Drug products: Altermol, Ardinex®, Burana Comp, Citodon®, Citodon® forte, Citodon® minor, Codalvonil, Kodein Alternova, Kodein RPH Pharma, Kodeinfosfat APL, Panocod®, Paracetamol/Kodein Evolan, Treo® comp
ATC code: A07DA, N02AJ06, N02AJ08, N02AJ09, R05DA04
Substances: codeine, codeine hydrobromide, codeine hydrochloride, codeine phosphate, codeine phosphate anhydrous, codeine phosphate hemihydrate, codeine phosphate, sesquihydrate
Controlled studies on differences between men and women in effect, safety, and pharmacokinetics of codeine are lacking. Codein is a pro-drug of morphine and the effects and adverse effects are derived from morphine (see separate document on morphine).
The present evidence concerning differences between men and women is limited and do not motivate differentiation in dosing or treatment.
Codeine is metabolized to its active metabolite morphine by the CYP2D6 isoenzyme. The activity of this isoenzyme is reported to be unaltered by sex [1, 2]. Clinical studies have shown effect with similar doses in men and women and no sex differentiation in dosing has been suggested .
A small randomized controlled study in healthy volunteers (9 men, 7 women) found that women were more sensitive to respiratory depression of 60 mg oral codeine .
In a double-blind trial evaluating the analgesic effect and adverse events of 1000 mg paracetamol/60 mg codeine after tooth extraction (44 men, 50 women) women were found to report more adverse events. The mean weight was 76 kg and 62 kg in men and women, respectively, and might explain the difference .
Regarding teratogenic aspects, please consult Janusmed Drugs and Birth Defects (in Swedish, Janusmed fosterpåverkan).
Date of litterature search: 2015-02-19
Reviewed by: Mia von Euler
Approved by: Karin Schenck-Gustafsson