Role of codeine in palliative care

2011 ◽  
Vol 7 (5) ◽  
pp. 401-406 ◽  
Author(s):  
Eric Prommer, MD
Keyword(s):  
Palliative Care ◽  
Enzyme Activity ◽  
Analgesic Effect ◽  
Palliative Medicine ◽  
Essential Medicine ◽  
Essential Medicines ◽  
Combination Product ◽  
Moderate Pain ◽  
Μ Opioid Receptors

Codeine is designated as one of the essential medicines of palliative care for symptoms such as pain and diarrhea. Essential drugs for palliative care are drugs that are effective for the treatment of common symptoms in palliative medicine, easily available, and are affordable. Codeine is recommended for the management of mild to moderate pain and is available as a combination product or as a stand-alone opioid. It is a prodrug and exhibits an affinity to μ-opioid receptors 200 times lower than morphine. Codeine is metabolized in the liver to inactive metabolites, which account for 90 percent of the transformed product, and morphine, which accounts for 10 percent of the transformed product and provides the main analgesic effect. The production of morphine is dependent on cytochrome oxidase 2D6 enzyme activity, which may not be fully active in some populations. The purpose of this review is to examine the efficacy of codeine for common symptoms encountered in palliative medicine, which has led to its designation as an essential medicine for palliative care.

scholarly journals Ensuring Palliative Medicine Availability: The Development of the IAHPC List of Essential Medicines for Palliative Care

2007 ◽  
Vol 33 (5) ◽  
pp. 521-526 ◽  
Author(s):  
Liliana De Lima ◽  
Eric L. Krakauer ◽  
Karl Lorenz ◽  
David Praill ◽  
Neil MacDonald ◽  
...  
Keyword(s):  
Palliative Care ◽  
Palliative Medicine ◽  
Essential Medicines ◽  
Medicine Availability

Malignant diseases

2016 ◽  
Author(s):  
Richard D.W. Hain ◽  
Satbir Singh Jassal
Keyword(s):  
Central Nervous System ◽  
Palliative Care ◽  
Nervous System ◽  
Palliative Medicine ◽  
Detailed Examination ◽  
Solid Tumours ◽  
Malignant Diseases ◽  
Central Nervous System Tumours ◽  
Palliative Phase

With respect to palliative medicine, malignant diseases can be considered in three broad groups: haemopoietic malignancies, central nervous system tumours, and other solid tumours. The likelihood of needing referral for specialist palliative medicine is influenced by prognosis, as well as by incidence, and therefore change as outcomes improve. This chapter includes an easy-to-assimilate list of the commonest symptoms experienced by children with cancer, broken down by incidence. A detailed examination of the interface between oncology and palliative care is provided, with discussion of the primary fears experienced by patients and families, the transition from a curative to a palliative phase, and the role of chemotherapy in palliative cases.

Qualitative research

2015 ◽  
Author(s):  
Kate Flemming
Keyword(s):  
Qualitative Research ◽  
Palliative Care ◽  
Palliative Medicine ◽  
Mixed Methods Research ◽  
Evidence Based Practice ◽  
Evidence Based ◽  
Methodological Development ◽  
Clinical Questions ◽  
Developing Area

This chapter outlines the importance of qualitative research as a method to provide answers to clinical questions arising in palliative medicine. Rather than being a chapter about how to ‘do’ qualitative research, it is a chapter that seeks to outline the role and purpose of qualitative research for palliative care by looking at the kind of questions qualitative research can answer, exploring qualitative research and its relationship to evidence-based practice, the role of qualitative research within mixed methods research, and the developing area of the synthesis of qualitative research. It addresses some of the more practical aspects of searching for qualitative research and undertaking an appraisal of its quality, whilst acknowledging that these are contested areas undergoing methodological development. In exploring these issues it firmly establishes a place for qualitative research within evidence-based practice and for palliative medicine in particular.

