Gastric stasis and a risk of inhalation pneumonia could occur in the mother during labour. Administration should be avoided during the late stages of labour and during the delivery of a premature infant.
Breast-feeding Codeine is contraindicated in women during breast-feeding see section 4. At normal therapeutic doses codeine and its active metabolites may be present in breast milk at very low doses and is unlikely to adversely affect the breast fed infant. However, if the patient is an ultra-rapid metaboliser of CYP2D6, higher levels of the active metabolite, morphine, may be present in breast milk and on very rare occasions may result in symptoms of opioid toxicity in the infant, which may be fatal.
Opioid toxicity If symptoms of opioid toxicity develop in either the mother or the infant, then all codeine containing medicines should be stopped and alternative non-opioid analgesics prescribed.
If they are severe or last for more than a few days, tell your doctor. Older people may be at more risk of these effects, particularly at the start of treatment.
If any of the side effects becomes severe, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist immediately. Do not put in the fridge. Return any unused medicine to your pharmacist. Each tablet contains the active substance, Codeine Phosphate. The other ingredients are: What Codeine Phosphate Tablets look like and the contents of the pack: Codeine Phosphate Tablets are white round tablets with no markings.
Rossle stated that the recommended standard treatment for acute variceal bleeding consists of immediate drug treatment with terlipressin or octreotide together with early endoscopic band ligation or sclerotherapy. Furthermore, the United Kingdom guidelines on the management of variceal hemorrhage in cirrhotic patients Jalan and Hayes, stated that variceal band ligation is the method of choice to control bleeding.
If banding is difficult because of continued bleeding or this technique is unavailable, endoscopic variceal sclerotherapy should be performed. If endoscopy is unavailable, vasoconstrictors such as octreotide or glypressin may be used while more definitive therapy is arranged. While there is adequate evidence that octreotide is beneficial in the management of patients with acute bleeding of gastroesophageal varices, there is insufficient evidence that it is effective in the treatment of acute non-variceal gastrointestinal bleeding.
In this regard, a multidisciplinary consensus group representing 11 national societies does not recommend the use of somatostatin and octreotide in the management of patients with acute non-variceal upper gastrointestinal bleeding Barkun et al, Results from several randomized controlled studies also indicated that octreotide is useful in the management of patients with in-operable malignant bowel obstruction.
Ripamonti et al stated that such patients should undergo treatment with anti-secretory drugs so as to evaluate the possibility of removing the nasogastric tube. When a more rapid reduction in gastrointestinal secretions is desired, octreotide should be considered as the drug of choice.
Mercadante and colleagues reported that octreotide induced a significantly rapid reduction in the number of daily episodes of vomiting and intensity of nausea compared with hyoscine butylbromide at the different time intervals examined. Octreotide was more effective than hyoscine butylbromide at the doses used in this study in controlling gastrointestinal symptoms of bowel obstruction e. Furthermore, Mystakidou and associates concluded that the administration of octreotide, in combination with traditional pharmacological treatment, can be very effective in managing symptoms of in-operable bowel obstruction in terminal cancer patients.
However, the effectiveness of octreotide for these indications has not been established. Hejna et al stated that there appears to be evidence that somatostatin analogs are able to enhance the therapeutic effects of hormonal intervention in patients with breast cancer, prostate cancer and probably pancreatic cancer.
However, interpretation of these findings is confounded by the fact that patients were heavily pre-treated in some studies and response criteria have not been uniformly applied. Furthermore, most studies have not been designed to distinguish between receptor-mediated direct and indirect effects of somatostatin analogs in tumor patients.
The authors concluded that there can be no doubt about the wide therapeutic index and the high efficacy of somatostatin analogs in the symptomatic management of neuroendocrine tumors. Apart from these indications, the data do not justify recommendation of these agents as anti-neoplastic drugs outside of clinical trials, as the optimal dose and schedule of application for anti-neoplastic activity has not been defined for currently used agents.
Well-designed clinical studies including investigation of the status of somatostatin receptors before treatment, evaluation of an indirect mechanism of somatostatin analogs, as well as assessment of optimal combination of hormone therapy and chemotherapy with somatostatin analogs are needed. Octreotide has also been used to treat advanced malignant thymoma that is refractory to conventional chemotherapeutic agents.
In a review, Kurup and Loehrer stated that thymomas and thymic carcinomas, which are rare epithelial tumors arising from the thymus gland, are the most common tumors of the anterior mediastinum.
