Codeine is an opiate used to treat pain, as a cough medicine, and for diarrhea. Usually used to treat mild to moderate pain. Larger benefits can occur when combined with paracetamol (acetaminophen) or nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen. The evidence does not support its use for acute cough suppression in children or adults. In Europe it is not recommended as a cough medicine for those under the age of twelve. It's generally drunk. It usually starts working after half an hour with maximum effect on two hours. Total duration of effect lasts for about four to six hours.
Common side effects include vomiting, constipation, itching, head feeling light, and drowsiness. Serious side effects may include difficulty breathing and addiction. It is unclear whether its use in pregnancy is safe. Treatment should be used during breastfeeding because it can cause opiate poisoning in infants. Its use in 2016 is not recommended in children. Kodein works after being broken down by the liver into morphine. How quickly this happens depends on one's genetics.
Kodein was discovered in 1832 by Pierre Jean Robiquet. In 2013 about 361,000 kilograms of codeine is produced while 249,000 kilograms is used. This makes it the most commonly used opium. It's in the List of Essential Medicines of the World Health Organization, the most effective and safe drugs needed in the health system. Wholesale costs in developing countries are between 0.04 and 0.29 USD per dose in 2014. In the United States it costs about a dollar per dose. Codeine occurs naturally and forms about 2% of the opium.
Video Codeine
Medical use
Codeine is used to treat mild to moderate pain and relieve cough. Codeine is also used to treat diarrhea and irritable bowel syndrome, although loperamide (which is available without a prescription for milder diarrhea), diphenoxylate, paregoric or even laudanum is more commonly used to treat severe diarrhea.
There is weak evidence that it is useful in cancer pain but is associated with increased side effects. The American Academy of Pediatrics does not recommend its use in children because of side effects. The FDA registers under 12 years of age as contraindicated for use.
Furthermore, codeine has been found to be an endogenous compound, together with morphine, in the brain of non-human primates with depolarized neurons, suggesting that codeine may serve as neurotransmitters or neuromodulators in the central nervous system.
Cough
The evidence does not support its use for acute cough suppression in children or adults. In Europe it is not recommended as a cough medicine for those under the age of twelve. There is some tentative evidence that can reduce the chronic cough in adults.
Formulation
Codeine is marketed both as a single-agent drug and in combination with paracetamol preparation (as co-codamol: for example, Paracod , Panadeine brand, and series < i> Tylenol -with-codeine, including Tylenol 3 and 1,2,4); with aspirin (as co-codaprin); or with ibuprofen (such as Nurofen Plus ). This combination provides a greater pain relief than an agent alone (drug synergy).
Codeine is also commonly marketed in products containing codeine with pain killers or other muscle retardants, as well as codeine mixed with phenacetin ( Emprazil with codeine No. 1, 2, 3, 4, and 5), naproxen , indomethacin, diclofenac, and others, as well as more complex mixtures, including mixtures such as aspirin paracetamol kodein Ã, Â ± caffeine Ã, Â ± antihistamines and other agents, as mentioned above.
The just-codeine product can be obtained by prescription as a time release tablet. Codeine is also marketed in cough syrup with zero to a half-dozen other active ingredients, and a linctus ( for example, Pavillion ) for all uses for which codeine is indicated.
Injectable codeine is only available for subcutaneous or intramuscular injection; intravenous injection is contraindicated as this may cause degranulation of non-immune mast cells and produce anaphylactoid reactions. Codeine suppository is also marketed in several countries.
Maps Codeine
Adverse effects
Common side effects associated with codeine use include drowsiness and constipation. Less common are itching, nausea, vomiting, dry mouth, miosis, orthostatic hypotension, urinary retention, euphoria, dysphoria, and cough. Rare side effects include anaphylaxis, seizures, acute pancreatitis, and respiratory depression. Like all opiates, long-term effects may vary, but may include reduced libido, apathy, and memory loss. Some people may have allergic reactions to codeine, such as skin swelling and rashes.
Tolerance to many effects of codeine, including its therapeutic effect, develops with long-term use. This occurs at different rates for different effects, with tolerance to the effects that trigger constipation to develop very slowly for example.
A potentially serious adverse drug reaction, like other opioids, is respiratory depression. This depression is associated with doses and is a mechanism for the fatal consequences of overdose. When codeine is metabolized into morphine, morphine can be passed through breast milk in potentially lethal amounts, fatally suppressing the infants' breastfed breathing. In August 2012, the Federal Medical Administration of the United States issued a warning on deaths in pediatric patients & lt; 6 years after ingesting "normal" dose of paracetamol with codeine after tonsillectomy; this warning was upgraded to black box warning in February 2013.
