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PubMed1985

Simultaneous high-performance liquid chromatographic stability-indicating analysis of acetaminophen and codeine phosphate in tablets and capsules.

A high-performance liquid chromatographic method has been developed for the simultaneous determination of acetaminophen and codeine phosphate for product stability studies, and release and dissolution testing of tablets and capsules. The reversed-phase method utilizes UV detection at 214 nm, a C18 column and requires a maximum of 10 min per analysis. The method has been validated for use with products containing as much as 500 mg of acetaminophen and as little as 7.5 mg of codeine phosphate. The known potential degradation products, p-aminophenol, codeine N-oxide, and codeinone are separated for quantitation simultaneous with the parent compounds. The method has been shown to be linear, reproducible, specific, sensitive and rugged.

Acetaminophen↗
PubMed1996

Histamine release in intact human skin by monocyte chemoattractant factor-1, RANTES, macrophage inflammatory protein-1 alpha, stem cell factor, anti-IgE, and codeine as determined by an ex vivo skin microdialysis technique.

BACKGROUND: The chemokines monocyte chemoattractant factor-1, RANTES, and macrophage inflammatory protein-1 alpha release histamine from human basophils, as well as rat and mouse mast cells. The purpose of this investigation was to determine whether these chemokines release histamine from human skin mast cells in situ. METHODS: A microdialysis technique was used to measure histamine release in skin. First, the model was validated by using anti-IgE, codeine, and stem cell factor (SCF); then the histamine-releasing effects of the chemokines were investigated. A total of 47 skin specimens from 41 donors were investigated. Hollow microdialysis fibers were inserted intradermally, and each fiber was slowly perfused (3 microliters/min). Anti-IgE, codeine, SCF, or chemokines were injected intradermally above individual fibers, and dialysate was collected at 2-minute intervals for 20 minutes. Each series of investigations comprised five to eight single experiments. RESULTS: Anti-IgE (4 to 4000 U/ml), codeine (0.001 to 1 mg/ml), and SCF (5.4 x (10(-11) to 10(-8) mol/L)) released histamine in a dose-dependent manner; maximum histamine release was 97.4, 116.3, and 9.5 pmol/20 min, respectively. Monocyte chemoattractant factor-1, RANTES, and macrophage inflammatory protein-1 alpha in concentrations of 10(-10) to 10(-6) mol/L did not release histamine; histamine release by 10(-6) mol/L chemokine was less than 0.2 pmol/20 min. None of the chemokines modulated anti-IgE-induced histamine release. In contrast, SCF significantly potentiated anti-IgE-induced histamine release by 33%. All chemokines, but not SCF, released histamine from human basophils. CONCLUSION: We conclude that the chemokines monocyte chemoattractant factor-1, RANTES, and macrophage inflammatory protein-1 alpha do not release histamine from human skin mast cells.

Aged↗
PubMed1999

A comparison of ketorolac tromethamine and acetaminophen codeine in the management of acute apical periodontitis.

Effective management of severe endodontic pain is often a major problem. The analgesic effect of ketorolac tromethamine (Toradol, 10 mg p.o.) was compared with acetaminophen codeine (325 mg/15 mg p.o.) in patients with severe pain due to acute apical periodontitis in a double-blind clinical study. A total of 66 patients presenting with severe pain (defined as 7 cm and more using a visual analog scale) were randomly assigned to receive either ketorolac tromethamine or acetaminophen codeine (33 patients in each group), and recorded their pain score once every 10 min for 90 min after administration. Results indicate that patients in the ketorolac group had significantly less pain than those who received acetaminophen codeine (p = 0.005).

Acetaminophen↗
PubMed1993

The effect of an ibuprofen-codeine combination for the treatment of patients with pain after removal of lower third molars.

A double-blind randomized crossover analgesic trial was carried out on 70 patients undergoing surgical removal of one lower third molar at each visit. The analgesic efficacy of a two-dose regimen of the combination ibuprofen-codeine, 400 to 60 mg, was compared with ibuprofen, 400 mg. Each of the two doses was taken when the patient needed pain relief and the pain intensity was measured on a visual analog scale during the 10-hour period after the first medication. Because of carryover effects between periods 1 and 2, the analysis was carried out only for period 1 according to a parallel group design. Of the 60 patients who were evaluated for analgesic effect, the mean pain reduction of dose 1 was 63% for the 29 patients given ibuprofen-codeine and 50% for the 31 patients given ibuprofen; the mean duration of effect was 7.5 and 6.3 hours, respectively. The difference in pain reduction index (pain reduction X duration of effect) between the two treatments was significant in favor of the combination, whereas the separate variables of pain reduction and duration of effect were not significantly different. The mean pain reduction was 67% after doses 1 and 2 for patients on ibuprofen-codeine and 52% for those on ibuprofen; the mean duration of effect was 9.4 and 9.2 hours, respectively. For doses 1 and 2, the difference in pain reduction index per dose between the two treatments was significant but not the difference for the separate variables, pain reduction, and duration of effect.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1998

Double-blind evaluation of short-term analgesic efficacy of orally administered diclofenac, diclofenac plus codeine, and diclofenac plus imipramine in chronic cancer pain.

