The chief concern is that of respiratory depression when larger doses are being used. Suggested dose guidelines given here will minimise the possibility of this and yet still give effective pain relief. Codeine is effective by mouth for mild to moderate pain and is usually taken in combination with paracetamol. Caution is needed when using this drug with neonates who may be more liable to respiratory depression. Codeine can be given by subcutaneous or intramuscular injection to provide pain relief for babies or children who are outpatients.
Doses are similar whichever route is chosen.
Codeine is effective when given by suppository. However, children between the ages of 2 and 12 may not always appreciate the virtues of giving the drug by this method. Codeine is not suitable for intravenous use as it can produce severe falls in blood pressure and apnoea. Morphine is the drug of choice for children who are inpatients. The preferred route of injection is intravenous but other routes can be used.