Talk:Codeine

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Regarding references to codeine legality in Denmark

Noticed that the article says the reference is missing so went digging around, but the only openly available and valid reference articles about "Kodimagnyl" are all in Danish, with no English counterparts. The thing is that this is a purely Danish product, produced here and only sold here, and thus doesn't have available documentation in other languages. As such, editing to add the references is problematic, and I'm far from an expert on neither pharmacology or chemistry, so would rather leave it up to someone who is.

As to the actual drug, "Kodimagnyl" is the brand name, and it contains 150 mg acetalic (sp?) acid ASA, 9.6 mg codeine, and 150 mg magnesium oxide.

As for relevant references:

• From the National Health Department's section for control with legal drugs: [1] (these are Word documents, in Danish - the pharmacological legal documentation for the products as I understand it).
• From netdoktor.dk (most trustworthy medical site we have, as it's independent and run by doctors): [2] (the common-man's description of the drug).

This remains the only codeine based OTC product available in Denmark. As of a legal change a couple years ago, no painkiller (no matter what it is) may be sold in amounts greater than 20 pills without prescription (although I've seen pharmacists willingly greater amounts, but I'm unsure if that's legal or not). --Metalbunny (talk) 00:46, 26 July 2016 (UTC)

Please fix this tiny mistake, someone

At the bottom of the page, there are two "Opioidergics" templates, one on top and one at the bottom (with the others in-between), so probably it was forgotten there by someone who edited it, I don't edit pages so often to do it smoothly and more of can't be bothered to, so just putting it out there - look at the bottom of the page and you'll see it there - twice. Thanks if anyone bothers. — Preceding unsigned comment added by 84.109.37.236 (talk) 23:22, 11 October 2014 (UTC)

Also this mistake. "Evidence does not support its use for cough suppression" Allanana79 (talk) 17:26, 16 March 2016 (UTC)

syrup

When used to relieve dry coughs, codeine is used in doses ranging from 5-15 mg and is usually mixed as a syrup with other drugs such as promethazine[9] which is an antihistamine/antipsychotic with strong sedative activity (some formulations come with different types of antihistamines),[10] guaifenesin which is an expectorant,[11] and other drugs.

In Belgium, seven syrups containing codeine are approved for sale in pharmacies, none of them contain any other active ingredient: BROMOPHAR (Qualiphar),BRONCHODINE (Pharmacobel),BRONCHOSEDAL CODEINE (Johnson & Johnson Consumer), BRONCHO-PECTORALIS CODEINE (Medgenix), GLOTTYL (Meda Pharma), TOULARYNX (Qualiphar),TOUX-SAN CODEINE (Nycomed) (source: official list)

So in which countries apart from the US are those mixtures sold, or even legal? Ssscienccce (talk) 23:17, 28 June 2012 (UTC)

In Denmark we have AFAIK only one cough syrup that contains codeine (only it's considered codeine in liquid form and is primarily sold as a painkiller, but it contains ethanol like most our efficient cough syrups do). Ref: [3] (article is in Danish, but from the most trustworthy medicinal website we have). It's however typically only prescribed for severe and painful cough, or to use the codeine's effect to suppress the cough (it works for some people I guess), and only rarely so. Typically efficient cough syrups here, both OTC and prescription, contain ephedrine instead for the pain relief. From personal experience, the codeine based cough syrup is inefficient while the ephedrine works almost instantly and has fewer side effects (whether or not that's relevant for the article I cannot say). --Metalbunny (talk) 00:10, 26 July 2016 (UTC)

Non-existent reference

As far as I can tell, "The December 2008 issue of The Bulletin of the National Codeine OTC Lobby (Vol. XVIII, No. 4)" is a false reference - this organization does not seem to actually exist beyond Wikipedia and other websites that only seem to copy/paste what is in this paragraph regarding OTC access to Codeine. I've had a professional literature search done and come back with absolutely nothing.

Greece, clarification needed

The entry on Greece seems contradictory [[4]]. It says you cannot have it even with a prescription and then, that you can have it with a prescription. Clarification is needed, for instance, it might be the case that you cannot have it under a foreign prescription but you can with a local one. Politis (talk) 14:29, 6 January 2016 (UTC)

Emprazil mention - kind of a leadon to a #5 formulation

Emprazil has been banned in the United States since the 80's but was under scrutiny in the 60's. I don't need to cite a source for that as it's on Wikipedia already. By mentioning an Emprazil formulation with codeine with versions of 1-5, it leads one on to believe it is legal. Further mentioning of a #5 being 90mg codeine mislieads many to think there may be a Tylenol 5.

I just think it should be mentioned that Emprazil is banned in the United States and many western nations. In particular, Emprazil doesn't even exist! Only its generic which is rare.

Kyle — Preceding unsigned comment added by 2602:306:CCB9:9F20:95C5:115D:D914:A969 (talk) 00:42, 15 August 2016 (UTC)

Schedule of codeine as a controlled substance needs revision

Codeine formulations over 90mg and by itself is Schedule 2 in the U.S. but formulations such as APAP are schedule 3 and cough syrups like promethazine with codeine are schedule V. (Five.) I think listing it only as a schedule two can be misleading. Similarly, Schedule 1 in Canada, not all formulations.