A prospective double-blind randomized trial was conducted on 184 cancer patients with moderate to severe chronic pain to evaluate the analgesic efficacy and tolerability of diclofenac alone (50 mg q.i.d.) or in combination with a weak opioid (codeine 40 mg q.i.d.), or with an anti-depressant (imipramine, 10 or 25 mg t.i.d.). All demographic and clinical characteristics including cancer type, presence of bone metastases, baseline pain severity, neuropathic and nociceptive pain, and depressive state, were well balanced between the three treatment groups. The main analysis of the study was on the VAS scores at visit 2 (day 4). The mean VAS values for both associations imipramine plus diclofenac and codeine plus diclofenac were similar to the association placebo plus diclofenac. Patients on imipramine plus diclofenac and on placebo plus diclofenac were withdrawn mainly for inadequate efficacy, while patients on codeine plus diclofenac discontinued equally for inadequate efficacy or adverse events. In conclusion, in a short-term evaluation the addition of a tricyclic anti-depressant or a weak opioid to diclofenac did not provide further analgesia with respect to diclofenac administration alone.

Administration, Oral↗
PubMed1986

Simultaneous determination of codeine and chlorpheniramine in human plasma by capillary column gas chromatography.

A specific and highly sensitive capillary column gas chromatographic method was developed for the simultaneous determination of codeine and chlorpheniramine in human plasma. The method involves a solvent extraction and analysis by capillary column gas chromatography on a cross-linked 50% phenylmethyl silicone fused-silica capillary column with flame thermionic detection. A 10% solution of n-butanol in toluene was used as extraction medium and pyrilamine was used as internal standard. Reproducibility, linearity of calibration curves and specificity were all satisfactory with both drugs. The plasma concentration of codeine and chlorpheniramine could be measured at levels down to 0.9 ng/ml as codeine phosphate and 0.4 ng/ml as chlorpheniramine maleate, respectively. The method was applied to plasma samples from normal volunteers, and was confirmed to be adequate for biopharmaceutical and pharmacokinetic studies.

Adult↗
PubMed1999

Highly sensitive gas chromatographic-tandem mass spectrometric method for the determination of morphine and codeine in serum and urine in the femtomolar range.

A sensitive and specific method was developed for the determination of codeine and morphine in human serum and for the determination of trace amounts of endogenous morphine in human urine. The analytes were recovered from serum by a simple liquid-liquid extraction method. Urine samples were hydrolyzed, and purified by two liquid-liquid extraction steps and a solid-phase extraction. Samples were derivatized to the pentafluoropropionic esters and measured by gas chromatography tandem mass spectrometry. Using the deuterated analogues as internal standards a limit of quantification of 20 fmol/ml (5.7 pg/ml) morphine and 500 fmol/ml (150 pg/ml) codeine in human serum and of 2.5 fmol/ml (0.71 pg/ml) morphine in urine was achieved. The method was suitable for the determination of morphine and codeine in pharmacokinetic studies and for the determination of the urinary excretion of endogenous morphine.

Calibration↗
PubMed2001

Effect of an enteric-release formulation of naloxone on intestinal transit in volunteers taking codeine.

INTRODUCTION: Constipation is a common side-effect of opioid therapy; in addition to their analgesic effect, opioids reduce intestinal secretion and motility with an increase in whole-gut transit time. Naloxone, a specific opioid antagonist, reverses these effects but may also cause symptoms of opioid withdrawal in patients on long-term therapy. AIM: To use an enteric-release formulation, designed to produce a topical effect in the gut, with minimum systemic effects. METHODS: Naloxone 10 mg b.d. and codeine 30 mg b.d. were used with identical placebo capsules in four sets of studies; 12 male volunteers were given the drugs alone and in combination, with a control study involving double placebo, during each of four study periods. Whole-gut transit time was calculated and compared for each treatment period. RESULTS: Naloxone, both alone and with codeine, significantly shortened the mean whole-gut transit time compared with the control period, respectively, from 53.1 to 42.1 h (P=0.005) and to 40.7 h (P=0.024). Urgency to defecate was reported by two volunteers on naloxone alone and by three on combination therapy. CONCLUSIONS: The results show that the naloxone formulation counteracts the effect of codeine on intestinal transit, suggesting that it may have useful clinical applications.