Some patients are very effective at converting codeine into its active form, morphine, which produces deadly blood levels. The FDA currently recommends the use of very careful codeine in young tonsillectomy patients: use the lowest amount of drugs that can control pain, use "as necessary" and do not "at all times", and seek medical advice immediately if a child in codein demonstrates sedation excessive or abnormal breathing.
Withdrawal and dependency
Like other opiate pain killers, the use of chronic codeine can cause physical dependence. When physical dependence has developed, withdrawal symptoms may occur if a person suddenly stops the treatment. Withdrawal symptoms include: drug craving, runny nose, yawning, sweating, insomnia, weakness, abdominal cramps, nausea, vomiting, diarrhea, muscle spasms, chills, irritability, and pain. To minimize withdrawal symptoms, long-term users should gradually reduce their codeine drugs under the supervision of a health care professional.
There is also no evidence that inhibition of CYP2D6 is useful in treating codeine dependence, although the metabolism of codeine to morphine (and hence further metabolism for conjugate morphine glucuronide) does have an effect on the potential for codeine abuse. However, CYP2D6 has been implicated in neonatal toxicity and death when codeine is given to nursing mothers, especially those with increased activity of 2D6 ("ultra-rapid" metabolizers).
Pharmacokinetics
Conversion of codeine into morphine occurs in the liver and is catalyzed by the cytochrome P450 CYP2D6 enzyme. CYP3A4 produces norcodeine and UGT2B7 conjugate codeine, norcodeine, and morphine to the corresponding 3- and 6- glucuronides. Srinivasan, Wielbo and Tebbett speculate that codein-6-glucuronide is responsible for most of the codeine analgesia, and, thus, these patients should undergo some analgesia. Many adverse effects will still be experienced in poor metabolism. In contrast, 0.5-2% of the population is "extensive metabolites"; many copies of genes for 2D6 result in high levels of CYP2D6 and will metabolize the drug through the path more quickly than others.
Some drugs are CYP2D6 inhibitors and reduce or even completely block codeine conversion to morphine. The most notable of these are two selective serotonin reuptake inhibitors, paroxetine (Paxil) and fluoxetine (Prozac) as well as antihistamine diphenhydramine (Benadryl) and antidepressants, bupropion (Wellbutrin, also known as Zyban). Other drugs, such as rifampicin and dexamethasone, induce CYP450 isozyme and thereby increase the rate of conversion.
CYP2D6 converts codeine into morphine, which then undergoes glucuronidation. Life-threatening toxicity, including respiratory depression requiring intubation, can develop within days in patients with multiple functional alleles CYP2D6, resulting in rapid metabolism of opioids such as codeine into morphine.
The study of the effects of codeine analgesics is consistent with the idea that metabolism by CYP2D6 into morphine is important, but some studies show no major difference between those with poor metabolism and extensive metabolism. Evidence supports the hypothesis that ultrarapid metabolism may gain greater analgesia than codeine because increased morphine formation is limited to case reports.
Because of the increased metabolism of codeine to morphine, ultrarapid metabolizers (those with more than 2 functional copies of the CYP2D6 allele) are at increased risk of adverse drug effects associated with morphine toxicity. Guidelines issued by the Clinical Pharmacogenomics Implementation Consortium (CPIC) recommend not to provide codeine to ultrarapid metabolizers, where this genetic information is available. CPIC also shows that the use of codeine is avoided in poor metabolism, due to the lack of efficacy in this group.
Codeine and its salts are readily absorbed from the gastrointestinal tract and ingestion of codeine phosphate produces peak plasma concentrations in about an hour. The half-life of plasma is between 3 and 4 hours and the ratio of oral/intramuscular analgesic potential is approximately equal to 1: 1.5. The most common conversion ratios, given on the equianalgesia charts used in the United States, Canada, United Kingdom, Republic of Ireland, European Union, Russia and elsewhere as 130mg IM equals 200mg PO - both are equivalent to 10mg of sodium sulfate IV and 60mg morphine sulphate PO. Salt: the ratio of freebase from both salts of drugs used roughly equivalent, and generally does not make a clinical difference.
Codeine is metabolized by O- and N-demethylation in the liver to morphine and norcodeine. Codeine and its metabolites are excreted almost entirely by the kidneys, especially as conjugated with glucuronic acid.
