Codeine is an opioid drug indicated for mild-to-moderate pain. It functions as a selective μ-opioid receptor agonist and provides milder analgesia and fewer euphoric effects than morphine and several of the synthetic opioids (e.g., fentanyl). Patients in whom non-opioid pain control (e.g., NSAIDS, acetaminophen, combination medications) has failed should be considered for weak opioids like codeine or tramadol before escalation to strong opioids like hydrocodone or morphine.
Codeine is sometimes prescribed off-label for cough (it is FDA-approved for this use only in combination with chlorpheniramine/guaifenesin/etc) and for acute diarrhea unresponsive to other anti-motility agents. The drug is contraindicated in fast CYP2D6 metabolizers due to accelerated conversion to morphine and increased risk of respiratory depression and death. Codeine carries a significant risk of abuse and dependency.
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