What is Codal?
Codeine is an opioid pain medication. An opioid is sometimes called a narcotic. Acetaminophen (Codal) is a less potent pain reliever that increases the effects of codeine.
Codal is a combination medicine used to relieve moderate to severe pain.
Codal may also be used for other purposes not listed in this medication guide.
Codal indications
Codal phosphate tablets are indicated for the relief of mild to moderately severe pain, severe enough to require an opioid analgesic and for which alternative treatments are inadequate.
Limitations of Use
Because of the risks of addiction, abuse, and misuse, with opioids, even at recommended doses, reserve Codal phosphate tablets for use in patients for whom alternative treatment options [e.g., non-opioid analgesics]
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- Have not been tolerated, or are not expected to be tolerated,
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- Have not provided adequate analgesia, or are not expected to provide adequate analgesia
How should I use Codal?
Use Codal as directed by your doctor. Check the label on the medicine for exact dosing instructions.
- Take Codal by mouth with or without food. If stomach upset occurs, take with food to reduce stomach irritation.
- If you have been taking Codal regularly or for longer than a few weeks, do not suddenly stop taking it without checking with your doctor. Your doctor may need to gradually lower your dose.
- If you miss a dose of Codal and you are taking it regularly, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.
Ask your health care provider any questions you may have about how to use Codal.
Uses of Codal in details
Use: Labeled Indications
Pain management: Management of mild to moderate pain where treatment with an opioid is appropriate and for which alternative treatments are inadequate.
Limitations of use: Reserve for use in patients for whom alternative treatment options (eg, nonopioid analgesics) are ineffective, not tolerated, or would be otherwise inadequate.
Codal dosage
Important Dosage and Administration Instructions
Initiate the dosing regimen for each patient individually, taking into account the patient’s severity of pain, patient response, prior analgesic treatment experience, and risk factors for addiction, abuse, and misuse.
Monitor patients closely for respiratory depression, especially within the first 24 to 72 hours of initiating therapy and following dosage increases with Codal phosphate tablets and adjust the dosage accordingly.
Initiating Treatment with Codal Phosphate Tablets
Dosage should be adjusted according to severity of pain and response of the patient.
The usual adult dosage is:
Single Doses (range) | Maximum 24 Hour Dose | |
Codeine Phosphate (Codal) | 15 mg to 60 mg | 360 mg |
Acetaminophen (Codal) | 300 mg to 1000 mg | 4000 mg |
The usual dose of Codeine Phosphate (Codal) in children is 0.5 mg/kg.
Doses may be repeated up to every 4 hours.
The prescriber must determine the number of tablets per dose, and the maximum number of tablets per 24 hours based upon the above dosage guidance. This information should be conveyed in the prescription.
It should be kept in mind, however, that tolerance to codeine can develop with continued use 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 but merely prolong analgesia and are associated with an appreciably increased incidence of undesirable side effects. Equivalently high doses in children would have similar effects.
Conversion from Other Opioids to Codal Phosphate Tablets
There is inter-patient variability in the potency of opioid drugs and opioid formulations. Therefore, a conservative approach is advised when determining the total daily dosage of Codal phosphate tablets. It is safer to underestimate a patient’s 24 hour Codal phosphate tablet dosage than to overestimate the 24 hour Codal phosphate tablet dosage and manage an adverse reaction due to overdose.
Titration and Maintenance of Therapy
Individually titrate Codal phosphate tablets to a dose that provides adequate analgesia and minimizes adverse reactions. Continually reevaluate patients receiving Codal phosphate tablets to assess the maintenance of pain control and the relative incidence of adverse reactions, as well as monitoring for the development of addiction, abuse, or misuse. Frequent communication is important among the prescriber, other members of the healthcare team, the patient, and the caregiver/family during periods of changing analgesic requirements, including initial titration.
If the level of pain increases after dosage stabilization, attempt to identify the source of increased pain before increasing the Codal phosphate tablet dosage. If unacceptable opioid-related adverse reactions are observed, consider reducing the dosage. Adjust the dosage to obtain an appropriate balance between management of pain and opioid-related adverse reactions.
