-IBIS-1.7.0-
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interactions
Codeine
Integrative Therapies

Definition

Codeine

generic name: Codeine phosphate

synonym: Codeine

trade name: Tylenol III®

type of drug: Narcotic pain reliever (analgesic); cough suppressant.

used to treat: Pain and cough; codeine is frequently combined with Tylenol or aspirin for more effective pain relief.

» Interactions:
herbs affecting drug performance: Salicylate-containing Herbs such as Betula lenta (Sweet Birch bark), Cimicifuga racemosa (Black Cohosh rhizome), Filipendula ulmaria (Meadowsweet flower), Gaultheria procumbens (Wintergreen leaves), Populus canadensis (Poplar bark and/or buds), and Salix spp. (Willow bark)
Note: See Herb Groups: "Immunologic: Salicylate-containing" for a full list of herbs in common use containing salicylates.

reports: It has been suggested by some authrorities that since salicylate-containing herbs can selectively precipitate some alkaloids, high doses of these herbs may impair the absorption of codeine.
(Brinker F. J Naturopathic Med 1997;7(2):14-20; Brinker F. 96, 99-100, 1997.)

• mechanism: Pharmacokinetic data on salicylate-containing herbs suggest that naturally occurring phenolic glycosides act pharmacokinetically as pro-drugs, with a much slower rise to maximum plasma concentrations than with aspirin and related salicylate drugs.In addition, the existence of several commercial codeine and aspirin combination preparations are listed in the literature (PDR 1999) and the bioavailability of the combination, e.g. Fiorinal with Codeine®, is listed as equivalent to the bioavailability of the separate components, suggesting that pharmokinetic interaction is unlikely.

• interaction concerns: Herbs high in salicylates should not be consumed concurrently with codeine administration as a general precaution against the possible reduction of bioavailability of the drug.

herbs affecting drug performance: Herbs containing Tannins such as Camellia sinensis (Green Tea and Black Tea), Arctostaphylos uva-ursi (Uva ursi), Juglans nigra (Black Walnut), Rubus idaeus (Red Raspberry), Quercus spp. (Oak), and Hamamelis virginiana (Witch Hazel)
Note: See Herb Groups: "GI Modifiers: Tannins" for full listing

mechanism: Herbs high which yield high amounts of tannins when extracted by hot water can precipitate alkaloids.Tannins may also complex proteins, carbohydrates and other large molecules, hence they may exert various effects on nutrient and drug availability. On the whole, specific data are lacking, although pH is a significant determinant of precipitate solubility.
Tannins will not precipitate low concentrations of alkaloidal salts in the presence of many gums present in plants such as Acacia, Agar, Aloe, Flax, Guar, Irish moss, Locust bean, Marshmallow root, Okra fruit, pectin powder, Psyllium seed husks and Slippery Elm bark.
(Brinker F. J Naturopathic Med 1997;7(2):14-20; Brinker F. 1997, 99-101.)

interaction concerns: Herbs high in tannins should not be consumed concurrently with codeine administration as a general precaution against the possible reduction of bioavailability of the drug.


Footnotes

Brinker F. Interactions of pharmaceutical and botanical medicines. J Naturopathic Med 1997;7(2):14-20.

Brinker F. Herb Contraindications and Drug Interactions. Sandy, OR: Eclectic Institute, Inc., 1997; 2nd Ed. 1998.

Various authors. Physicians Desk Reference®. 53rd edition. Medical Economics, 1999.