Codeine's active metabolites, especially morphine, exert its effect by binding and activating the -opioid receptors.
Relation to other opioids
Codeine has been used in the past as a starting material and prototype of the lightest to moderate strongest opioid class; such as hydrocodone (1920 in Germany), oxycodone (1916 in Germany), dihydrocodeine (1908 in Germany), and derivatives such as nicocodeine (1956 in Austria). However, these opioids are no longer synthesized from codeine and are usually synthesized from other opium alkaloids; special thebaine. Other sequences of codeine derivatives include isocodeine and its derivatives, developed in Germany beginning around 1920. In general, various classes of morphine derivatives such as ketones, semisynthetic such as dihydromorphine, halogeno-morphides, esters, ether, and others have codeine, dihydrocodeine, and analog isocodeine. Codeine ester acetylcodeine is a common active impurities in street heroin because some of the codeine tends to dissolve with morphine when extracted from opium in underground heroin and underground morphine labs.
As an analgesic, codeine compares weakly with other opiates. Associated with codeine in other ways is codoxime, thebacon, codeine- N -oxide (genocodeine), associated with nitrogen morphine derivatives such as methobromide codeine, and heterocodeine, which is a drug six times stronger than morphine and 72 times stronger than codeine because of the small reset of molecules, ie. move the methyl group from position 3 to 6 on the morphine carbon skeleton.
Drugs that have a resemblance to codeine in effect due to close structural relationships are variations in the methyl group at position 3 including ethylmorphine a.k.a. codethyline (Dionine) and benzylmorphine (Peronine). Although it does not have its own narcotic effect, thebaine's important opioid precursors differ from codein only slightly in structure. Pseudocodeine and several other similar alkaloids that are not currently used in the drug are found in trace quantities in opium as well.
History
Codeine, or 3-methylmorphine, is an alkaloid found in opium poppy, Papaver somniferum var. album , plants in the papaveraceae family. Opium poppy has been cultivated and used throughout human history for various medicinal properties (analgesic, anti-tusive and anti-diarrhea) and hypnosis associated with the diversity of its active components, which include morphine, codeine and papaverine.
Codeine is found in concentrations of 1% to 3% in opium prepared by the latex method of raw pow Papaver somniferum . Code name is derived from Ancient Greek ?????? ( k? deia , "poppy head"). The relative proportions of codeine to morphine, the most common opium alkaloids at 4% to 23%, tend to be somewhat higher in the poppy straw method in preparing opium alkaloids.
Until the beginning of the nineteenth century, raw opium was used in various preparations known as laudanum (see Thomas de Quincey's Confessions of the English Opium-Eater, 1821) and paregoric elixirs, a number of which were popular in Britain early the 18th century; the original preparations seem to have been described in Leiden, the Netherlands circa 1715 by a chemist named Lemort; in 1721
The progressive isolation of some of the active components of opium paves the way for increasing the selectivity and safety of the opiate-based pharmacopoeia.
Morphine was isolated in Germany by Friedrich SertÃÆ'¼rner in 1804. Codeine was first isolated in 1832 in France by Pierre Robiquet , is well known for the discovery of alizarin, the most extensive red dye, while working on the process of extracting processed morphine. Robiquet is also credited with finding caffeine independently from Pelletier, Caventou, and Runge. This opens the way for the elaboration of a new generation of safer, antitussive and antidiare-based formulations.
Codeine is the most widely used opiate in the world, and is one of the most commonly used drugs in its entirety according to various reports by organizations including the World Health Organization and its predecessor's League of Nations. It is one of the most effective oral opioid analgesics and has a wide margin of safety. Its strength ranges from 8% to 12% of morphine in most people; the difference in metabolism can change this figure like any other drug, depending on the route of administration.
While codeine can be directly extracted from opium, the original source, most of the codeine synthesized from morphine is much more abundant through the O-methylation process, through a process first settled in the late 20th century by Robert C. Corcoran and Junning Ma.
In 1972, the effects of the War on Drugs have led to a shortage of illegal and illegal opium extensively because of the scarcity of natural opium, poppy straw, and other sources of opium alkaloids, and the increasingly difficult geopolitical situation for the United States. After a lot of opium and morphine in National Stockpile of Strategic & amp; Critical materials are tapped to reduce the severe shortage of opiate drugs - their antecedents are primarily code-based - by the end of 1973, researchers were assigned to find ways to synthesize codeine and its derivatives. They quickly succeeded in using petroleum or coal tar and a process developed at the National Institutes of Health of the United States.
