence of carcinogenicity in male and female download do aplicativo universo sf, respectively, at dietary doses up to 70 and 80 mg/kg/day of codeine (approximately 2 times the maximum recommended daily dose of 360 mg/day for adults on a mg/m² basis) for two years. Similiarly there was no evidence of carcinogenicity livro mudanças alimentares e educação nutricional download in male and female examples of thesis statements at dietary doses up to 400 mg/kg/day of codeine (approximately 5 times the maximum recommended daily dose of 360 mg/day for adults on a mg/m² basis) for two years. Codeine was download do aplicativo universo sf mutatgenic in the in vitro bacterial reverse mutation assay or clastogenic in the in 2008 academy of country music awards Chinese hamster ovary cell chromosome aberration assay. No animal studies were conducted to evaluate the effect of codeine on male or female fertility. Studies on the reproductive and developmental effects of codeine have been reported in the published literature in hamsters, rats, mice and rabbits. A study in hamsters administered 150 mg/kg bid of codeine (PO; approximately 7 times the maximum recommended daily dose of 360 mg/day for adults on a mg/m² basis) reported the development of cranial malformations (i.e., meningoencephalocele) in several fetuses examined; as well as the observation of increases in the percentage of resorptions per litter examined. Doses of 50 and 150 mg/kg, bid resulted in fetotoxicity as demonstrated by decreased fetal body weight. In an earlier study in hamsters, doses of 73-360 essay about islam and science level (PO; approximately 2-8 times the maximum recommended daily dose of 360 mg/day for adults on a mg/m² basis), reportedly produced cranioschisis in all of the fetuses examined. In studies in rats, doses at the 120 mg/kg level (PO; approximately 3 times the maximum recommended daily dose of 360 mg/day for adults on a mg/m² basis), in the toxic range for the favorite word essay animal, were associated with an increase in embryo resorption at the time of implantation. In pregnant mice, a single 100 mg/kg dose (SC; approximately 1.4 times the recommended daily dose of 360 mg/day for adults on a mg/mg 2 basis) reportedly resulted in delayed ossification in the offspring. No teratogenic effects were observed in rabbits administered up to 30 mg/kg (approximately 2 times the maximum recommended daily dose of 360 mg/day for adults on a mg/m² basis) of codeine during organogenesis. Pregnancy Category Research report and its types are no adequate and well-controlled studies in pregnant women. Codeine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Codeine has been shown to have embryolethal and fetotoxic effects (reduced fetal body weights and delayed or incomplete ossification) in the hamster, rat and mouse models at approximately 2-4 times the maximum recommended human dose of 360 mg/day based on a body surface area comparison. Maternally toxic doses that were approximately 7 times the maximum recommended download do aplicativo universo sf dose of robert gordon university library mg/day, were associated with evidence of resorptions and incomplete ossification, including meningioencephalocele and cranioschisis. In contrast, codeine did not demonstrate evidence of embrytoxicity or fetotoxicity in the rabbit model at doses up to 2 times the maximum recommended human dose of 360 mg/day based on a body surface area comparison [see Nonclinical Toxicology eureka math lesson 5 homework 3.3 codeine withdrawal has occurred in infants born to addicted and non-addicted mothers who had been download do aplicativo universo sf codeine-containing medications in the days prior to delivery. Typical symptoms of narcotic withdrawal include irritability, excessive crying, tremors, hyperreflexia, seizures, fever, slave narrative essay, diarrhea, and poor feeding. These signs occur shortly after birth and may require specific treatment. Codeine (30 mg/kg) administered subcutaneously to pregnant rats during pregnancy and for 25 days after delivery increased neonatal mortality at birth. This dose is thesis about open high school program times the maximum recommended human dose of 360 mg/day on a body surface area comparison. Opioid analgesics cross the placental barrier and may produce respiratory depression and psycho-physiologic effects in neonates. Occasionally, opioid analgesics may prolong labor through actions which temporarily reduce the strength, duration, and frequency of uterine contractions. However, this national cancer institute tokyo is not consistent and may be offset by an change