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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by NARCOLEPTIC on March 3, 2005, at 16:36:22
Took 15 mg of codeine for a dry cough post-flu. Never felt so alert and anxiety free in my life. No early-to-late afternoon sleepiness, mental fuzziness and limb weakness.
How weird is that!??
Although my name reads NARCOLEPTIC I have never been officially diagnosed as such.
Posted by Spriggy on March 3, 2005, at 17:33:18
In reply to Codeine produced the opposite effect!!!, posted by NARCOLEPTIC on March 3, 2005, at 16:36:22
I don't know how weird it is..
For some reason, if I take hydrocodone, I feel more alert but no anxiety ( I feel gooood) but if I take just codeine, I zonk out.I know if either of my kids' have to take a cough syrup with codeine, while one of my son's is bouncing off the walls and talking non stop.. my other son will sleep for 12 hours.
Brain chemistry is so different for everyone so drugs effect us all differently.
Posted by Phillipa on March 3, 2005, at 17:59:31
In reply to Re: Codeine produced the opposite effect!!!, posted by Spriggy on March 3, 2005, at 17:33:18
Codeine relaxes you, that's what makes it possible to rest and not cough so much I think. Fondly, Phillipa
Posted by NARCOLEPTIC on March 3, 2005, at 21:32:09
In reply to Re: Codeine produced the opposite effect!!!, posted by Phillipa on March 3, 2005, at 17:59:31
I know it relaxes me, that much is apparent, but the strange thing is that is feels very much like Ritalin but without the initial rush, its like being/ feeling so alive without euphoria everything has so much more detail......its very hard to explain.
Posted by Phillipa on March 3, 2005, at 22:39:23
In reply to Re: Codeine produced the opposite effect!!! » Phillipa, posted by NARCOLEPTIC on March 3, 2005, at 21:32:09
Sounds like something I could become addicted to quickly. I would love to feel like that. Fondly, Phillipa
Posted by gromit on March 4, 2005, at 2:07:29
In reply to Re: Codeine produced the opposite effect!!! » Phillipa, posted by NARCOLEPTIC on March 3, 2005, at 21:32:09
You aren't the only one, I can't take vicodin at night, it makes me really wired in a good way. Codeine does nothing for me though.
Posted by Larry Hoover on March 4, 2005, at 10:32:19
In reply to Codeine produced the opposite effect!!!, posted by NARCOLEPTIC on March 3, 2005, at 16:36:22
> Took 15 mg of codeine for a dry cough post-flu. Never felt so alert and anxiety free in my life. No early-to-late afternoon sleepiness, mental fuzziness and limb weakness.
>
> How weird is that!??
>
> Although my name reads NARCOLEPTIC I have never been officially diagnosed as such.Here's the probable explanation for that effect.
Codeine is actually a pro-drug, with respect to its most commonly expected effects. A pro-drug is an inactive form of the drug, which becomes active upon being transformed by enzymes in the body, usually the liver's cytochrome (P450) enzymes.
Codeine is O-desmethylated to morphine by cytochrome 2D6. Typical rates of desmethylation are 4% per hour. Under ordinary circumstances, codeine is really analogous to slow-release morphine.
However, the 2D6 enzyme is quite a freak, genetically. Inter-individual variation in the activity of the 2D6 enzyme differs by 118-fold. Not per cent. Times. 118-fold variation is a rate differential of 11,800 per cent.
There are well over 100 different forms (genetically distinct alleles) of the 2D6 enzyme yet identified, and I have no doubt that if they continue to look, they will find more.
People who have the fastest rates of 2D6 activity are called extensive metabolizers. Codeine ingested by these individuals rapidly becomes morphine; psychoactive effects far exceed analgesic ones. They are high, plain and simple.
On the other end of the spectrum are poor metabolizers. Poor metabolizers get all of the unintended effects of codeine itself (constipation, dry mouth, sedation) without any of the high, or sometimes, even any analgesic effect.
Variability in 2D6 activity is very much a part of some people's poor response to SSRI meds. Knowing how you react to codeine is a pretty good indicator of 2D6 activity, and should be a factor influencing medication selection in other realms of treatment.
Lar
Posted by ed_uk on March 4, 2005, at 10:36:54
In reply to Re: Codeine produced the opposite effect!!! » NARCOLEPTIC, posted by Larry Hoover on March 4, 2005, at 10:32:19
Hi,
>Codeine ingested by these individuals rapidly becomes morphine; psychoactive effects far exceed analgesic ones. They are high, plain and simple.
