After receiving an oral dose of codeine for an intractable cough, the male client asks the nurse, “How long will it take for this drug to work?” How should the nurse respond?
A. In 30 minutes
B. In 1 hour
C. In 2.5 hours
D. In 4 hours
Correct Answer: A. In 30 minutes
Codeine’s onset of action is 30 minutes. Within the nervous system, activation of mu receptors in the midbrain is the dominant mechanism of opioid-induced analgesia. The cough reflex primarily gets mediated through the opioid receptors present in the medulla.
Option B: Its peak concentration occurs in about 1 hour. In patients who are on around-the-clock continuous codeine with breakthrough pain, short-acting opioids may be an option. The dose can vary from 15 mg to 120 mg a day. It is, however, indicated in the management of prolonged cough (in specific populations like lung cancer) usually as 30 mg every 4 to 6 hours as needed.
Option C: Its half-life, in 2.5 hours. Initial dosing and titration can be individualized depending on the patient’s health status, previous opioid exposure, attainment of therapeutic outcomes, and predicted or observed adverse events.
Option D: Its duration of action is 4 to 6 hours. Codeine is useful in the treatment of various etiologies producing chronic cough. Also, 46% of patients with chronic cough do not have a distinct etiology despite a proper diagnostic evaluation. Codeine produces a decrease in cough frequency and severity in these patients.
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