After extracting completely morphine and codeine from opizoic tablets with a mixture of 3 volumes of isopropanol and 7 volumes of chloroform, an HPLC method was used to determine simultaneously morphine and codeine in the extracts. The HPLC technique was carried out on the column Lichrosorb (4x250mm, 10m) with diode array detector or UV-detector at =285 nm and a mixture of 42 volumes of 0.24% sodium heptanesulfonat solution adjusted to pH=3.2 by phosphoric acid and 18 volumes of Acetonitrile as mobile phase at flow rate 1.0ml/min. The experimental results proved that the proposed HPLC method was rapid, specific, accurate and precise.
Morphine ; Codeine

After extracting completely morphine and codeine from liquid extract of opinum with a mixture of 3 volumes of isopropanol and 7 volumes of chloroform, an HPLC method was used to determine simultaneously morphine and codeine in the extracts. The HPLC technique was carried out on the column lichrosorb (4x250mm, 10 Mm) with diode array detector or UV- detector at landa = 285 nm and a mixture of 42 volumes of 0.24% sodium heptanesulfonat solution adjusted to pH = 3.2 by phosphoric acid and 18 volumes of Acetonitrile as mobile phase at flow rate 1.0 ml/min. The experimental results proved that the proposed HPLC method was rapid, specific, accurate and precise.
Morphine ; Codeine

Although various analgesics have been administrated for postoperative pain control, postoperative pain has not been adequately controlled . The purpose of this study was to evaluate the effects and patient's satisfaction of Myprodol(R)(combination analgesics with codeine, ibuprofen, paracetamol) compared to Acetamionphen and placebo drug after periodontal surgery and dental implant surgery. We studied 98 cases of outpatients which were composed of 67 cases of flap operation(which separated to 3 groups: Placebo group(n=25), Myprodol(R) group(n=22), Acetaminophen group(n=20)) and 21 cases of dental implant surgery(which separated to 3 groups : Placebo group(n=10), Myprodol(R) group(n=12), Acetaminophen group(n=9)). We evaluated the postoperative pain(Pain 1), Pain after first drug administraion(Pain 2), the degrees of pain reduction(pain 3), patient's satisfaction for drug, and side-effects. We obtained following results; 1. In Pain 1, making a comparison among groups, there was no significant difference in both cases of flap operation-group and dental implant surgery-group 2. In Pain 2, establishing a comparison among groups, there was no significant difference in flap operationgroup, but significant difference was seen between placebo group and Myprodol(R) group in cases of dental implant surgery group(P<0.05). 3. In Pain 3, making a comparison among groups, Myprodol(R) group showed significant differences compared to placebo group and Acetaminophen group in both cases of flap operation group and dental implant surgery group(P<0.05). 4. In patient's satisfactory score, making a comparison among groups, there were significant differences between placebo group and Myprodol(R) group in cases of flap operation group and between Myprodol(R) group and Acetaminophen group in cases of dental implant surgery group(P<0.05). 5. Making a comparison in side-dffect, no significant differrence was seen. Our conclusion is that Myprodol(R) is a effective oral analgesics to the patients who underwent periodontal surgery or implant surgery for it's synergism among three dugs.
Acetaminophen ; Analgesics ; Codeine ; Dental Implants* ; Humans ; Ibuprofen ; Outpatients ; Pain, Postoperative

BACKGROUND AND OBJECTIVES: Pain is one of most troublesome discomfort after tonsillectomy. Although various analgesics have been administrated for pain control, it has not been effectively controlled until now. This study was performed to evaluate the effectiveness of Myprodol(R) codein combination analgesics, on the pain control and time to return to normal daily activities. SUBJECTS AND METHOD: Ninety adult patients undergoing tonsillectomy were included in this study. Patients were randomly divided into a Myprodol(R) group (n=30), a NSAID group (n=30) and a codeine group (n=30). They received Myprodol(R) NSAID and codeine, respectively, from the 3rd to 14th postoperative days. On the 1st, 7th and 14th postoperative days, which consisted of rising, breakfast, lunch and supper time, we assessed pain intensity by visual analogue scale. And on the 21st postoperative day, we investigated time to return to normal daily activities and adverse effects of analgesics. RESULTS: When pain intensity on the 1st postoperative day was compared, there was no significant difference among 3 groups. On the 7th postoperative day, the Myprodol(R) group showed significant pain decrease compared with the codeine group but did not with the NSAID group. On the 14th postoperative day, the Myprodol(R) group showed significant pain decrease compared with both NSAID and codeine groups. The Myprodol(R) group also showed shortened recovery time compared with the others and there was no significant adverse effects in any of the groups. CONCLUSION: We find that Myprodol(R) is an effective and safe oral analgesics for pain control and shortens time to return to normal daily activities.
Adult ; Analgesics ; Breakfast ; Codeine ; Humans ; Lunch ; Meals ; Tonsillectomy

