Positive evidence of fetus risks but benefits may outweigh risks in some cases
How it works
Mechanism information is still being processed. Check the DailyMed link in the sidebar for the official prescribing information.
Dosing & administration
Dosing varies by indication and patient profile. Always follow your institution's current prescribing guidelines.
Renal impairment
Consult protocols for adjustment.
Liver impairment
Consult protocols for adjustment.
Use during pregnancy
1st trimester
Avoid. Risk of NOWS with chronic use; prefer acetaminophen.
2nd trimester
Avoid if possible.
3rd trimester
Avoid. Neonatal respiratory depression and NOWS risk.
Clinical note
Avoid. Codeine is a prodrug converted by CYP2D6 to morphine. Ultra-rapid metabolizers produce excessive morphine, posing risk of neonatal opioid toxicity. In 2017, the FDA contraindicated codeine (and tramadol) for breastfeeding mothers due to neonatal deaths from morphine toxicity in infants of ultra-rapid metabolizers. In pregnancy, opioids carry risk of Neonatal Opioid Withdrawal Syndrome (NOWS), fetal growth restriction, and preterm birth with chronic use. For acute pain in pregnancy, acetaminophen is preferred. Short-term use of codeine near term poses additional risk of neonatal respiratory depression.
Breastfeeding
Contraindicated during breastfeeding. FDA issued contraindication in 2017 after neonatal deaths in infants of CYP2D6 ultra-rapid metabolizers.
