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可待因

Codeine

Codeine phosphate, Codeine sulfate

鴉片類促效劑 / 鎮痛藥 / 鎮咳藥POIMIVSC狗貓小型哺乳類

別名: Tylenol with Codeine · Empirin with Codeine · Pardale-V · Co-codamol (human combination) · Codeine phosphate hemihydrate · Codeini phosphas hemihydricus · Codeinii phosphas · Codeinum · Methylmorphine · Codeine sulfate

由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本

經審核的 v13 劑量證據

結構化劑量計算證據

Antitussive (extra-label)

1–2 mg/kgPO

須由已驗證獸醫確認

  • q6-12h

NA

必須同時考慮的臨床上下文 (2)
  • ■ This medicine may be given with food or on an empty stomach.
  • Store codeine sulfate tablets in light-resistant, well-closed containers at room temperature 15°C to 30°C (59°F-86°F).
受管制藥物須由已驗證獸醫確認formulary方案年份 2023審核 dose-audit-plumb-v13

劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。

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概覽

​可待因 (Codeine)​ 是一種菲衍生物鴉片類促效劑，在獸醫學中主要用作​鎮咳藥​（止咳）和輕度​鎮痛藥​。偶爾也用作止瀉劑。

  • ​鎮痛​：用於輕度至中度疼痛，通常在非類固醇消炎止痛藥 (NSAIDs) 無效或有禁忌時使用。
  • ​鎮咳​：對抑制無痰乾咳（例如氣管塌陷、慢性支氣管炎）非常有效。
  • ​止瀉​：可降低胃腸道蠕動。

​臨床要點​：雖然在人類醫學中廣泛使用，但可待因在犬隻的使用存在爭議。犬對口服可待因的吸收極差，且缺乏將其轉化為活性代謝物（嗎啡）的強效酵素途徑。因此，其在犬隻的鎮痛效果變異極大，通常被認為不如丁基原啡因 (Buprenorphine) 或美沙酮 (Methadone) 等其他鴉片類藥物。

作用機制

Codeine acts as a weak agonist at mu (μ) opioid receptors.

  • Analgesia: Binds to ​μ-receptors​ in the central nervous system → inhibits the release of excitatory neurotransmitters (such as Substance P) in ascending pain pathways → alters the perception of and response to pain.
  • Antitussive: Causes direct depression of the medullary cough center in the brainstem.
  • Antidiarrheal: Binds to enteric μ-receptors → decreases gastrointestinal motility and increases sphincter tone.
  • Metabolism Note: In humans, codeine is a prodrug metabolized by the enzyme CYP2D6 → morphine. Dogs lack significant CYP2D6-equivalent activity, relying mostly on codeine-6-glucuronide for any analgesic effect, which explains its limited efficacy in this species.

安全性與警告

禁忌症

  • Hypersensitivity to narcotic analgesics
  • Patients receiving monoamine oxidase inhibitors (MAOIs) like amitraz or selegiline
  • Diarrhea caused by toxic ingestion (until toxin is eliminated)
  • Repeated use in severe inflammatory bowel disease
  • Scorpion stings (Centruroides sculpturatus and C. gertschi) as it may potentiate venom
  • Combination products containing acetaminophen are STRICTLY CONTRAINDICATED in cats
  • Hypersensitivity to opioids
  • Severe respiratory depression or asthma
  • Cats (especially if using combination products containing paracetamol)

不良反應

  • Sedation (most common)
  • Constipation
  • Anorexia
  • Vomiting
  • Ileus
  • Biliary and pancreatic duct spasms
  • Respiratory depression (at high doses)
  • Cats: CNS stimulation, hyperexcitability, tremors, seizures
  • Nausea

注意事項

Use with caution in patients with hypothyroidism, severe renal insufficiency, Addison's disease, and in geriatric or severely debilitated patients.

Use with caution in patients with head injuries or increased intracranial pressure, and in those with acute abdominal conditions (e.g., colic) as it may obscure the diagnosis.

Use with extreme caution in patients suffering from respiratory disease or acute respiratory dysfunction (e.g., pulmonary edema secondary to smoke inhalation).

Warning: Opiates can increase plasma amylase and lipase values up to 24 hours following administration due to increased biliary tract pressure.

