Efferalgan Codeine – how to apply? Is Efferalgan Codeine anti-inflammatory?

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Efferalgan Codeine is a preparation in the form of effervescent tablets. Contains paracetamol and codeine phosphate. It has an analgesic, antipyretic and antitussive effect. Read how to use Efferalgan Codeine, its mechanism of action and side effects.

Efferalgan Codeine – composition and characteristics

Efferalgan Codeine is an analgesic drug that contains paracetamol (Paracetamolum) 500 mg and Codeini phosphas 30 mg. The auxiliary substances are:

1. sodium bicarbonate,
2. anhydrous sodium carbonate,
3. anhydrous citric acid,
4. sorbitol,
5. sodu ninecian
6. benzoic acid,
7. powidon,
8. aspartame,
9. natural grapefruit flavor.

Efferalgan Codeine is used in pain of moderate and severe intensity, which is not relieved by the use of peripheral analgesics (paracetamol with codeine has no effect on phantom, neurogenic pain).

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Efferalgan Codeine – indications

The drug can be used to relieve pain of various origins (headache, joint pain, bone pain, toothache, menstrual pain, post-traumatic pain, postoperative pain and neoplastic pain). The active substances in the drug fight fever. The preparation supports the treatment of colds and flu, especially if the disease is accompanied by a dry, tiring cough.

Codeine can be used in adolescents from 12 years of age to treat acute moderate painunless other medications (such as paracetamol or ibuprofen) have the desired effect.

In the case of severe menstrual pains, it is worth performing a package of preventive examinations, thanks to which the general control of the woman’s health is possible, as well as the proven work of individual organs.

Efferalgan Codeine – mechanism of action

Efferalgan Codeine is a pain reliever that contains two active substances: paracetamol and codeine phosphate hemihydrate. Paracetamol has an analgesic and antipyretic effect. As a result of inhibition of arachidonic acid cyclooxygenase, paracetamol inhibits the synthesis of prostaglandins in the central nervous system.

The effect of this interaction is a reduction in the sensitivity to the effects of mediators such as kinins and serotonin, which is marked by an increase in the pain threshold. The reduction in prostaglandin levels in the hypothalamus is responsible for the antipyretic effect of paracetamol. Paracetamol does not inhibit platelet aggregation. Codeine is a centrally acting weak analgesic.

Codeine acts through the μ-opioid receptors, although codeine has a low affinity for these receptors and its analgesic effect is due to conversion to morphine. Codeine has been shown to be effective in the treatment of acute nociceptive pain, particularly when combined with other analgesics such as paracetamol.

The combination of paracetamol and codeine phosphate causes a longer and stronger analgesic effect compared to the action of each component separately. Codeine also has an antitussive effect.

Paracetamol is effectively absorbed from the digestive system and is fully effective after about 30-60 minutes. It is broken down in the liver, where as a result of its metabolism inactive and non-toxic products are formed.

Codeine is an analgesic as a result of conversion to morphine. It is easily absorbed from the digestive tract (its bioavailability is 40-70%). The maximum effect is achieved approximately 60 minutes after application. In the liver it is metabolized to morphine and norcodeine and then excreted in the urine. Its complete removal from the body occurs after 48 hours.

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Efferalgan Codeine – dosage

The drug is administered orally after dissolving the tablet in a small amount of liquid. The dose and frequency of taking the preparation is determined by the doctor. For the treatment to be effective, you must follow the instructions of your doctor.

Dosage of Efferalgan Codeine for Adults:

1 effervescent tablet at a time. If necessary, the dose can be repeated, but not more frequently than every 6 hours. In case of intense pain, you can take 2 effervescent tablets at a time. Do not exceed 8 tablets in good time.

Dosage of Efferalgan Codeine for children under 12 years of age:

Codeine should not be used in children under 12 years of age due to the risk of opioid toxicity associated with the variable and unpredictable metabolism of codeine into morphine.

