PANADEINE FORTE (CODEINE) 30MG X 20 CAPSULES

Description

Pain

15-60 mg PO q4-6hr PRN; not to exceed 360 mg/day in naive patients

Dosing considerations

• Patients with prior opioid exposure may require higher initial doses
• Titrate dose to pain relief; use lowest effective dose for shortest period of time

Cough (Off-label)

7.5-30 mg PO q4-6hr PRN

Dosing Consideration

Access to naloxone for opioid overdose

• Assess need for naloxone upon initiating and renewing treatment

• Consider prescribing naloxone

  • Based on patient’s risk factors for overdose (eg, concomitant use of CNS depressants, a history of opioid use disorder, prior opioid overdose); presence of risk factors should not prevent proper pain management
  • Household members (including children) or other close contacts at risk for accidental ingestion or overdose

• Consult patients and caregivers on the following:

  • Availability of naloxone for emergency treatment of opioid overdose
  • Ways to obtain naloxone as permitted by individual state dispensing and prescribing requirements or guidelines (eg, by prescription, directly from a pharmacist, as part of a community-based program). Buy Panadeine Forte Codeine online in Australia

Black Box Warnings

Opioid analgesic risk evaluation and mitigation strategy (REMS)

• Drug exposes patients and other users to the risks of opioid addiction, abuse and misuse, which can lead to overdose and death; assess each patient’s risk prior to prescribing drug, and monitor all patients regularly for the development of these behaviors and conditions
• To ensure that benefits of opioid analgesics outweigh risks of addiction, abuse, and misuse, the Food and Drug Administration (FDA) has required a REMS for these products; under requirements of the REMS, drug companies with approved opioid analgesic products must make REMS-compliant education programs available to healthcare providers

• Healthcare providers are strongly encouraged to: Buy Panadeine Forte Codeine online in Australia

  • Complete a REMS-compliant education program
  • Counsel patients and/or their caregivers, with every prescription, on safe use, serious risks, storage, and disposal of these products
  • Emphasize to patients and their caregivers the importance of reading the Medication Guide every time it is provided by their pharmacist
  • Consider other tools to improve patient, household, and community safety

Life-Threatening Respiratory Depression

• Serious, life-threatening, or fatal respiratory depression may occur with therapy
• Monitor for respiratory depression, especially during initiation of therapy or following a dose increase
• Respiratory depression and death reported following tonsillectomy and/or adenoidectomy in patients that appeared to be rapid metabolizers of codeine due to CYP2D6 polymorphism. Buy Panadeine Forte Codeine online in Australia

Ultra-rapid metabolism of codeine and other risk factors for life-threatening respiratory depression in children

• Life-threatening respiratory depression and death have occurred in children who received codeine; most of reported cases occurred following tonsillectomy and/or adenoidectomy and many of the children had evidence of being ultra-rapid metabolizers of codeine due to a cytochrome P450 (CYP) 2D6 polymorphism
• Avoid use of in adolescents 12-18 years of age who have other risk factors that may increase their sensitivity to respiratory depressant effects of codeine. Buy Panadeine Forte Codeine online in Australia

Neonatal Opioid Withdrawal Syndrome

• Prolonged use during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated, and requires management according to protocols developed by neonatology experts; if opioid use is required for a prolonged period in a pregnant woman, advise patient of risk of neonatal opioid withdrawal syndrome and ensure that appropriate treatment will be available. Buy Panadeine Forte Codeine online in Australia

Interactions with Drugs Affecting Cytochrome P450 Isoenzymes

• The effects of concomitant use or discontinuation of CYP3A4 inducers, CYP3A4 inhibitors, or CYP2D6 inhibitors with codeine are complex; use of CYP3A4 inducers, CYP3A4 inhibitors, or CYP2D6 inhibitors with drug requires careful consideration of effects on parent drug, codeine, and active metabolite, morphine. Buy Panadeine Forte Codeine online in Australia

Risks from concomitant use with benzodiazepines or other CNS depressants

• Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death
• Reserve concomitant prescribing of with
• benzodiazepines or other CNS depressants for use in patients for whom alternative treatment options are inadequate
• Limit dosages and durations to minimum required
• Follow patients for signs and symptoms of respiratory depression and sedation. Buy Panadeine Forte Codeine online in Australia