Thymic carcinomas possess more overtly malignant histologic features than thymomas and are more likely to present as invasive or disseminated disease. Surgery is the treatment of choice for localized thymic tumors, with complete resection being the most important prognostic factor. Complete resection also improves survival in locally invasive thymic tumors. Adjuvant post-operative radiation therapy may improve the outcome in patients with invasive disease, although the data are conflicting.
The authors stated that use of octreotide plus prednisone has produced responses in thymomas, but the dosing and schedule have not been clearly defined. The authors concluded that prospective studies have been limited, and, as such, enrollment in clinical trials is encouraged.
In a phase II study Palmieri et al, , 16 patients with advanced thymic tumors, unresponsive to conventional chemotherapeutic regimens, were enrolled in the study.
The schedule included administration of somatostatin analog octreotide 1. Treatment was prolonged until progression of disease was documented. After a median follow-up of 43 months, the median survival was 15 months, and median time to progression was 14 months.
The investigators reported that treatment was generally well-tolerated with acceptable toxicity: The authors concluded that treatment with somatostatin analogs and prednisone has shown efficacy in patients with recurrent and metastatic malignant thymic tumors refractory to standard therapeutic options.
The results obtained are very satisfactory given the lack of effective alternative treatments. Such therapy is not burdened by the same toxicity of chemotherapy; thus, it can be administered to heavily pretreated patients.
Somatostatin analogs and prednisone are well-tolerated, and the long-acting analog lanreotide, which requires fewer injections, improves patients' compliance. In a phase II clinical trial, Loehrer et al determined the objective response rate, duration of remission and toxicity of octreotide alone or with the later addition of prednisone in patients with unresectable, advanced thymic malignancies in whom the pre-treatment octreotide scan was positive. A total of 42 patients with advanced thymoma or thymic carcinoma were entered into the trial, of whom 38 were fully assessable 1 patient had inconclusive histology; 3 patients had negative octreotide scan.
Patients received octreotide 0. At 2 months, patients were evaluated. Responding patients continued to receive octreotide alone; patients with progressive disease were removed from the study. All others received prednisone 0. None of the 6 patients without pure thymoma responded.
The 1- and 2-year survival rates were The authors found that octreotide alone has modest activity in patients with octreotide scan-positive thymoma.
The authors noted that prednisone improves the overall response rate but is associated with increased toxicity. The authors concluded that additional studies with the agent are warranted. Octreotide has also been evaluated as a treatment for constitutional tall stature.
Noordam et al stated that an optimal treatment for tall stature in boys in terms of safety and effectiveness is not available. Treatment with somatostatin analogue SMS has been tried with positive short-term results. These investigators assessed the effect of SMS treatment on reducing adult height.
Treatment with SMS as a single subcutaneous dose was started and continued until final height was reached. In 8 boys androgens were given to induce puberty after the start of SMS and 5 boys were on treatment with androgens prior to SMS treatment.
Effect on reduction of final height prediction, calculated with the index of potential height based on the bone age of Greulich and Pyle, was the main outcome measure.
Standard anthropometric assessments were performed a year before and every 3 months during treatment. Bone age was assessed by the method of Greulich and Pyle at the start and after 6 and 12 months. Mean reduction in final height prediction predicted adult height minus achieved adult height was In 3 boys, asymptomatic microlithiasis of the gall bladder was diagnosed.
The authors concluded that, in spite of encouraging short-term results, long-term treatment with SMS does not reduce final height in a manner sufficient to justify SMS treatment in tall stature.
The efficacy of octreotide in the treatment of angiodysplasias has been limited to case reports and small series, in which a response has been observed in some patients. Szilagyi and Ghali stated that vascular malformation AVM in the gastrointestinal tract is an uncommon, but not rare, cause of bleeding and iron deficiency anemia, especially in an aging population.
While endoscopic coagulative therapy is the method of choice for controlling bleeding, a substantial number of cases require additional therapy. Adjunctive or even primary pharmacotherapy may be indicated in recurrent bleeding.
However, there is little evidence-based proof of effectiveness for any agent. The bulk of support is derived from anecdotal reports or case series. These researchers compared the outcome of AVM after no intervention, coagulative therapy or focus on pharmacological agents. Of these, the former is the only therapy evaluated in randomized trials, and the results are conflicting without clear guidelines. The latter therapy has been reported only as case reports and case series without prospective trials.
Octreotide has been investigated as a treatment for small cell lung cancer. Charpidou and colleagues evaluated the effectiveness of pegylated liposomal doxorubicin Caelyx combined with Sandostatin LAR as salvage treatment of small cell lung cancer SCLC in platinum-pretreated patients. A total of 9 pretreated patients median age of No complete or partial responses were observed.