Discontinuation of Codal Phosphate Tablets
When a patient who has been taking Codal phosphate tablets regularly and may be physically dependent no longer requires therapy with Codal phosphate tablets, use a gradual downward titration of the dosage to prevent signs and symptoms of withdrawal. Do not stop Codal phosphate tablets abruptly.
Codal interactions
See also:
What other drugs will affect Codal?
Codal must be taken carefully with the following medicaments:
- CNS depressants ( including alcohol ) like sleeping medicine, tranquilizers, antihistamines.
- anticholinergic
Codal side effects
See also:
What are the possible side effects of Codal?
The most frequently reported adverse reactions are drowsiness, lightheadedness, dizziness, sedation, shortness of breath, nausea and vomiting. These effects seem to be more prominent in ambulatory than in nonambulatory patients, and some of these adverse reactions may be alleviated if the patient lies down.
Other adverse reactions include allergic reactions, euphoria, dysphoria, constipation, abdominal pain, pruritus, rash, thrombocytopenia, agranulocytosis, adrenal insufficiency, serotonin syndrome.
At higher doses codeine has most of the disadvantages of morphine including respiratory depression.
Androgen deficiency
Chronic use of opioids may influence the hypothalamic-pituitary-gonadal axis, leading to androgen deficiency that may manifest as symptoms of hypogonadism, such as impotence, erectile dysfunction, or amenorrhea. The causal role of opioids in the syndrome of hypogonadism is unknown because the various medical, physical, lifestyle, and psychological stressors that may influence gonadal hormone levels have not been adequately controlled for in studies conducted to date. Patients presenting with symptoms of androgen deficiency should undergo laboratory evaluation.
To report SUSPECTED ADVERSE REACTIONS, contact Valeant Pharmaceuticals North America at 1-800-556-1937 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
Codal contraindications
See also:
What is the most important information I should know about Codal?
Codal phosphate tablets are contraindicated in patients with:
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- Significant respiratory depression
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- Acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment
Codeine-containing products are contraindicated for postoperative pain management in children who have undergone tonsillectomy and/or adenoidectomy.
This product should not be administered to patients who have previously exhibited hypersensitivity to codeine or Acetaminophen (Codal).
Active ingredient matches for Codal:
Acetaminophen/Codeine Phosphate
List of Codal substitutes (brand and generic names) | Sort by popularity |
Unit description / dosage (Manufacturer) | Price, USD |
Acetacodine-sobhan | |
acetaminophen and codeine | |
Acetaminophen and Codeine Oral Solution | |
Acetaminophen Codeine | |
Acetaminophen Plus Codeine | |
Acetaminophen/Codeine phosphate (Taiwan) | |
Capital & Codeine | |
473 milliliter in 1 bottle | |
Chemists Own Pain | |
Codrix | |
Tablet; Oral; Acetaminophen 500 mg; Codeine Phosphate 15 mg | |
Tablet; Oral; Acetaminophen 500 mg; Codeine Phosphate 30 mg | |
Tablet; Oral; Acetaminophen 500 mg; Codeine Phosphate 60 mg | |
100 tablet in 1 bottle | |
1000 tablet in 1 bottle | |
500 tablet in 1 bottle | |
Extramol | |
Paracodin 8 | |
Ratio-lenoltec No 4 | |
Revacod | |
Ruz-acetaminophen CodeineĀ® | |
Sytamolextra | |
Titretta Schmerz | |
Tydol Codeine (Vietnam) | |
Tydol Codeine Forte 10 Blister x 10 Tablet | |
Tydol Codeine 10 Blister x 10 Tablet | |
Tydol Codeine 1 Bottle 100 Tablet | |
Tylenol No 4 With Codeine |
References
- DailyMed. "CODEINE SULFATE: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
- DailyMed. "ACETAMINOPHEN; ASPIRIN; CAFFEINE: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
- PubChem. "codeine". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
Reviews
The results of a survey conducted on ndrugs.com for Codal are given in detail below. The results of the survey conducted are based on the impressions and views of the website users and consumers taking Codal. We implore you to kindly base your medical condition or therapeutic choices on the result or test conducted by a physician or licensed medical practitioners.User reports
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Information checked by Dr. Sachin Kumar, MD Pharmacology