While it may be accurate when mentioning pure codeine, most users are researching formulations (particularly APAP/codeine) and often just look for codeine. Yet it is wide knowledge that most codeine is in a mixture with other prominent meds. Just think it needs revision in several areas to better note that — Preceding unsigned comment added by 2602:306:CCB9:9F20:95C5:115D:D914:A969 (talk) 00:47, 15 August 2016 (UTC)

unsourced content from US availabability

Moved here per WP:PRESERVE

Bulk codeine falls into two categories, where codeine itself is used as an active ingredient portioned into medicines which can be Schedule II, III, IV, or V depending on composition and concentration, and where codeine is used as a precursor in making other drugs. Both categories of bulk codeine are Schedule II controlled substances, sharing an ACSCN of 9050. Bulk codeine for sale has an aggregate annual manufacturing quota for the US of 49 506.25 kilos as of 2013. Bulk codeine for conversion has a quota of 81 250 kilos. Both quotas are unchanged from the prior year.

The narcotic content number in the US names of codeine tablets and combination products (i.e., Tylenol With Codeine No. 3, Emprin With Codeine No. 4, the former Emprazil With Codeine No. 5 and pure codeine tablets) are as follows: No. 1 – 7½ or 8 mg (1/8 grain), No. 2 – 15 or 16 mg (1/4 grain), No. 3 – 30 or 32 mg (1/2 grain), No. 4 – 60 or 64 mg (1 grain), No. 5 – 90 or 96 mg (1 1/2 grains). The Canadian "Frosst 222" series is identical to the above list: "222" contains 8 mg codeine, "282" 15 mg, "292" 30 mg, and "293" 60 mg. This system, which is also used at present in the trade names of some dihydrocodeine and ethylmorphine products both in and outside of North America, was inaugurated with the Pure Food and Drug Act of 1906 and related legislation and refined since. For example, the dihydrocodeine/aspirin/caffeine capsule Synalgos DC and its generic equivalents and paracetamol analogues are labelled as No. 2 (16 mg) or No. 3 (32 mg) in most cases; the No. 1 and 4 products disappeared decades ago, as did plain Synalgos without narcotic content.

Equivalent scales for labeling stronger opioids such as diacetylmorphine (heroin), morphine, opium salts mixtures, and others were in common use in the past, and on occasion one can find past references to brand names for hydrocodone (invented 1920, introduced in US 1943), hydromorphone (invented 1924), oxycodone (invented 1916), paregoric and similar drugs containing narcotic content numbers. For example. from circa 1900 to 1925, the most common cough medicine was terpin hydrate With Heroin Elixir No. 2.

Contrary to the advertising matter of some pharmacies, 60 mg is No. 4, not No. 6, and tablets with 45 mg of codeine are not No. 4 and would in all likelihood be classified as No. 3½ under that system. Whether the scale goes to No. 6 (presumably 2 grains or 120 or 128 mg) and higher is moot at this point, as in the United States and Canada single-dose-unit concentrations of more than 64 mg are no longer manufactured. The United States Controlled Substances Act of 1970 does place dosage unit strengths of 90 mg of codeine and higher in Schedule II, even if mixed with another active ingredient.

Oral tablets, hypodermic tablets, liquid forms, and capsules of less common doses are available in some cases the equivalent dihydrocodeine, dionine, benzylmorphine, and opium dosages were previously available in North America (and in most cases still are in other countries, particularly the 45 mg paracetamol/codeine and 50 and 100 mg single-ingredient codeine tablets).

Preparations for cough or diarrhea containing small amounts of codeine in combination with two or more other active ingredients are Schedule V in the US, and in some states may be dispensed in amounts up to 4 fl. oz. per 48 hours (one or two states set the limit at 4 fl. oz. per 72 hours) without a prescription. Schedule V specifically consigns the product to state and local regulation beyond certain required record-keeping requirements (a dispensary log must be maintained for two years in a ledger from which pages cannot easily be removed and/or are pre-numbered, and the pharmacist must ask for photo identification) and also maintain controlled substances in the closed system at the root of the régime intended by the Controlled Substances Act of 1970; the codeine in these products was a Schedule II substance when the company making the Schedule V product acquired it for mixing up the end-product.

In locales where dilute codeine preparations are non-prescription, anywhere from very few to perhaps a moderate percentage of pharmacists will sell these preparations without a prescription. However, many states have their own laws that do require a prescription for Schedule V drugs. The December 2008 issue of The Bulletin of the National Codeine OTC Lobby (Vol. XVIII, No. 4) listed 12 states with some kind of OTC access to codeine, noting that small independent pharmacies are the most likely to have it. This situation is roughly equivalent to that in February 1991, when the aforementioned organisation undertook its first comprehensive study of Schedule V and overall codeine, dihydrocodeine, ethylmorphine, and hydrocodone availability.

Other drugs that are present in Schedule V narcotic preparations like the codeine syrups are ethylmorphine and dihydrocodeine. Paregoric and hydrocodone were transferred to Schedule III from Schedule V even if the preparation contains two or more other active ingredients, and diphenoxylate is usually covered by state prescription laws even though this relative of pethidine is a Schedule V substance when adulterated with atropine to prevent abuse.

References

The sourced bit there is actually not supported by the source provided. -- Jytdog (talk) 19:49, 17 September 2016 (UTC)

Duplicate References

References 4 and 14 are identical references, so are 5 and 15. The duplicates should be removed and the reference points in the article need to be updated with the remaining reference numbers. 96.30.196.23 (talk) 16:41, 27 December 2016 (UTC)