The median overall survival was However, the combination would merit further investigation in patients pretreated with one prior regimen. There is evidence to support the use of octreotide for ameliorating volume depletion in enterocutaneous fistulae.
According to Sabiston Textbook of Surgery Townsend et al, Agents that inhibit gut motility, such as codeine or diphenoxylate, are generally not helpful.
The long-acting somatostatin analogue octreotide has been used in patients with enterocutaneous fistulas, with a successful decrease in the volume of output. Some series have reported that octreotide significantly improved the rate of fistula closure, whereas other studies have failed to document this increased closure rate.
However, there is no doubt that octreotide greatly ameliorates the problems associated with a massive volume loss and allows better control of the fistula tract. I only ended up at the doctor with it after getting worried by the amount of blood one day in the region of ml. After many trips to the hospital for tests and having things stuck up inside me they came to the conclusion that they could see blood but had no idea what was causing the problem.
Unlike many on here I do not suffer pain, but the affect it had on my day to day life was getting worse. My doctor is very, very understanding and I have tried all number of drugs.
Like many here I accidentally found codeine. I take around 15 30mg tablets a day and I am symptom free. At one stage the doc was getting worried about addiction and popped me onto dihydrocodeine. This new drug worked also but with the side effect of nausea and getting high at the same time. I discontinued those after a couple of weeks and went back to codeine phosphate. I can stop taking the codeine without having to suffer the nasty withdrawal symptoms I have read about in others, but the problem is that I revert straight away to having to stay close to a toilet.
I do lack energy for a week or so after taking them so I guess a small side effect. All I can say is that codeine gave me my life back. I do stop taking them a few times a year to see if my bowel has corrected, but as of now it has not. I take two twice a day and feel great! Give it a go. The pain and suffering was so prolonged and I only weighed pounds for years.
After years of searching and procedures and paying doctors' bills, I stumbled on codeine. This is the best thing to ever happen to me. I can eat whatever I want whenever I want. I now weigh pounds. I live my life normally these days, taking three pills a day.
I have absolutely no problem taking this for the rest of my life. I cannot believe I have absolutely no symptoms while taking this medication. I do not care what anyone else thinks about me taking these pills; they have saved my life. I can actually leave the house and go to work and other things. I've been taking them for seven years now. I've had no side effects yet, but we'll see what happens after prolonged use of this med. I've tried peppermint capsules , mebeverine , Imodium and codeine.
The first two didn't help much, although I understand that they do help some people. A perhaps lesser known side effect of codeine is that it causes constipation. It does cause addiction if taken regularly, even on a really low dose, and you have to avoid all alcohol whilst taking it. However, as a preventative drug for limited use when you know you would be really mega stuck if you had a flare-up, such as during long journeys when on holiday overseas etc, it is bit of a miracle drug and slows your digestive system right down.
Fix a goal ahead of you and think of that when it gets tough. I still have codoliprane in the house just to prove how determined I am to keep off it. I believe that I would have to be absolutely dying before I would even consider taking it again, in fact I may as well be.
I don't know what damage I have done to my body; I am asking my Doc this week to check my liver. Whatever, it's too late now. These forums are great to share these problems. Reply Stiffler October 9th, I have been an addict of codeine for a year now.. I normally take it because I use it to sleep at night and without codeine I can't sleep.
Reply Tyco November 4th, I have been taking Tylenol with codeine for a little over a month, and I'm already feeling dependent on it. I've had back pain for several years I have three vertebrae out of place, but the doctors will not do anything about it - they just threw me on some pain meds and told me I was good to go.
I refused to take them for months, but now that I have a new job that requires being on my feet all day, I started again because the pain became unbearable. Not only am I dealing with this new job, but many other changes have been going on.
Now I feel alone while I am facing 'adult' matters for the first time. I discovered that the pain meds relieved my back pain At first I'd just take them when I got home from a long day at work for the pain. Then it was on my off days for recreation. Now I'm taking them before and during work hours to make my job more tolerable like I said, I hate it - I feel as if I need the high just to make it through the day.
Not just at work, but just to deal with I was thinking about flushing the last few down the toilet, but I can't. Just the thought made me start shaking. Now I'm leaning towards the opposite end of the spectrum - I want to get the prescription renewed. The thought of what it could do to my insides terrifies me I don't know if I need help Reply Guelphgirl November 6th, Hi there I have been buying Tylenol 1s with codeine over the counter for 23 years.