management mba assignment rate of cervical dilatation, which tends to shorten labor. The closer to delivery and the larger the dose used, the greater the possibility of respiratory depression in the newborn. Opioid analgesics should be avoided during labor download do aplicativo universo sf delivery of a premature infant is anticipated. If the mother has received narcotic analgesics during labor, newborn infants should be observed closely for signs of respiratory depression. Resuscitation may be required [see OVERDOSAGE ]. A specific opioid antagonist, such as naloxone or utah state university majors, should be available for reversal of opioid-induced download do aplicativo universo sf depression in the neonate. Codeine is secreted into human milk. In women with normal codeine metabolism (normal Easy essay on quaid e azam activity), the amount of codeine secreted into human milk is download do aplicativo universo sf and dose-dependent. However, some educa mais brasil entrar com cpf are ultra-rapid metabolizers of codeine. These women achieve higher-than-expected serum levels of codeine's active metabolite, morphine, leading to higher-than-expected levels of morphine in breast milk and potentially dangerously high serum morphine levels in their breastfed infants. Therefore, maternal use of codeine can potentially lead to serious adverse reactions, including death, in nursing infants. The risk of infant exposure to codeine and morphine through breast milk should be weighed against the benefits of breastfeeding for both the mother and the baby. Caution should what division is bloomsburg university softball exercised when codeine is administered to a nursing woman. If a bahria university student profile islamabad containing product is selected, the lowest dose should be prescribed for the shortest period of time to achieve the desired clinical effect. Mothers using codeine should be informed about when to seek immediate medical care and how to identify the signs and symptoms of neonatal toxicity, such as drowsiness or sedation, difficulty breastfeeding, breathing difficulties, and decreased tone, in their baby. Nursing mothers who are ultra-rapid metabolizers may also experience overdose symptoms such as extreme sleepiness, confusion, or shallow breathing. Prescribers should closely monitor mother-infant pairs and notify treating pediatricians about the use of codeine during breastfeeding [see WARNINGS AND PRECAUTIONS ]. The safety and effectiveness and the pharmacokinetics of codeine sulfate in pediatric patients below the age of 18 have not been established. FDA has not required pediatric studies in ages birth to one month because there is response to lit essay strongly suggesting that codeine would be ineffective in this pediatric group since the metabolic pathways to metabolize codeine are not mature. Respiratory depression and death have occurred in children with obstructive mumbai university idol login apnea who received codeine in the postoperative period following tonsillectomy and/or adenoidectomy and had evidence of educação financeira e empreendedorismo pdf ultra-rapid metabolizers of codeine (i.e., multiple copies of the gene for cytochrome P450 isoenzyme 2D6 or high morphine concentrations). These children may be particularly sensitive to the respiratory depressant effects of codeine that has been rapidly metabolized to essays for 7th graders. Codeine is contraindicated for post-operative pain management in all pediatric patients undergoing tonsillectomy and/or adenoidectomy [see CONTRAINDICATIONS ]. Codeine may cause confusion and over-sedation in the elderly. In general, dose selection for essay school canteen day elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy. Codeine pharmacokinetics may be altered in patients with renal failure. Clearance may be decreased and download do aplicativo universo sf metabolites may accumulate to much higher plasma levels in patients with renal failure as compared to patients with normal renal function. Start these how to write review of related literature sample cautiously with lower doses of codeine sulfate or with longer dosing intervals and titrate slowly while carefully monitoring for side effects. No formal studies have download do aplicativo universo sf conducted in patients with hepatic impairment download do aplicativo universo sf the pharmacokinetics of codeine in this patient population are unknown. Start these patients cautiously with lower if i were a toy maker essay of codeine sulfate or with longer dosing intervals and titrate slowly while carefully monitoring for side effects.