But they would also get a good analgesic effect. Morphine is an effective analgesic.
Ed.
Posted by ed_uk on March 4, 2005, at 10:47:27
In reply to Re: Codeine produced the opposite effect!!! » NARCOLEPTIC, posted by Larry Hoover on March 4, 2005, at 10:32:19
In fact, I think it is quite possible that extensive metabolisers are among the few people who *do* get a substantial analgesic effect from codeine at standard analgesic doses (30-60mg).
Unfortunately, most people do not seem to get a good analgesic effect from standard doses of codeine (on its own). In many cases, it is significantly less effective than other analgesics such as paracetamol (acetaminophen). Combining 60mg of codeine with 1000mg of paracetamol seems to be a useful combination though.
See codeine 60mg at the bottom of the analgesic 'league table'.
http://www.jr2.ox.ac.uk/bandolier/booth/painpag/Acutrev/Analgesics/lftab.html
Codeine 60mg NNT 16.7
Ed.
Posted by Hattree on March 4, 2005, at 17:43:32
In reply to Re: Codeine produced the opposite effect!!! » NARCOLEPTIC, posted by Larry Hoover on March 4, 2005, at 10:32:19
So if I get high and wide awake from Codeine, does that make me a good candidate for SSRIs or the reverse?
Posted by Larry Hoover on March 5, 2005, at 9:44:16
In reply to Re: Codeine produced the opposite effect!!! » Larry Hoover, posted by ed_uk on March 4, 2005, at 10:36:54
> Hi,
>
> >Codeine ingested by these individuals rapidly becomes morphine; psychoactive effects far exceed analgesic ones. They are high, plain and simple.
>
> But they would also get a good analgesic effect. Morphine is an effective analgesic.
>
> Ed.Ya. The analgesic dose is less than the psychoactive dose, though.
Lar
Posted by Larry Hoover on March 5, 2005, at 9:48:46
In reply to Re: Codeine produced the opposite effect!!! » Larry Hoover, posted by ed_uk on March 4, 2005, at 10:47:27
> In fact, I think it is quite possible that extensive metabolisers are among the few people who *do* get a substantial analgesic effect from codeine at standard analgesic doses (30-60mg).
>
> Unfortunately, most people do not seem to get a good analgesic effect from standard doses of codeine (on its own). In many cases, it is significantly less effective than other analgesics such as paracetamol (acetaminophen). Combining 60mg of codeine with 1000mg of paracetamol seems to be a useful combination though.
>
> See codeine 60mg at the bottom of the analgesic 'league table'.
>
> http://www.jr2.ox.ac.uk/bandolier/booth/painpag/Acutrev/Analgesics/lftab.html
>
> Codeine 60mg NNT 16.7
>
> Ed.Nice table.
Given this data, it seems absurd how often e.g. Tylenol 3 (30 mg codeine, 325 acetominophen/paracetamol) is prescribed for pain.
I had a shoulder surgery some years back, which involved a hammer, chisel, grinder, saw, and drill. They sent me home with T3's. Ya, right.
Lar
Posted by Larry Hoover on March 5, 2005, at 9:50:37
In reply to Re: Codeine/SSRIs » Larry Hoover, posted by Hattree on March 4, 2005, at 17:43:32
> So if I get high and wide awake from Codeine, does that make me a good candidate for SSRIs or the reverse?
Well, of those SSRIs which are cleared by 2D6, you'd likely need a higher than typical dose, and you may escape some side effects. There are a lot of factors which weigh on the side-effect issue, though.
It's been suggested that poor metabilizers at 2D6 are most likely to be intolerant of SSRIs.
Lar
Posted by ed_uk on March 5, 2005, at 10:15:58
In reply to Re: Codeine produced the opposite effect!!! » ed_uk, posted by Larry Hoover on March 5, 2005, at 9:44:16
Hi Lar :-)
>The analgesic dose is less than the psychoactive dose, though.
I think a lot of people can't form enough morphine from 60mg codeine to even get a good analgesic effect though.
>Given this data, it seems absurd how often e.g. Tylenol 3 (30 mg codeine, 325 acetominophen/paracetamol) is prescribed for pain.
We don't have that combination! We've got co-codamol 30/500 (30mg codeine, 500mg paracetamol). All our paracetamol tablets are 500mg - usual dose two tablets four times a day, I think the Americans like low dose tablets for some reason, I guess it's the same in Canada.