Essential medicines for palliative care

2021 ◽  
pp. 13-18
Author(s):  
Lukas Radbruch ◽  
Liliana De Lima
Keyword(s):  
Palliative Care ◽  
World Health Organization ◽  
Essential Medicine ◽  
Essential Medicines ◽  
World Health ◽  
Health Conditions ◽  
Health Coverage ◽  
Loved One ◽  
The World ◽  
Health Organization

The World Health Organization defines essential medicines as those which satisfy the primary healthcare needs of the population. In 2013, the World Health Organization introduced a new section on medicines for pain and palliative care in the 18th edition of the Model List of Essential Medicine including 15 medicines for the most common symptoms in life-limiting health conditions. More recently, the Lancet Commission on palliative care developed an essential package which also includes equipment and human resources in addition to the essential medicines. The Lancet Commission specified that in order to achieve universal health coverage, coverage of the essential package is recommended by dedicated, pro-poor, public or publicly mandated funding and for all relevant health conditions. However, in many regions of the world, all or some of the essential medicines are not available at all, or if they are available in the country, they are regularly out of stock in the local pharmacy, out-of-pocket costs are so high that patients cannot afford the medicines, or whole families become impoverished buying treatment for their loved one. Problems with accessibility, affordability, and availability are particularly evident with opioid analgesics such as morphine. However, accessibility, affordability, and availability of essential medicines is a pivotal prerequisite for the delivery of quality palliative care.

scholarly journals Should Codeine Still be Considered a WHO Essential Medicine?

2021 ◽  
Vol 24 ◽  
pp. 329-335
Author(s):  
Boni Singu ◽  
Roger K Verbeeck
Keyword(s):  
Analgesic Effect ◽  
Low Dose ◽  
Clinical Evidence ◽  
Essential Medicine ◽  
Essential Medicines ◽  
World Health ◽  
Randomized Controlled ◽  
Health Organization ◽  
Available Information ◽  
Analgesic Response

Codeine continues to be widely used as an analgesic, antidiarrhoeal and antitussive agent. Its analgesic effect depends on its biotransformation to morphine, a strong opioid. The highly variable biotransformation of codeine to morphine, catalysed by CYP2D6, underlies the pronounced interindividual variability of its analgesic response. Randomized controlled trials have demonstrated that codeine administered alone has the poorest analgesic effect among all commonly used analgesics in acute postoperative pain. Moreover, it is highly unlikely that the low dose of codeine contributes to the pain-relieving effect of the non-opioid component in combination analgesic products. In addition, there is a lack of reliable clinical evidence to support the use of codeine as an antitussive in acute or chronic cough. Codeine use, through its active metabolite morphine, has the potential to lead to abuse and dependence. The World Health Organization (WHO) removed codeine from the essential medicines list for children in 2011. Based on the available information in the scientific literature on the efficacy and safety of codeine, the WHO should seriously consider removing it also from the list of essential medicines for adults, which would be a strong signal for all health professionals to prescribe and dispense codeine with the utmost caution.

Models of paediatric palliative care

2016 ◽  
Author(s):  
Richard D.W. Hain ◽  
Satbir Singh Jassal
Keyword(s):  
Palliative Care ◽  
Palliative Medicine ◽  
The Other ◽  
Paediatric Palliative Care ◽  
Other Hand ◽  
The World ◽  
The Uk

The UK has a variety of resources for children with life-limiting conditions that are perhaps unrivalled in the world. This is both good and bad. It offers the potential for children and their families to have choices about the location of their care. On the other hand, a multiplicity of agencies brings with it the risk of miscommunication and internecine strife. This chapter summarizes ideal models of palliative care, defining the four categories of life-limiting conditions in childhood and the role of paediatric palliative medicine specialists.

Palliative medicine: Historical record and challenges that remain

2016 ◽  
Author(s):  
David Clark
Keyword(s):  
Palliative Care ◽  
Palliative Medicine ◽  
Evidence Base ◽  
Central Place ◽  
Historical Record ◽  
Life Threatening Illness ◽  
The Face ◽  
Life Threatening ◽  
Global Coverage

With its growing recognition by the early decades of the twentieth century, palliative medicine was moving from the margins to a more central place within medicine. Much had been achieved and there was growing evidence of palliative care’s successes around the world. At the same time, there were ongoing concerns about the quality of the evidence base to support its practices. There were questions about the relationship between palliative care and end-of-life care. There was also the challenge of delivering good care to all who might need it in the face of serious and life-threatening illness in an era of population growth and ageing. There seemed to be many ways to conceptualize and deliver palliative care. Would this lead to global coverage and spread, and what would be the particular role of palliative medicine within the process? This chapter concludes with reflections on progress to date and challenges for the future.

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