Administration, Oral↗
PubMed1999

Comparison of morphine sulphate and codeine phosphate in children undergoing adenotonsillectomy.

We undertook a double-blind study to evaluate equianalgesic doses of intramuscular morphine sulphate (0.15 mg.kg-1) and codeine phosphate (1.5 mg.kg-1) in 40 healthy children undergoing adenotonsillectomy. There were no significant differences in pain scores, analgesic requirements or sedation scores between the two groups over the following 24 h. More children vomited in the morphine group (60%) than the codeine group (30%) between one and six h after the procedure (P < 0.05). Codeine phosphate is associated with less postoperative vomiting than morphine sulphate while providing comparable postoperative analgesia for adenotonsillectomy.

Adenoidectomy↗
PubMed1986

Presence and formation of codeine and morphine in the rat.

Endogenous codeine and morphine were identified in rat brain by immunological determination following HPLC. To demonstrate occurrence of a biosynthetic pathway to morphine in mammals similar to that used by the poppy plant, (+)-salutaridine, (-)-thebaine, and (-)-codeine were administered to rats intravenously. These compounds, which are intermediates in the synthesis of morphine in Papaver somniferum, caused a marked increase in the codeine and morphine levels in rat tissues. This provides evidence for a biosynthetic pathway to morphine in mammalians.

Animals↗
PubMed1988

Changes in pupil diameter after oral administration of codeine.

Pupillary constriction occurs following administration of opioids and may be used as a marker of opioid activity. We have measured plasma concentrations and pupil diameters in 16 healthy volunteers after the oral administration of placebo or codeine. Pupil size decreased significantly after codeine compared with placebo. Pupil size was related to the plasma concentrations of codeine (P less than 0.05).

Administration, Oral↗
PubMedDate not supplied

A closer look at acetyl and pentafluoropropionyl derivatives for quantitative analysis of morphine and codeine by gas chromatography/mass spectrometry.

PFPA and acetic anhydride derivatives of morphine and codeine were evaluated with respect to stability, chromatography, potential for analytical interferences by other opiates, and suitability of major fragment ions for analysis by GC/MS with deuterated internal standards and selected ion monitoring (SIM). The PFPA derivatives showed acceptable stability and could be analyzed without interference from other opiates, but the codeine derivative had relatively poor chromatography and its mass spectrum had only two ions suitable for SIM. The acetic anhydride derivatives were stable and chromatographed well, but diacetyl hydromorphone enol, a minor product of derivatization of hydromorphone, interfered with analysis of morphine. 3-Monoacetylmorphine, a minor product of derivatization of morphine, prevented use of the abundant m/z 285 ion of derivatized D3-codeine as a qualifying ion in quantitative assays. The acetic anhydride derivative of morphine cannot be distinguished from the corresponding derivative of the heroin metabolite 6-monoacetylmorphine.

Acetic Anhydrides↗
PubMedDate not supplied

The certification of morphine and codeine in a human urine standard reference material.

The National Institute of Standards and Technology (NIST, formerly the National Bureau of Standards) has developed and certified a Standard Reference Material, SRM 2381, for use in testing for bias in determinations of morphine and codeine in human urine. Each unit of this SRM consists of three vials with different levels of morphine and codeine in lyophilized urine. Three different analytical methods, employing GC/MS, LC/MS, and MS/MS, were used to certify the concentrations of each analyte. Results from the three methods were in good agreement and, therefore, were statistically combined to yield certified values of 138, 293, and 578 ng/mL for morphine and 134, 283, and 591 for codeine. A round-robin study on this material among nine military laboratories demonstrated the suitability of the SRM for its intended purpose.

Chromatography, Liquid↗
PubMedDate not supplied

Hydromorphone and hydrocodone interference in GC/MS assays for morphine and codeine.

The specificity of a GC/MS assay of morphine and codeine was examined with particular regard to the potential interference due to hydromorphone and hydrocodone, compounds that cross-react extensively in opiate screening tests. A GC/MS method with solid-phase extraction and acetylation or trimethylsilylation was used. The equilibrium between keto and enol forms of the potential interferents was evaluated. Sodium borohydride was tried as a means for converting potential interferents into products that are more clearly separated from morphine and codeine. It was found that borohydride reduction proceeded easily and led to products that could be distinguished from morphine and codeine. Moreover, the quantitation of morphine in the presence of hydromorphone was improved if the borohydride step was included in the analysis.

Acetylation↗
PubMed2000

The disposition of cocaine and opiate analytes in hair and fingernails of humans following cocaine and codeine administration.