Fixed drug eruption is a distinctive and clinically recognizable entity that is characterized by well-demarcated erythematous plaques recurring in exactly the same sites as on previous occasions. Unlike the pigmenting form of fixed drug eruption, nonpigmenting fixed drug eruption leaves no pigmentation when it resolves. We now report the case of a 44-year-old man who presented with diffuse ill-defined erythematous patches on both hands, feet and lower legs with a burning sensation, which is considered an atypical manifestation for fixed drug eruption. The patient had a history of similar skin lesions developing after medications on the corresponding regions. The patch test with suspected drugs showed negative reactions on both lesions and unaffected sites. The lesions were reproduced on the oral provocation test with codeine and resolved without pigmentation. The patient was diagnosed with nonpigmenting fixed drug eruption due to codeine.
Adult ; Burns ; Codeine ; Drug Eruptions ; Foot ; Hand ; Humans ; Leg ; Patch Tests ; Pigmentation ; Sensation ; Skin

BACKGROUND: The discomfort caused by chronic cough, that is persistent for more than 3 weeks, causes a number of patients to seek medical attention. However, the underlying disorder often remains undetermined despite thorough examinations, and is considered to be idiopathic. This study compared the efficacy of inhaled corticosteroid with conventional cough suppressants on chronic idiopathic cough. METHODS: Eligible patients with chronic idiopathic cough were randomly assigned to either the inhaled fluticasone group or the codeine plus levodropropizine oral administration group. The subjects in each group took their planned medication for 2 weeks. After the trial, comparative analyses of outcomes were performed in terms of the remnant cough (%) at the end of treatment, drug compliance, and adverse drug events. RESULTS: Seventy-seven patients were enrolled in this randomized trial; 38 to the inhaled fluticasone group and 39 to the codeine plus levodropropizine group. The remnant cough was 41.0+/-35.8% in the inhaled fluticasone group, and 32.4+/-32.0% in the codeine+levodropropizine group (p=0.288). Drug compliance was 95.4+/-7.4% and 81.8+/-18.6% in the inhaled fluticasone and the codeine+levodropropizine group, respectively (p<0.001). Nine patients had adverse drug events in the codeine+levodropropizine group compared to one in the inhaled fluticasone group (p<0.001). CONCLUSION: Short-term inhaled corticosteroid is not inferior to conventional antitussive agents in controlling chronic idiopathic cough without significant adverse events.
Administration, Oral ; Androstadienes ; Antitussive Agents ; Codeine ; Compliance ; Cough ; Drug Toxicity ; Humans ; Propylene Glycols ; Fluticasone

BACKGROUND: The discomfort caused by chronic cough, that is persistent for more than 3 weeks, causes a number of patients to seek medical attention. However, the underlying disorder often remains undetermined despite thorough examinations, and is considered to be idiopathic. This study compared the efficacy of inhaled corticosteroid with conventional cough suppressants on chronic idiopathic cough. METHODS: Eligible patients with chronic idiopathic cough were randomly assigned to either the inhaled fluticasone group or the codeine plus levodropropizine oral administration group. The subjects in each group took their planned medication for 2 weeks. After the trial, comparative analyses of outcomes were performed in terms of the remnant cough (%) at the end of treatment, drug compliance, and adverse drug events. RESULTS: Seventy-seven patients were enrolled in this randomized trial; 38 to the inhaled fluticasone group and 39 to the codeine plus levodropropizine group. The remnant cough was 41.0+/-35.8% in the inhaled fluticasone group, and 32.4+/-32.0% in the codeine+levodropropizine group (p=0.288). Drug compliance was 95.4+/-7.4% and 81.8+/-18.6% in the inhaled fluticasone and the codeine+levodropropizine group, respectively (p<0.001). Nine patients had adverse drug events in the codeine+levodropropizine group compared to one in the inhaled fluticasone group (p<0.001). CONCLUSION: Short-term inhaled corticosteroid is not inferior to conventional antitussive agents in controlling chronic idiopathic cough without significant adverse events.
Administration, Oral ; Androstadienes ; Antitussive Agents ; Codeine ; Compliance ; Cough ; Drug Toxicity ; Humans ; Propylene Glycols ; Fluticasone