Best Regards,
Ed.
Posted by Larry Hoover on March 5, 2005, at 10:45:15
In reply to Re: Codeine » Larry Hoover, posted by ed_uk on March 5, 2005, at 10:15:58
> We don't have that combination! We've got co-codamol 30/500 (30mg codeine, 500mg paracetamol). All our paracetamol tablets are 500mg - usual dose two tablets four times a day, I think the Americans like low dose tablets for some reason, I guess it's the same in Canada.
>
> Best Regards,
> Ed.In the interest of thoroughness, Canada has a bizarre regulation that codeine cannot be in a medication unless there are at least two other active ingredients. For that reason, Canadian codeine tablets contain caffeine, as well as acetominophen or aspirin.
Lar
Posted by ed_uk on March 5, 2005, at 11:01:27
In reply to Re: Codeine » ed_uk, posted by Larry Hoover on March 5, 2005, at 10:45:15
>In the interest of thoroughness, Canada has a bizarre regulation that codeine cannot be in a medication unless there are at least two other active ingredients. For that reason, Canadian codeine tablets contain caffeine, as well as acetominophen or aspirin.
Hi Lar,
That's very weird! Don't you even have prescription-only codeine-only tablets? Our codeine tablets available on prescription come in 15mg, 30mg and 60mg strengths. Our OTC co-codamol 8/500 contains 8mg codeine and 500mg paracetamol, you can also get it with caffeine and various other drugs. Prescription-only co-codamol 30/500 contains 30mg codeine and 500mg paracetamol. A similar range of products containing dihydrocodeine are also available. We don't have Vicodin here, or anything else containing hydrocodone.
Ed.
Posted by Larry Hoover on March 5, 2005, at 12:09:01
In reply to Re: Codeine » Larry Hoover, posted by ed_uk on March 5, 2005, at 11:01:27
> >In the interest of thoroughness, Canada has a bizarre regulation that codeine cannot be in a medication unless there are at least two other active ingredients. For that reason, Canadian codeine tablets contain caffeine, as well as acetominophen or aspirin.
>
> Hi Lar,
>
> That's very weird! Don't you even have prescription-only codeine-only tablets? Our codeine tablets available on prescription come in 15mg, 30mg and 60mg strengths. Our OTC co-codamol 8/500 contains 8mg codeine and 500mg paracetamol, you can also get it with caffeine and various other drugs. Prescription-only co-codamol 30/500 contains 30mg codeine and 500mg paracetamol. A similar range of products containing dihydrocodeine are also available. We don't have Vicodin here, or anything else containing hydrocodone.
>
> Ed.OK, I retract what I said. I just checked the Health Canada database, and codeine tablets and syrup are in there. I read it somewhere, though, to explain the presence of caffeine in those analgesic tablets. <shrug>
Lar
Posted by ed_uk on March 5, 2005, at 13:10:23
In reply to Re: Codeine » ed_uk, posted by Larry Hoover on March 5, 2005, at 12:09:01
>I read it somewhere, though, to explain the presence of caffeine in those analgesic tablets. <shrug>
Hi Lar,
Maybe it just applies to OTCs. I suppose they are trying to reduce the ease at which codeine can be extracted from the tablets. You can still buy codeine syrup from some pharmacies in England, although most pharmacies don't sell it anymore.
Ed.
Posted by Larry Hoover on March 5, 2005, at 13:23:29
In reply to Re: Codeine » Larry Hoover, posted by ed_uk on March 5, 2005, at 13:10:23
> >I read it somewhere, though, to explain the presence of caffeine in those analgesic tablets. <shrug>
>
> Hi Lar,
>
> Maybe it just applies to OTCs. I suppose they are trying to reduce the ease at which codeine can be extracted from the tablets. You can still buy codeine syrup from some pharmacies in England, although most pharmacies don't sell it anymore.
>
> Ed.Ya, I thought of that, too. But that doesn't explain why codeine is in prescription strength formulations. We can buy 8 mg codeine tables OTC, just as you can. But 15 and up are script only, and they have caffeine as well. Who knows why.
Lar
Posted by ed_uk on March 5, 2005, at 13:27:39
In reply to Re: Codeine » ed_uk, posted by Larry Hoover on March 5, 2005, at 13:23:29
Hi Lar,
Things are strange in Canada!
Ed.
This is the end of the thread.
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