A number of codeine salts have been prepared since the drug was invented. The most commonly used are hydrochloride (conversion ratio of freebase 0.805), phosphate (0.736), sulfate (0.859), and citrate (0.842). Others include salicylate NSAIDs, codeine salicylates (0.686), bromides (codeine methylbromide, 0.759), and at least four codeine-based barbiturates, cyclopentenilallylbarbiturate (0,561), cyclopentenilallylbarbiturate (0,561), and diethylbarbiturate (.619). ). The latter was introduced as Codeonal in 1912, indicated for pain with nervousness. Codeine methylbromide is also considered a separate drug for various purposes.
Codeine and morphine, as well as opium, were used in an attempt to treat diabetes in the 1880s and thereafter, more recently in the 1950s.
Society and culture
Name
It is often sold as salt in the form of codeine sulphate or codeine phosphate in the United States, Britain and Australia. Codeine hydrochloride is more common worldwide and citrate, hydroiodide, hydrobromide, tartrate, and other salts are also seen. The chemical name for codeine is morphinan-6-ol, 7.8-didehydro-4,5-epoxy-3-methoxy-17-methyl-, (5 ?, 6?) -
Use of recreation
Codeine can be used as a recreational drug.
A heroin (diamorphine) or other opioid/opioid addict may use codeine to counteract the withdrawal effect during the period in which the drug they like is unavailable or unreachable.
Codeine is also available in conjunction with promethazine anti-nausea drugs in the form of syrup. A brand named Phenergan with Codeine or in generic form as promethazine with codeine. In the 1990s it began to be used as a recreational drug and was called 'syrup', 'lean', or 'purple drink'. Rapper Pimp C, of ​​UGK group, died of this combination overdose.
Codeine is used in illegal drug labs to make morphine.
Detect
Codeine and/or major metabolites can be quantified in blood, plasma or urine to monitor therapy, confirm the diagnosis of poisoning or assist in the investigation of medico-legal deaths. Narcotics screening programs generally test urine, hair, sweat or saliva. Many commercial opiate screening tests aimed at cross-reacting morphine with codeine and its metabolites, but chromatographic techniques can easily differentiate codeine from opiates and other opioids. It is important to note that the use of codeine produces morphine in significant amounts as a product of excretion. Furthermore, heroin contains codeine (or acetyl codeine) as an impurity and its use will result in the excretion of small amounts of codeine. Poppy seed food is another source of low levels of codeine in a person's biofluid. The concentration of blood or plasma of codeine is usually in the range of 50-300 Ã, μg/L in people taking the drug therapeutically, 700-7000 Âμg/L in chronic users and 1000-10,000 Âμg/L in fatal fatty cases exceeding dose.
Codeine is produced in the human body along the same biosynthetic pathway as morphine. Urine concentrations of endogenous codeine and morphine have been found to significantly increase in individuals taking L-DOPA for the treatment of Parkinson's disease.
Legal status
Worldwide, codeine, depending on its concentration, drugs Schedule II and III under the Single Convention on Narcotics Drugs. In Australia, Canada, New Zealand, Sweden, the United Kingdom, the United States and many other countries, codeine is regulated under various narcotics control laws. In some countries it is available without a doctor's prescription in preparation of a combination of licensed pharmacists in doses up to 20 mg, or 30 mg when sold in combination with 500 mg of paracetamol.
Australia
In Australia, Since February 1, 2018, preparations containing codeine are not available without a prescription.
Preparations containing pure codeine (eg, codeine phosphate tablets or phosphatus phosphate codeine) are available by prescription and are considered S8 (Schedule 8, or "Drug Ownership Controlled without illegal authority"). Schedule 8 preparations are subject to strict regulations of all drugs available to consumers.
Canada
In Canada, tablets containing 8 mg codeine combined with 15 mg of caffeine and 300 mg of paracetamol are sold as T1s (Tylenol Number 1) without a prescription. Similar tablets called "A.C. & amp; C." (Which stands for Acetylsalicylic Acid with Caffeine and Codeine) containing 325-375 mg of acetylsalicylic acid (Aspirin), not paracetamol, is also available without a prescription. Both tablets are kept behind the counter and must be removed by the pharmacist who can limit the quantity. The names of many of the codeine and dihydrocodeine products in Canada tend to follow the narcotics content system (Tylenol With Codeine No. 1, 2, 3, 4 & amp; c) mentioned below in the section on the United States; it comes in its current form with Pure & amp; Drug Act of 1906.
