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Drilldown: Medicines

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Medicines > classes : Antipsychotic or Opioid or None

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generic:
Codeine (2)
brand:
None (16)
classes: (Click arrow to add another value)
mechanism:
Potent mu-opioid receptor agonist (6) · Phenothiazine D2 antagonist (5) · Mu-opioid receptor agonist (4)
uses:
None (53) · Antimanic, Antidepressive, Antisuicide (1) · Mild to moderate pain; cough suppression (low-dose). (1) · Pain, cough, disquiet (1) · '"`UNIQ--vote-0000152F-QINU`"' (1) · '"`UNIQ--vote-00001582-QINU`"' (1)
starting dose:
None (55) · 1 capsule (20/10 mg dextromethorphan/quinidine) PO once daily × 7 days, then 1 capsule BID (1) · 2 tablets (75 mg tramadol / 650 mg acetaminophen) PO every 4-6 hours as needed; maximum 8 tablets/day for ≤5 days (1) · Adult: 15–60 mg every 4 hours as needed. (1)
preparations:
None (55) · 20 mg dextromethorphan HBr / 10 mg quinidine sulfate capsules (1) · Tablet (15, 30, 60 mg); oral solution; combination products (with [[Acetaminophen|acetaminophen]] or ibuprofen). (1) · Tramadol/acetaminophen 37.5/325 mg tablets (1)
fda max:
None (55) · 1 capsule BID (40 mg DXM / 20 mg quinidine per day) (1) · 360 mg/day (1) · 8 tablets/d (300 mg tramadol / 2600 mg acetaminophen); 5-day duration limit per label (1)
routes:
None (55) · Oral (2) · PO (only formulation marketed in the US). (1)
onset:
None (55) · 30-60 minutes (1) · 30–60 min (PO) (1) · PBA episode reduction within 1-2 weeks (1)
duration:
None (55) · 12 hours (1) · 4-6 hours (1) · 4–6 hours (1)
halflife:
None (55) · 2.5–3 hours (1) · Dextromethorphan substantially prolonged by quinidine's CYP2D6 inhibition (typical extensive metabolizers see ~10× higher AUC); quinidine ~6-8 hours'"`UNIQ--ref-00001583-QINU`"' (1) · Tramadol ~5-7 hours (M1 metabolite ~9 hours); acetaminophen 1-3 hours'"`UNIQ--ref-00001530-QINU`"' (1)
bioavailability:
None (55) · Increased substantially via CYP2D6 inhibition'"`UNIQ--ref-00001584-QINU`"' (1) · Tramadol ~75% (oral); acetaminophen 85-98%'"`UNIQ--ref-00001531-QINU`"' (1) · ~50% (variable, CYP2D6-dependent for analgesic effect). (1)
pregnancy:
None (55) · Avoid; neonatal opioid withdrawal documented.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Avoid; risk of neonatal opioid withdrawal with chronic use; UM-mother breastfeeding contraindicated. (1) · Limited data; quinidine has been used in pregnancy as antiarrhythmic.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1)
legal:
None (55) · US Schedule II (single-entity); Schedule III–V (combination products by content). (1) · [[USLegal:Prescription only|Rx-only]] in US. Caution with QT-prolonging medicines (quinidine itself is class IA antiarrhythmic, and the dose here, though sub-antiarrhythmic, still contributes to QT)'"`UNIQ--ref-00001585-QINU`"' (1) · [[USLegal:Schedule IV|Schedule IV controlled substance]] in US (tramadol was reclassified from non-controlled to Schedule IV in 2014 after recognition of dependence risk) (1)

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