IV codeine vs paracetamol/acetaminophen

[talaxandra]

A colleague asked me tonight about the merits of IV codeine vs paracetamol (acetaminophen for North American members). She was particularly interested in neuro patients, which is why she asked me (I work on a neuro ward). We only started using IV paracetamol a few years ago, and we don't use IV codeine - I don't think I've ever seen it, let alone used it - so I couldn't say anything useful. I tried googling for information and didn't come up with anything useful.

Now my curiosity's piqued - so do you use IV codeine and what do you think?

[GilaRRT]

You will hard pressed to find people who do not speak the queens English, using IV codeine or paracetamol. :chuckle

Codeine would not be a choice medication for a neuro patient IMHO.

-Respiratory depression can lead to hypercapnea, causing increased ICP and cerebral hypoxia with the hypoxemia related to the respiratory depression.

-Some patients simply lack the ability to metabolize codeine into it's active metabolite, and thus do not even benefit from the analgesic effects of codeine.

-Nausea and vomiting is frequently associated with codeine use and thus aspiration risk is a significant consideration.

-Constipation is also a consideration.

While many narcotic can cause the same problems, better agents exist IMHO.

Paracetamol given IV is actually a good consideration IMHO. I am unsure why we do not use it in the US. In addition, to analgesia effects without respiratory depression, paracetamol can help with hypothalamic alterations common in people with intracranial pathology. Typically, in the form of hyperpyrexia.