Dafalgan codeine®, a common prescription drug based on codeine, is used in moderate pain insufficiently relieved by paracetamol or ibuprofen. Its use has been the cause of drifts such as abuse, due to its increased risk of addiction.
What is codeined Dafalgan?
Codeine® Dafalgan is a analgesic medicine that aims to relieve moderate pain. It contains paracetamol dosed at 500 mg and codeine dosed at 30 mg. Paracetamol is an analgesic and an antipyretic (against fever), while codeine is a central analgesic. Its analgesic effect is due to its conversion into morphine. The combination of paracetamol and codeine has a analgesic activity greater than that of these same substances taken alone, with a more prolonged effect over time. Dafalgan codeine® comes in boxes of 16 tablets to swallow or 16 tablets sparkling.
Indications: when to take codeine Dafalgan?
Codeine® Dafalgan is indicated for adults and children over 12 years old in case of acute pain of moderate intensity which is not sufficiently relieved by other analgesics such as paracetamol alone or ibuprofen. Neuropathic pain does not respond to the effects of Dafalgan codeine®, so this drug is not indicated for this type of pain.
Is it available by prescription or over the counter?
Dafalgan codeine® is a drug on list I of poisonous substances which means thata prescription is needed to get it.
After how long do the effects come?
The absorption of codeine® Dafalgan in the body is fast and the maximum concentration of paracetamol and codeine is reached in about 60 minutes after taking. Its effects on pain are therefore rapid. However, they do not last over time since the drug begins to gradually disappear after about 2 hours, to be almost completely eliminated after 24 hours.
What are the dangers and side effects?
Overdose-related toxicity may occur in hepatic impairment (limit paracetamol to a maximum of 3g per day), kidney failure (by accumulation of codeine and paracetamol in the kidneys: adjust the dosage to 8 hours between doses, reduce the dose as much as possible and ensure monitoring during treatment), in the elderly (establish a half dose in initial treatment then increase the dosage if necessary according to tolerance), in the event of malnutrition, alcoholism, dehydration or in adults weighing less than 50 kg (adjust the maximum dose of paracetamol to 60mg/kg/d and maximum 3g per day). Paracetamol can cause severe skin reactions (acute generalized exanthematous pustulosis, Stevens-Johnson syndrome, toxic epidermal necrolysis) which can be fatal. The appearance of a rash or any other sign of hypersensitivity requires discontinuation of treatment. The effects of codeine on the central nervous system may cause sedation or severe respiratory depression which can be fatal. Prolonged use of codeine increases the risk of headache by drug abuse. Also, the constipation(often refractory to laxative treatment), is an adverse effect of codeine and requires monitoring of intestinal transit during treatment. Codeine can also cause nausea and vomiting, itching, decreased hormone levels, muscle rigidity or even urinary retention. A risk of tolerance exists with Dafalgan codeiné® which results in a decrease in efficacy on pain in the event of prolonged use. This may lead to a corresponding increase in the dosage of the treatment, which will only increase the problem of tolerance. Finally, codeine Dafalgan® can cause addiction and lead to abuse or misuse, linked to the presence of codeine whose prolonged use leads to psychological and physical dependence. This is why its use must be done with great caution in people with a history of addiction and / or abuse (alcohol, drugs) or mental disorders (major depression for example). Abuse or dependence can lead to overdose or even death.
For whom is codeine Dafalgan contraindicated?
Codeine Dafalgan, due to the presence of codeine, is contraindicated in children under 12 because codeine can be transformed into morphine once absorbed in the organism, this quantity of morphine thus produced being variable. It may cause opioid toxicity. This medicine is also contraindicated in case of hypersensitivity to any of the components of the medicinal product, in case severe hepatic impairment or in patients asthmatics or suffering from respiratory failure, even slightly. Codeine® Dafalgan should not be taken during breastfeeding or after tonsil removal or adenoids in the context of sleep apnea in minors because of the potentially serious effects that codeine could cause (up to death). Codeine® Dafalgan is contraindicated in persons known to be ultra-rapid metabolizers of cytochrome P2D6. Dafalgan codeine® should not be taken concomitantly with other medicines containing codeine or paracetamol, if this leads to exceeding the maximum doses, namely 240 mg/day of codeine and 4 g/day of paracetamol (in adults without risk factors). Codeine should be used with caution in people with epilepsy because of its ability to reduce the seizure threshold, as well as in people with a history of alcohol or drug dependence or suffering from mental disorders (risk of misuse and overdose). Finally, codeine® Dafalgan should be used with caution. in case of alcohol intake, intracranial hypertension, productive cough, low weight, anorexia or bulimia, chronic malnutrition, dehydration, liver failure, Gilbert’s syndrome and G6PD deficiency. Vigilance is required in the elderly who are more at risk of overdose, adverse effects (respiratory depression, constipation) and drug interactions. Effervescent tablets are contraindicated in case fructose intolerance, glucose-galactose malabsorption syndrome or sucrase/isomaltase deficiency (rare hereditary diseases) due to the presence of sucrose and glucose, in case of hereditary fructose intolerance due to the presence of sorbitol (E420) and in case of phenylketonuria due to the presence of aspartame.
What are the risks of an overdose?
The risks of an overdose are a severe poisoning occur more frequently in the elderly, in young children, in case of liver damage, in case of chronic alcoholism, in case of chronic malnutrition and in case of consumption of enzyme-inducing drugs. Poisoning can sometimes be fatal, including paracetamol overdose. Signs may be: acute depression of the respiratory centers (cyanosis, slowed breathing), drowsiness, rash, vomiting, pruritus, difficulty speaking, pulmonary oedema, slowed breathing rate, pauses in breathing , miosis, seizures, facial puffiness, urinary retention, anorexia, pallor, malaise, sweating or abdominal pain.
With which drugs should codeine Dafalgan not be taken?
It is advisable not to combine several medicines containing paracetamol and/or codeineand to ensure in all cases that the maximum daily doses are not exceeded, namely maximum 240 mg of codeine per day and maximum 4g of paracetamol per day. Codeine® Dafalgan is contraindicated with sodium oxybate (risk of respiratory depression which can be fatal). If its use is required, monitoring and dose adjustment may be necessary when taking other medications. This is the case of vitamin K antagonists (hemorrhagic risk), flucloxalline (risk of metabolic acidosis), drugs that contain alcohol or have sedative effects (altered alertness by adding the sedative effects of codeine), bupropion, cinacalcet, duloxetine, terbinafine, fluoxetine, paroxetine, and quinidine (risk of ineffectiveness or reduced effectiveness of codeine), morphine (decreased analgesic effect), opioid cough suppressants, methadone, barbiturates and benzodiazepines and related drugs (risk of respiratory depression which may be fatal) and atropine drugs (risk of colonic akinesia and severe constipation).