Temozolomide is an oral alkylating agent indicated for the treatment of patients with glioblastoma multiforme concomitantly with radiotherapy and subsequently as monotherapy treatment. We report the case of a patient who developed toxic epidermal necrolysis (TEN) while she was being treated with chemoradiotherapy and several drugs. Cutaneous tests were performed with the drugs involved with negative result. Although the occurrence of TEN contraindicates suspected drug readministration, we based the decision to perform the controlled administration of temozolomide on the following reasons: (1) the poor prognosis of the underlying disease, (2) the lack of therapeutic alternatives, (3) the suspicion that other drugs taken by the patient simultaneously may be responsible (as anticonvulsants and trimethoprim sulfamethoxazole [TMP-SMX]), and (4) temozolomide was the first choice for treating the patient's disease. The administration of a cumulative dose of 60 mg of temozolomide caused a slight skin reaction. Given this result, we conducted controlled administration of other drugs involved. Dexamethasone, codeine, omeprazole and levetiracetam were well tolerated. However, TMP-SMX produced a similar reaction to that caused by temozolomide. In conclusion, we present the first case of TEN induced by temozolomide and TMP-SMX associated with cranial radiotherapy confirmed by controlled administration. Radiotherapy in combination with these drugs could have favored TEN, as some authors have postulated, but we cannot prove this.
Anticonvulsants ; Chemoradiotherapy ; Codeine ; Dexamethasone ; Drug Hypersensitivity ; Glioblastoma ; Humans ; Omeprazole ; Prognosis ; Radiotherapy* ; Skin ; Stevens-Johnson Syndrome* ; Trimethoprim, Sulfamethoxazole Drug Combination

Objective: To estimate the consumption level of four drugs in Beijing using wastewater-based epidemiology (WBE). Methods: The primary sludge from one large wastewater treatment plants (WWTPs) was collected in Beijing from July 2020 to February 2021. The concentrations of codeine, methadone, ketamine and morphine in the sludge were detected through solid-phase extraction-liquid chromatography-tandem mass spectrometry. The consumption, prevalence and number of users of four drugs were estimated by using the WBE approach. Results: Among 416 sludge samples, codeine had the highest detection rate (82.93%, n=345) with a concentration [M (Q₁, Q₃)] of 0.40 (0.22-0.8) ng·g^-1, and morphine had the lowest detection rate (28.37%,n=118) with a concentration [M (Q₁, Q₃)] of 0.13 (0.09, 0.17) ng·g^-1. There was no significant difference in the consumption of the four drugs on working days and weekends (all P values>0.05). Drug consumption was significantly higher in winter than that in summer and autumn (all P values <0.05). The consumption [M (Q₁, Q₃)] of codeine, methadone, ketamine and morphine in winter was 24.9 (15.58, 38.6), 9.39 (4.57, 26.72), 9.84 (5.18, 19.45) and 5.67 (3.57, 13.77) μg·inhabitant^-1·day^-1, respectively. For these drugs, there was an upward trend in the average drug consumption during summer, autumn and winter (the Z values of the trend test were 3.23, 3.16, 2.19, and 3.32, respectively and all P values<0.05). The prevalence [M (Q₁, Q₃)] of codeine, methadone, ketamine and morphine were 0.0056% (0.003 4%, 0.009 2%), 0.0148% (0.009 6%, 0.026 7%),0.0333% (0.0210%, 0.0710%) and 0.0072% (0.003 8%, 0.011 7%), respectively. The estimated number of drug users [M (Q₁, Q₃)] was 918 (549, 1 511), 2 429 (1 578, 4 383), 5 451 (3 444, 11 642) and 1 173 (626, 1 925),respectively. Conclusion: Codeine, methadone, ketamine and morphine have been detected in the sludge of WWTPs in Beijing, and the consumption level of these drugs varies in different seasons.
Humans ; Beijing ; Wastewater-Based Epidemiological Monitoring ; Sewage/analysis* ; Wastewater ; Ketamine/analysis* ; Codeine/analysis* ; Methadone/analysis* ; Water Pollutants, Chemical/analysis*

The serotonin syndrome is a serioius medical condition due due to an intensive stimulation of setonin receptors. It is a rare, but severe, consequence of interaction between serotomimetic agents. This is a report of a 70-year-old woman steadily in therapy with venlafaxine and rizatriptan for migraine and major depressive syndrome. She was admitted to neurology unit for decreased light reflex with miotic pupils, global hyperreflexia, tremor, anxiety, ataxia and incoordination. The patient was diagnosed as a probable case of serotonin syndrome due to a pharmacological interaction between venlafaxine and rizatriptan trigged by opioid intake. In this paper, the development of syntomatology, the clinical examination and the possible pharmacokinetics explanation were carefully discussed and analysed.
Aged ; Anxiety ; Ataxia ; Codeine* ; Depressive Disorder ; Depressive Disorder, Major ; Female ; Humans ; Migraine Disorders ; Neurology ; Pharmacokinetics ; Prescription Drug Misuse ; Pupil ; Reflex ; Reflex, Abnormal ; Serotonin Syndrome* ; Serotonin* ; Tremor ; Venlafaxine Hydrochloride