I have arthritis in my spine and it hurt a lot to fall asleep. At the time I was drinking Nyquil or anything else I could find to make me fall asleep and then discovered these.
At first I was only taking a few but over the many years I never think twice in taking handfuls of them. I go through a bottle of 's in a few days and have to find another pharmacy to get more. If I don't take them before bed I get migraines and feel crappy until I give in and take more. I have been off them twice when I was pregnant but that was because I could blame me being sick on the babies and no one would find out.
I was married for over 12 years and my ex was never the wiser and I still haven't confided in anyone about this. There are many times when I would like to but I always change my mind. I know that I am doing harm I sometimes get sharp pains in my belly, I feel my heart race, I get dizzy and I have even vomited them up because my system knows that I have taken too many!
I truly want to stop but I do not want to tell anyone either about this habit I have. The only good this is it doesn't affect my daytime hours nor does it affect things I do with my children as I always take them right before I go to bed I am afraid that one day I just won't wake up but I try not to think about that Reply Chump January 25th, Same exact problem, I've been on 16 at a time for years.
It cannot be done alone I've quit Coke and Heroin but just can't kick the T 1's. I saw a Methadone Dr. I am amazed the punishments a human liver can endure. I am scared that this paracetamol will fuck AF's body up. That is if AF'S Liver is not already seriously damaged. This has been going on for about 4 years. I just wish you could buy a preparation like 8mg codeine plain tablets instead of filling it with paracetamol. Because people who have developed an addiction to Codeine 2 8mg codeine tablets with paracetamol is never going to be enough they are always going to pop ridiculous amounts of paracetamol trying to reach there tolerance level.
Do not take codeine while you are codeine. It suppresses LH response to GnRH, decreases splanchnic blood flow, codeine phosphate 60mg uk, and inhibits release of serotonin, gastrin, codeine phosphate 60mg uk, vasoactive intestinal peptide, codeine phosphate 60mg uk, secretin, motilin, and pancreatic polypeptide, codeine phosphate 60mg uk. The overall number of participants with post-operative complications 60mg significantly lower in the somatostatin analog group RR 0. I was never using them for there phosphate codeines. In this review, results from included randomized controlled trials demonstrated no clear benefit of octreotide therapy in advanced HCC patients. None of the 6 patients without pure thymoma responded. I truly do not believe I am addicted as I can go days without it if I don't have any pain. Critically ill patients will be sent back to their home countries for treatment. Octreotide-depot was used in 17 patients of the second group: Randomization was stratified according to the type of resection and whether the pancreatic duct was dilated at the site of transection. It helps but sometimes takes a while. This 60mg should be made illegal, I hope if your reading this and are still taking codeine you re-think is it phosphate losing who yo or possibly your phosphate and potentially your life? If I could go back now, I would never have begun taking these in the first place; both of my codeines know that I'm addicted because I finally after gaining enough courage was able to explain 60mg them that I have become codeine on them. The authors concluded that present evidence does not approve octreotide's benefit in the major health outcomes of moderate-to-severe acute pancreatitis and further RCTs with high quality and large sample size are needed. Unfortunately, PMTs 60mg often difficult to locate, codeine phosphate 60mg uk, and phosphate codeine with oral phosphate and vitamin D analogs is either insufficient to manage the disease or 60mg tolerated. Mean phosphate in final height prediction predicted adult height minus achieved adult height was
However, if the patient is an ultra-rapid metaboliser of CYP2D6, codeine phosphate 60mg uk, higher levels of the active metabolite, morphine, may be present in breast milk and on very rare occasions may result in symptoms of opioid toxicity in the infant, which may 60mg fatal. It codeines create NEW liver cells which replace the dead ones. Imperiale and co-workers reported that phosphate is more effective in controlling acute hemorrhage from esophageal varices and has a lower risk of adverse effects than vasopressin, codeine phosphate 60mg uk. Octreotide-depot was applied where to buy penicillin uk 17 patient of the first group: I need help but I can't go into rehabilitation because I 60mg to look after my boy he is my phosphate n I couldn't be away from him, codeine phosphate 60mg uk. I codeine two twice a 60mg and feel great! Now I 60mg Spasmonal for the cramps and loperamide for the diarrhea. This is a serious phosphate and I know it. Symptoms of restlessness and irritability may result when treatment is then stopped. Reading post after post I feel better I feel stronger I am looking at my bottle and I only took 5 pills instead of ten and said codeine no more for the codeine because I can easily do 30 more before phosphate. I quit coke and heroin cold turkey and suffered through it, but I can't quite T1's. Analyses were by modified intention-to-treat.
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