Dosage of Efferalgan Codeine for adolescents 12 years of age and above (weighing from 33 kg to 50 kg, only approximate weight range for age is given):

the dose is based on body weight. The recommended dose of paracetamol is 10 to 15 mg / kg. every 4 to 6 hours, up to a maximum daily dose of 60 mg / kg / day (up to 3 g of paracetamol for a 50 kg patient).

The recommended dose of codeine is 0,5 mg / kg body weight. up to 1 mg / kg bw every 6 hours, up to the maximum daily dose of codeine – 240 mg. The usual recommended dose of Efferalgan Codeine is 500 mg of paracetamol and 30 mg of codeine phosphate hemihydrate once (1 effervescent tablet). If necessary, the dose may be repeated no more frequently than every 6 hours. Do not use more than 4 effervescent tablets a day.

Dosage of Efferalgan Codeine for adolescents weighing more than 50 kg:

1 effervescent tablet at a time. If necessary, the dose can be repeated, but not more frequently than every 6 hours. In case of intense pain, you can take 2 effervescent tablets at a time. Usually it is not necessary to take a daily dose of more than 6 effervescent tablets. However, in the case of very severe pain, the daily dose may be increased to a maximum of 8 effervescent tablets.

Dosage of Efferalgan Codeine in the elderly:

Elderly people may be more sensitive to the effects of opioid analgesics. The starting dose should be reduced by half the usual dose for adults. The dose can then be increased as required by drug tolerance and needs.

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Efferalgan Codeine – contraindications

The drug should not be taken by patients with hypersensitivity to paracetamol, codeine or excipients of the preparation. Especially patients with respiratory failure, bronchial asthma, impaired liver or kidney function, hypothyroidism, phenylketonuria, fructose intolerance and wet cough must consult a physician.

Caution should be exercised if a person is taking other medications that relieve pain and central nervous system effects, rifampicin, zidovudine, and anticoagulants. You should inform your doctor about their use, as well as about all drugs taken recently – including those that are available without a prescription.

Do not drink alcohol while taking Efferalgan Codeine. The codeine contained in the preparation increases the depressive effect on the central nervous system shown by alcohol.

It is not recommended to use the preparation in the first trimester of pregnancy. In the following trimesters of pregnancy, the drug should only be used when needed. It should not be taken by breastfeeding women.

Here are the contraindications related to the paracetamol in Efferalgan Codeine:

1. severe liver dysfunction or active decompensated liver disease,
2. severe kidney failure,
3. alcoholism,
4. treatment with MAO inhibitors and up to 14 days after the end of treatment,
5. simultaneous use with painkillers with agonist-antagonist action: buprenorphine, butorphanol, nalbuphine, nalorphine, pentazocine.

Here are the contraindications related to the codeine in Efferalgan Codeine:

1. the use of codeine, due to its depressant effect on the respiratory centers, is contraindicated in the case of respiratory failure, regardless of its severity,
2. in children under 12 years of age due to the risk of opioid toxicity due to the variable and unpredictable metabolism of codeine to morphine,
3. in children and adolescents (0-18 years of age) undergoing tonsilectomy and / or pharyngeal (adenoidectomy) surgery as part of the treatment of obstructive sleep apnea syndrome due to an increased risk of serious and life-threatening side effects,
4. bronchial asthma or respiratory failure (opioids, especially morphine and its derivatives, including codeine, may release histamine),
5. in breastfeeding women,
6. in people known to be highly metabolised by the enzyme CYP2D6. 

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Efferalgan Codeine – side effects

Efferalgan Codeine may cause certain side effects. Possible side effects include nausea and vomiting, kidney damage, constipation, dizziness, sleepiness, and apnea. Hypersensitivity reactions such as rash, erythema, hives or reddening of the skin, increased sweating, shortness of breath, bronchospasm or drop in blood pressure are rare. Changes in the blood picture have been observed very rarely.

In the case of long-term use, the risk of addiction to the active substances of the drug and the occurrence of withdrawal syndrome increases.