Codeine became the only prescribed drug in Manitoba province on February 1, 2016. A pharmacist can issue a prescription, and all purchases are recorded to the database center to prevent overprescribing.
Denmark
In Denmark codeine is sold on the table with a maximum mixture of 9.6 mg. Items are given on the table, without a prescription. The strongest available on the preparation table containing codeine has 9.6 mg (with aspirin, brand name Kodimagnyl); a stronger one needs a recipe.
French
In France, before 2017, most of the preparations containing codeine do not require a doctor's prescription. Examples of products containing codeine include NÃÆ'Â ° ocodion (codeine and camphor), Tussipax (ethylmorphine and codeine), Paderyl (codeine itself), Codoliprane (codeine with paracetamol), Prontalgine and Migralgine (codeine, paracetamol and caffeine). By 2017 the law was amended to make mandatory prescriptions for all codeine products along with ethylmorphine and dextromethorphan German, Switzerland, and Austria
Codeine is listed under BetÃÆ'¤ubungsmittelgesetz in Germany and the same narcotics laws and controlled substance laws in Switzerland. In Austria, these drugs are listed under Suchtmittelgesetz in a category that suits their classification under the Single Convention on Narcotics Drugs. Provision of products containing codeine and similar drugs (dihydrocodeine, nicocodeine, benzylmorphine, ethylmorphine etc.), In general, requires a prescription order from a doctor or pharmacist's discretion.
City and provincial regulations can affect availability, particularly in Austria and Switzerland, allowing cities and provinces to manage the most unregulated sales schedule of SMG/BtMG. Individual chemist stores may choose not to provide it or impose volume, frequency, or limitations on a single purchase and other things from the same store. Regular codeine hydrochloride tablets as well as other non-injectable codeine forms and their midrange derivatives may be channeled in this way; The same applies to most of the benzodiazepine chemistry classes, the majority of non-barbituric tranquilizers/hypnotics, and at least a handful of barbiturates.
The title 76 of the Schengen agreement has allowed countries in the signatory countries to import and export pharmaceuticals under various provisions, recording and ordering requirements, and various other rules.
Greek
Codeine is classified as an illegal drug in Greece, and people who have it can be arrested, even though they are legally prescribed in another country. It is sold only by prescription (Lonarid-N, Lonalgal).
Hong Kong
In Hong Kong, codeine is governed by Hong Kong Law, Dangerous Drug Act, Chapter 134, Schedule 1. It may be used legally only by health professionals and for university research purposes. Substance can be given by the pharmacist under the prescription. Anyone who supplies non-prescription ingredients can be fined $ 10,000 (HKD). The maximum penalty for trading or manufacturing of substance is a $ 5,000,000 (HKD) fine and life imprisonment. Substance holdings for unlicensed consumption from the Ministry of Health are illegal with a fine of $ 1,000,000 (HKD) and/or 7 years in prison.
However, codeine is available without a prescription from licensed pharmacists in doses up to 0.1% (ie 5 mg/5 ml)
India
Code preparation requires recipes in India. Preparation of paracetamol and codeine is available in India. Codeine is also present in various cough syrups as codeine phosphate including chlorpheniramine maleate. Pure codeine is also available as a codeine sulphate tablet. Codeine containing cough medicine has been banned in India with effect from March 14, 2016. The Ministry of Health and Family Welfare found no evidence of its efficacy against cough control.
Iran
The preparation of codeine in Iran usually comes with paracetamol or guaifenesin, and can be purchased without a prescription. Pure codeine is also available as a 30 mg etine phosphate tablet and special permission is required to purchase. Iran's deputy health minister reported that a combination of codeine is Iran's top-selling OTC drug.
ireland
In Ireland, the new regulation came into force on 1 August 2010 on codeine, due to concerns about excessive drug use. Codeine remains a non-prescriptive, over-the-counter semi-prescription drug up to a limit of 12.8 mg per pill, but codeine products must be out of the public view to facilitate legislative requirements that the product is "inaccessible to the public for independent selection". In practice, this means the customer should ask the pharmacist for a product containing codeine in the name, and the pharmacist makes an assessment whether it is suitable for the patient to use codeine, and that the patient is fully advised about the correct use of this product. Products containing more than 12.8 mg of codeine are only available on prescription.
Italy
Tablets or codeine preparations require recipes in Italy. Paracetamol preparation and codeine are available in Italy as Co-Efferalgan and Tachidol .