藥物相互作用

Anticholinergic drugs

May increase the chances of constipation developing

Antidepressants (TCAs/MAOIs)

May potentiate CNS depressant effects

CNS Depressants (anesthetics, antihistamines, phenothiazines, barbiturates, tranquilizers)

May cause increased CNS or respiratory depression

Quinidine

May inhibit the transformation of codeine to morphine in the liver, decreasing its efficacy

CNS Depressants (e.g., phenobarbital, diazepam)Moderate

Additive CNS and respiratory depression

SSRIs / MAOIsMajor

Increased risk of serotonin syndrome

CNS Depressants (e.g., sedatives, anesthetics, antihistamines)Major

Additive CNS and respiratory depression

Monoamine Oxidase Inhibitors (MAOIs)Major

May cause severe, unpredictable reactions (serotonin syndrome or severe respiratory depression)

監測

  • Efficacy (pain relief, reduction in coughing, or resolution of diarrhea)
  • Adverse effects (sedation, respiratory rate, GI signs)
  • Respiratory rate and depth
  • Level of sedation
  • Pain score or coughing frequency
  • Bowel movements (monitor for constipation)

藥物動力學

半衰期

貓Unknown狗1 - 2 hours

吸收

Very limited evidence of oral absorption in dogs. In humans, codeine salts are rapidly absorbed orally, with oral administration being about 2/3 as effective as parenteral. Onset of action is usually within 30 minutes.

分佈

Crosses the placenta and enters maternal milk.

代謝

Metabolized in the liver.

排除

Excreted into the urine.

過量

Opiate overdosage may produce profound respiratory and/or CNS depression. Other effects can include cardiovascular collapse, hypothermia, and skeletal muscle hypotonia.

  • Decontamination: Oral ingestions should be removed using standard gut removal protocols. Inducing vomiting should be attempted with caution due to rapid changes in CNS status.
  • Antidote: Naloxone is the agent of choice for treating respiratory depression. In massive overdoses, naloxone doses may need to be repeated, as its effects may diminish before subtoxic levels of codeine are attained.
  • Supportive Care: Mechanical respiratory support should be considered in cases of severe respiratory depression. Contact an animal poison control center for further guidance.

可用產品

劑型

  • Tablets
  • Oral solution/elixir
  • Parenteral injection
  • Combination products (with acetaminophen, aspirin, or guaifenesin)
  • 3 mg/5 ml paediatric linctus
  • 3 mg/ml linctus
  • 5 mg/ml syrup
  • 15 mg tablet
  • 30 mg tablet
  • 60 mg tablet

獸醫用

  • Pardale-V tablets (Combination: Paracetamol 400 mg + Codeine phosphate 9 mg)

人用標示

  • Codeine Phosphate Solution: 15 mg/5 mL
  • Codeine Sulfate Tablets: 15 mg, 30 mg & 60 mg
  • Codeine Phosphate Parenteral Injection: 15 mg/mL & 30 mg/mL
  • Codeine Phosphate Antitussives with expectorants (e.g., with guaifenesin)
  • Codeine Phosphate with Acetaminophen tablets (Tylenol® with Codeine #1, #2, #3, #4)
  • Codeine Phosphate with Aspirin tablets (Empirin® with Codeine #2, #3, #4)
  • Codeine linctus (3 mg/ml, 3 mg/5 ml)
  • Codeine syrup (5 mg/ml)
  • Codeine tablets (15 mg, 30 mg, 60 mg)

各地核准狀態

European Union✓ 已核准處方藥 · Controlled DrugEMA
🐕 Dogs

Availability of veterinary specific products varies by member state.

United Kingdom✓ 已核准處方藥 · Schedule 2 (pure codeine) or Schedule 5 (low dose combinations/linctus)VMD
🐕 Dogs

Classified as POM-V or POM depending on the specific product (e.g., Pardale-V is POM-V).

暫無法規資料: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU

儲存與穩定性

Codeine phosphate and sulfate tablets should be stored in light-resistant, well-closed containers at room temperature. Codeine phosphate injection should be stored at room temperature (avoid freezing) and protected from light. Do not use the injection if discolored or if it contains a precipitate.

飼主須知

  • ​請放置於兒童及寵物無法觸及處​：此為管制藥品。
  • ​對貓有毒​：​絕對不可​將任何含有乙醯胺酚 (Acetaminophen) 的產品（例如 Tylenol® with Codeine）給貓咪服用，這會導致迅速死亡。
  • ​副作用​：觀察是否有極度嗜睡、便秘、食慾不振或嘔吐。貓咪偶爾可能會變得異常過動、焦躁或出現顫抖。
  • ​何時應聯繫獸醫師​：若發現寵物行為、活動力有重大改變，或出現嚴重的胃腸道症狀，請立即向您的獸醫師報告。

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