Side effects resulting from the use of the drug, such as dizziness or drowsiness, preclude the ability to drive or operate machinery.

Other side effects with Efferalgan Codeine: pancreatitis, weakness, malaise, biliary colic, hepatitis, anaphylactic reactions (rapid allergic reactions), increased levels of alkaline phosphatase in the blood, increased levels of gamma-glutamyltransferase, rhabdomyolysis (a syndrome of associated with striated muscle damage), alternating muscle spasms and relaxation, paresthesia (tingling, numbness), fainting, tremors, confusional state, drug abuse, drug dependence, hallucinations, erythema, hypotension.

Elderly patients may show an increased risk of adverse effects associated with opioid treatment, such as respiratory depression and constipation. In these people it is recommended to start with a lower starting dose than usually used in adults. Seniors are also more likely to use other medications concomitantly, which may increase the risk of side effects.

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Efferalgan Codeine – precautions

Efferalgan Codeine contains paracetamol and codeine – an opioid pain reliever, so it should be used with the simultaneous use of other medicines containing paracetamol or codeine (including prescription or over-the-counter), so as not to exceed the recommended daily dose.

Long-term use of high doses of codeine can lead to addiction. Long-term use of the drug is not recommended. In people who practice sports, the drug may cause a positive doping test result.

Do not use doses higher than recommended. The use of paracetamol doses higher than recommended carries the risk of very serious liver damage. Symptoms of liver damage usually appear one to two days after overdose with paracetamol, with maximum intensity usually occurring after 3-4 days.

Paracetamol can cause severe skin reactions such as acute generalized pustular eruption, Stevens-Johnson syndrome and toxic epidermal necrolysis, which may be fatal. Tell your doctor if you develop skin reactions and stop taking the medicine if you develop a skin rash or any other sign of allergy.

Do not drink alcohol or take alcohol-containing drugs while using the product, due to the increased risk of hepatotoxicity and the increased effect of codeine. The risk of liver damage is particularly high in people who are long-term malnourished and drink alcohol regularly.

Caution should be exercised when administering paracetamol to a person with any of the following conditions:

1. mild to moderate liver problems, including Gilbert’s syndrome (familial hyperbilirubinemia),
2. moderate and severe renal impairment,
3. glucose-6-phosphate dehydrogenase deficiency,
4. chronic alcoholism, excessive alcohol consumption (intake of 3 or more alcoholic drinks every day),
5. anorexia, bulimia, cachexia,
6. long-term malnutrition,
7. low reserves of glutathione in the liver e.g. from eating disorders, cystic fibrosis, HIV infection, starvation or cachexia, sepsis,
8. dehydration,
9. oligemia (reduced volume of circulating blood).

If your doctor orders uric acid or blood glucose tests, tell your doctor that you are using this medicine.

Codeine should not be used to relieve pain in children and adolescents after removal of the tonsils or pharynx due to obstructive sleep apnea syndrome.

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The use of codeine in children with respiratory problems is not recommended as the symptoms of morphine toxicity may worsen in these children. Children and adolescents should be closely monitored for any progressive symptoms of codeine depression on the central nervous system, such as excessive somnolence and decreased respiratory rate.

Opioids should be used with caution in patients with epilepsy due to their effect lowering the seizure threshold. Long-term use of painkillers, including opioid medications, increases the risk of drug overuse headache. Treatment with opioids, especially with chronic use, can cause hyperalgesia in some people.

Constipation, which may be refractory to treatment with laxatives, is a side effect of opioid therapy and requires monitoring of bowel function. The drug should be used with caution in patients with diseases of the biliary tract (gallstone disease), prostatic hyperplasia or impaired urine drainage.

The sodium benzoate contained in the product is slightly irritating to the skin, eyes and mucous membranes. Sodium benzoate may increase the risk of jaundice in neonates whose mothers have used the product during pregnancy.

Efferalgan Codeine – overdose

Overdose is especially dangerous in the elderly, young children, long-term malnourished people, people with alcoholism, liver disease and people taking drugs that induce liver enzymes, as they are at increased risk of liver damage.

