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Palliative cancer care - cough - Management
What general information about codeine should I be aware of?

  • If the person is already taking a strong opioid such as morphine, do not try a weak opioid such as codeine. Instead an 'as required' dose of morphine solution should be used to relieve cough and, if this is beneficial, continue to use in this way, or increase the regular morphine dose [Twycross et al, 2002]. The 'as required' dose is a sixth of the total daily dose of regular morphine.
  • Codeine linctus BP 5 mL to 10 mL (15 mg to 30 mg) three to four times a day, or codeine phosphate tablets 30 mg to 60 mg three to four times a day can be taken for symptomatic relief of a dry cough [Twycross et al, 2002; Regnard and Hockley, 2004; BNF 53, 2007]. Doses of codeine 10 mg to 120 mg/day have been found to be effective in relieving the frequency and intensity of cough [Homsi et al, 2001].
  • Sugar-free brands of codeine linctus BP are available where preferred, and for people with diabetes.
  • Consider using codeine phosphate tablets if a dose requiring a large volume of linctus is required. Codeine phosphate tablets are not licensed for symptomatic relief of a dry or painful cough.
  • Codeine has the potential to cause gastrointestinal problems (e.g. constipation), and central nervous system (e.g. sedation) toxicity [Homsi et al, 2001; BNF 53, 2007]. People should be warned to avoid activities where drowsiness may be detrimental.
  • If codeine (or pholcodine) is ineffective, switch to morphine solution 5 mg to 10 mg every 4 hours and 'as required'.

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