Japanese
Low-dose codeine is available on the table in a pharmacy but not a higher dose. Maldives
Maldives take a very strict path on drugs, with many common medicines, especially anything that contains prohibited codeine unless you have a doctor's recipient notified and confirmed. Visitors break the rules, even by accident, have been deported or imprisoned.
Nigeria
Nigeria in 2018 plans to ban the manufacture and import of cough syrups containing codeine as an ingredient. This is due to concerns about its use for motion sickness.
Romanian
Codeine is not allowed without a doctor's prescription. Kodein is sold under the name Farmacod and its concentration does not exceed 15 mg. There is a known combination of acetylsalicylic acid, paracetamol and codeine phosphate hemihydrate named Aspaco which is allowed without a medical prescription but the case is signed with an exclamation red symbol which means driving will not be allowed during treatment. There is no sanction whether the drug is administered without a prescription.
Russian Federation
According to ITAR-Tass and Austrian Presse-Agentur, the availability of codeine product OTC was canceled nationally in 2012 due to the discovery of Krokodil's method of underground desomorphine synthesis. Opponents of the movement point out that codeine has not been available OTC in 22 of the Russian oblasts for years and requests will call its own supply, which means that only legitimate end users are negatively affected (activists cited in the Pravda story on the issue).
South Africa
Kodein is available at the counter in South Africa. Certain pharmacies require people to write their name and address to ensure that they do not buy too much in a short time even though many do not need this at all. According to Dr Lochan Naidoo, former chairman of the National Narcotics Control Board, making drugs more difficult to obtain can lead to worse problems in which people who resign will turn to illegal drugs to get repairs. Although codeine is freely available, South Africa has a relatively low rate of opiate use per year of 0.3% compared with the United States at 0.57% in which all opiates are strictly regulated.
Sri Lanka
Codeine preparation is available as a freely sold pharmaceutical drug in Sri Lanka. The most common preparation is Panadeine, which contains 500 mg of Paracetamol and 8 mg of Codeine. But codine-containing cough syrup is prohibited, even by prescription.
United Arab Emirates
The UAE takes a very strict line on drugs, with many common medications, especially anything that contains prohibited codeine unless a person has a doctor's recipient notified and confirmed. Visitors break the rules, even by accident, have been deported or imprisoned. The US Embassy in the UAE has an unofficial list of what might not be imported.
United Kingdom
In the United Kingdom, sales and possession of codeine are separately restricted by law.
Neat codeine and high-strength codeine formulations are generally prescribed medicines (POMs) meaning that the sale of these products is limited under the 1968 Drug Act. Lower strength products containing combinations of up to 12.8 mg codeine per unit dose, combined with paracetamol, ibuprofen or aspirin available on the table in a pharmacy. Codeine linctus 15 mg per 5ml is also available in some pharmacies, although the buyer should ask specifically from the pharmacist.
Under Drug Abuse Act 1971 codeine is a Class-controlled substance or Class A drug when prepared for injection. Ownership of substances that are controlled without a prescription is a criminal offense. However, certain preparations of codeine are exempt from this limitation under Schedule 5 of the Drug Abuse Act 2001. It is thus lawful to have codeine without a prescription, provided that it is compounded by at least one other active ingredient or inactivity and that the dosage of each tablet, capsules, etc. not exceeding 100 mg or 2.5% concentration in case of liquid preparation. Exceptions do not apply to codeine preparations designed for injection.
United States
In the United States, codeine is governed by the Controlled Substance Act. Federal law dictates that codeine is a controlled substance of Schedule II when used in products for pain relievers containing either codeine alone or more than 90 mg per unit dose. Codeine tablets in combination with aspirin or paracetamol (paracetamol/Tylenol) prepared for pain relief are listed as Schedule III (allowing electronic fills and refills without a copy of the physical paper from the prescribed doctor prescription); and cough syrup is Schedule III or V, depending on the formula. Paracetamol/codeine pain-relief elixir (trade name Tylenol Elixir with Codeine) is the substance contained in Schedule IV.
Some countries have chosen to classify Schedule V schedule preparations into a more rigorous schedule to reduce the misuse of codeine recipes. Minnesota, for example, has chosen to reclassify Schedule V codein preparations (such as Cheratussin) as the Schedule II-regulated substance.
In some jurisdictions where codeine is a Schedule V substance, it is available (in combination with paracetamol or aspirin) in limited strength and quantity without a prescription at the expense pharmacist's discretion (in most jurisdictions the sale is still incorporated into the narcotics distributed database to prevent abuse of the system by patients who practice the doctor/pharmacy "pharmacy" to get excessive amount of drugs).
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