This study investigated the disposition patterns of cocaine and opiates into hair and fingernail specimens collected from 8 volunteers enrolled in a 10-week inpatient clinical study. All subjects were African-American males with a confirmed drug use history. Scalp hair and fingernail scrapings were collected weekly throughout the course of the study. Head hair was collected from the posterior vertex region, and fingernail scrapings were collected along the entire ventral surface of the nail plate. The specimens were introduced to successive decontamination washes including an isopropanol wash and three phosphate buffer washes. All decontamination washes were collected and analyzed. All specimens were enzymatically digested prior to being subjected to solid-phase extraction and derivatization. Analyses were performed using electron impact gas chromatography-mass spectrometry. Analytes investigated included eight cocaine analytes and five codeine analytes. The limit of quantitation for all analytes ranged from 0.1 to 0.5 ng/mg for both matrices. Cocaine was present at the highest concentrations of any analyte in both hair and nail. Benzoylecgonine and ecgonine methyl ester were the primary metabolites in both matrices and were typically less than 15% of cocaine concentrations. Codeine was the only opiate analyte identified in either hair or nail. Observed drug disposition profiles were different for hair and nails. A significant dose-response relationship was observed for hair specimens. The mean peak concentrations in hair after low dosing were half the concentration observed after high-dose administration. Generally, no clear relationship was evident between nail drug concentrations and dose. Decontamination washes removed less than 20% of the total drug present in hair, but removed most of the drug concentrations (60-100%) in nail. This investigation demonstrated that higher concentrations of drug were found in the subjects' hair than in their fingernails and that cocaine was found in both matrices at a greater concentration than codeine. Although both hair and nail have similar physical and chemical properties and may share common mechanisms of drug incorporation, this clinical study suggests that there are distinct differences in their disposition profiles.

Area Under Curve↗
PubMed2001

Quantitation of morphine and codeine in human urine using high-filed asymmetric waveform ion mobility spectrometry (FAIMS) with mass spectrometric detection.

Morphine and codeine have been identified and measured in a human urine matrix using high-field asymmetric waveform ion mobility spectrometry (FAIMS) in a tandem combination with electrospray ionization (ESI) and mass spectrometric (MS) detection. The addition of helium to the nitrogen carrier gas resulted in a substantial improvement in the sensitivity of the ESI-FAIMS-MS instrument for the determination of morphine and codeine. Limits of detection in human urine were 60 ng/mL for morphine and 20 ng/mL for codeine with no clean-up, derivatization, or chromatographic separation of the sample prior to analysis.

Codeine↗
PubMed1989

A fatality involving secobarbital, nitrazepam, and codeine.

A fatal case involving the suicidal ingestion of secobarbital, nitrazepam, and codeine is presented. The drugs were quantified using gas chromatography for codeine and high-performance liquid chromatography for the two other drugs. The blood concentrations of secobarbital, nitrazepam, and codeine were found to be 11.48, 1.72, and 0.036 microgram/ml, respectively. Results are discussed in the light of the existing literature.

Adipose Tissue↗
PubMed1998

A comparison of the effects of intravenous tramadol, codeine, and morphine on gastric emptying in human volunteers.

UNLABELLED: We compared the effects of i.v. tramadol (1.25 mg/kg), codeine (1 mg/kg), morphine (0.125 mg/kg), and saline on gastric emptying in 10 healthy human volunteers using a double-blind, randomized, cross-over design. Subjects received one treatment at each of four sessions, 2 wk apart. Gastric emptying was studied using the paracetamol absorption test. There were significant differences when comparing all treatments for concentration-time data (P = 0.002), peak serum paracetamol concentrations (Cmax; P < 0.001), times at Cmax (Tmax; P = 0.003), and areas under the curves from Time 0 to 360 min (AUC(0-360); P = 0.049). Morphine profoundly inhibited gastric emptying. Tramadol had measurable but statistically insignificant inhibitory effects on gastric emptying compared with saline (mean +/- SEM: Cmax 22.4 +/- 2.2 vs 26.8 +/- 2.5 mg/L [P = 0.19], Tmax 33 +/- 5.4 vs 19.5 +/- 2.3 min [P = 0.054] for tramadol versus saline, respectively). Compared with morphine, the Cmax (P < 0.01), Tmax, and AUC(0-360) (P < 0.05) values for tramadol were significantly different. The Tmax value for codeine (63.3 +/- 11.7) was greater than that for tramadol (P = 0.034). We conclude that tramadol has a measurable but smaller inhibitory effect on gastric emptying compared with other opioids. IMPLICATIONS: We compared the effect of tramadol, an unconventional opioid painkiller, on stomach emptying with that of codeine and morphine in a human volunteer study. Tramadol had a measurable but smaller effect and may have clinical and economic advantages in acute pain management compared with conventional painkillers.

Acetaminophen↗