If you are:
FDB Only When Necessary: NEONATAL WITHDRAWAL/RESP.DEPRESS. W/CHRONIC OR HIGH DOSE; SMALL TERATOGENIC RISK
FDB Contraindicated or Not Recommended: NO FDA CATEGORY; NOT RECOMMENDED ESPECIALLY IN 3RD TRIMESTER OR NEAR TERM
Only When Necessary: REPORTS OF MISCARRIAGE,POOR FETAL GROWTH POSSIBLY ASSOC W/HIGH DOSES OF CAFFEINE
Precaution: OTHER OPIATES EXCRETED IN MILK;LONG TERM EFFECTS ON NURSING INFANT UNKNOWN
Precaution: HIGH DOSES MAY CAUSE HYPERACTIVITY AND WAKEFULNESS IN INFANT.
Absolute Contraindication: ONE REPORT OF METABOLIC ACIDOSIS; RISK OF REYE'S SYND IN VIRAL ILLNESS.
An adult over 60:
management or monitoring precaution: Neuro/Psych-Avoid in elderly with insomnia due to CNS stimulation effects.
management or monitoring precaution: Gastrointestinal-Aspirin doses > 325 mg/day carry an increased risk for hemorrhage, GI bleed and ulceration. Lower doses preferred.
management or monitoring precaution: Pulmonary-Life threatening respiratory depression is more likely to occur with high doses, SR products, cachexia, or debilitation due to altered pharmacokinetics with poor fat stores, muscle wasting, or altered clearance. Monitor closely at initiation and with dose titration. Neuro/Psych-Risk for increased confusion and delirium. May increase fall risk. Avoid treatment with 3 or more CNS active drugs. Gastrointestinal-Constipation risk. Urogenital-Urinary retention risk.
Giving Aspirin-caffeine-dihydrocodein to a child under 12:
management or monitoring precaution: Adverse CNS effects of insomnia, restlessness, nervousness, and mild delirium, more severe in children.
Severe Precaution: Contraindicated post-surgical tonsillectomy or adenoidectomy age < 18 years. Contraindicated for any indication age < 12 years per Health Canada. Respiratory depression and death reported in CYP2D6 ultra-rapid metabolizer patients post tonsillectomy or adenoidectomy. Specific CYP2D6 genotypes convert codeine into morphine more rapidly and achieve high levels of morphine. Increased risk of CNS and respiratory depression especially with asthma or other underlying breathing problem.
Severe Precaution: Contraindicated for pain management post-surgical tonsillectomy and or adenoidectomy. Respiratory depression and death reported in CYP2D6 ultra-rapid metabolizer patients post tonsillectomy or adenoidectomy. Specific CYP2D6 genotypes convert codeine into morphine more rapidly and achieve higher levels of morphine even with standard dosing. Slow or difficult breathing risk in patients with asthma or other underlying breathing problem.
Severe Precaution: Reye syndrome risk with viral illness, fever, and/or flu symptoms.
management or monitoring precaution: Caution in: seizure disorder, cardiovascular disease, or in premature neonates with renal or hepatic impairment.