Overdosing of the drug may cause symptoms such as nausea, vomiting, anorexia, pallor, hyperhidrosis, drowsiness and general weakness within a few to several hours. These symptoms may disappear the next day, although liver damage begins to develop, which then manifests itself as abdominal distension, return to nausea, and jaundice.

Procedure in the event of an overdose: Whenever you take paracetamol in a dose of 5 g (10 tablets) or more at a time, you must induce vomiting, if it is not more than an hour after consuming it and contact your doctor immediately. It is recommended to administer 60-100 g of activated charcoal orally, preferably mixed with water. Seek medical advice immediately.

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Symptoms of codeine overdose in adults: Acute respiratory depression (cyanosis, respiratory depression, shortness of breath), sedation and constriction of the pupils are the main symptoms of overdose with codeine and other opioids. Other symptoms related to the central nervous system such as headache, vomiting, urinary retention, slow bowel function, bradycardia and low blood pressure may also occur.

In addition, there may be a decrease in heart rate, there may be drowsiness, rash, vomiting, itching of the skin, ataxia, pulmonary edema (less common), interrupted breathing, convulsions, symptoms of histamine release: redness and swelling of the face, hives, collapse, retention. urine.

Symptoms of codeine overdose in children (toxic threshold dose: 2 mg / kg bw administered once): decreased respiratory rate, interrupted breathing, constriction of the pupils, convulsions, symptoms of histamine release: facial redness and swelling, hives, collapse, urinary retention.

Procedure in the event of an overdose: the person should be immediately transported to the hospital and their breathing monitored, if necessary, provide respiratory support, oxygen therapy and other symptomatic treatment, and administer the antidote – naloxone.

Efferalgan Codeine – interaction with other drugs

Efferalgan Codeine may react with other medications. Before taking the drug, tell your doctor about all medications (prescription and over-the-counter) and supplements you are taking.

Efferalgan Codeine may interact with the following drugs / substances:

1. inhibitory MAO,
2. medicines containing salicylamide (a painkiller, also used in feverish conditions) drugs that increase hepatic metabolism – simultaneous use of paracetamol and drugs such as St. John’s wort, antiepileptic drugs, barbiturates (a drug used mainly in epilepsy), rifampicin (a drug used in tuberculosis and other infectious diseases), can lead to liver damage, even with the recommended doses of paracetamol.
3. isoniazid (a medicine for tuberculosis) and zidovudine (an antiviral medicine for HIV infection)
4. non-steroidal anti-inflammatory drugs (NSAIDs),
5. oral anticoagulants
6. phenytoin (medicine for epilepsy),
7. probenecid (a medicine for gout)
8. morphine agonists and antagonists (buprenorphine, butorphanol, nalbuphine, nalorphine, pentazocine – opioid analgesics),
9. naltrexone (opioid antagonist (blocker)),
10. other morphine derivatives with analgesic effect.

Other CNS depressants such as barbiturates, anxiolytics (medicines for anxiety) and antidepressants, including tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs), benzodiazepines and depressants may increase action of codeine on the central nervous system.

Other drugs that are metabolized by or inhibit the liver enzyme CYP2D6, such as SSRIs (paroxetine, fluoxetine, bupropion, and sertraline), neuroleptics (chlorpromazine, haloperidol, levomepromazine, thioridazine), and tricyclic antidepressants (imipramine, ), celecoxib, quinidine, dexamethasone, and rifampicin may all reduce the analgesic effect of codeine.

Other sedating drugs: morphine derivatives (painkillers, antitussives and substitution drugs), neuroleptics, barbiturates, benzodiazepines, non-benzodiazepine anxiolytics (meprobamate), sleeping pills, sedative antidepressants which may cause drowsiness ( Amitriptyline, doxepin, mianserin, mirtazapine, trimipramine) sedative H1 antihistamines, centrally acting antihypertensives, baclofen and thalidomide.