N02AJ06 - Codeine and Paracetamol |
Probably not porphyrinogenic |
PNP |
Rationale
Paracetamol: Low extent of oxidative metabolism. Inducer of CYP 3A4. Three references consider it safe. Occasional patient reports of suspected porphyrinogenicity, but vast and significant clinical experience of non-porphyrinogenicity. Codeine: Opioid substrate for CYP2D6 and 3A4. Several references consider it safe for use.
Chemical description
Paracetamol: Anilide (acetaminophen) derivative metabolized by conjugation with glucuronic acid and sulfate. A small part (<4%) is oxidatively metabolized by CYPs and excreted as cysteine and mercapto conjugates. At low concentrations inducer of CYP 3A4, increasing activity and content. Codeine: Opioide with analgetic and antitussive properties. Demetylated by CYP2D6 and 3A4. Inhibitor of 2D6.
Personal communication
Paracetamol: Thunell, patient inquiry: tolerated (n=28), possibly not tolerated (n=2).
Andersson C, patient inquiry: used without ill effects (n=18).
Used in Swedish porphyria ward.
IPNet drug reports
Paracetamol: Uneventful use reported in 430 patients with acute porphyria. Codeine: Uneventful use reported in 27 patients with acute porphyria.
Similar drugs
References
| # | Citation details | PubMed ID |
|---|---|---|
| 1. | Effects of antihypertensive drugs on hepatic heme biosynthesis, and evaluation of ferrochelatase inhibitors to simplify testing of drugs for heme pathway induction.
Anderson KE. Biochim Biophys Acta. 1978 Oct; 543(3):313-27.
|
708789 |
| 2. | The paradoxical effect of acetaminophen on CYP3A4 activity and content in transfected HepG2 cells
Feierman DE, Melnikov Z, Zhang J Arch Biochem Biophys. 2002 Feb 1;398(1):109-17.
|
11811955 |
| 3. | Drugs in the acute porphyrias--toxicogenetic diseases.
Moore MR, Hift RJ. Cell Mol Biol (Noisy-le-grand). 1997 Feb; 43(1):89-94.
|
9074793 |
| Porphyria Drug Lists | ||
| 4. | Australian List
Australian Porphyria Association No longer maintained
|
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| 5. | French List
Centre Français des Porphyries
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| 6. | EPI List
European Porphyria Initiative No longer maintained
|
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| 7. | South African List
Porphyria South Africa No longer maintained
|
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Tradenames
Paracetamol / Codeinefosfaat · Paracetamol/codeïnefosfaat / coffeïne 
Algocod · Dafalgan Codeine · Dafalgan Codeïne · Paracetamol / Codeine 
Claradol Codeine · Codoliprane · Dafalgan Codeine · Klipal · Lindilane · Paracetamol /cod pfb · Paracetamol cod 
Algidol · Analgilasa · Analgiplus · cod-Efferalgan · Coxumadol · Dolocatil Codeina · Dolomedil · Fludeten · Paracetamol / Codeina · Paracetamol/ Codeina · Talgo Codeina · Termaldina Codeina 
Parcodin 
co Efferalgan · co-Efferalgan · Codamol · Padeina · Paracetamolo e Codeina · Parycod · Tachidol · Zeuseff 
Co-Dafalgan 
Boots Tension Headache Relief · Co-codamol · Codasolve 8mg/500mg/30mg · Codipar · Emcozin · Feminax Period Pain · Kapake · Kapake Insts · Medocodene · Migraine Relief · Migraleve Yellow · Numark Co-codamol · Painex · Panadol Ultra · Paracodol · Propain Plus · Solpadeine · Solpadol · Syndol · Tylex · Zapain · Zipamol Plus 8mg/500mg effervescent tablets 
Kodipar · Pinex comp 
Altermol · Citodon · Codalvonil · Panocod · Paracetamol / Kodein 
Altermol · Kodein / paracetamol · Paralgin Forte · Paralgin Major · Pinex Forte 
Efferalgan Codeine · Klipal · Talvosilen · Talvosilen Forte 
Acetaminofen · Acetaminofén · Algimide · Aprix · Aprix-f · Bupiridol · Codalgen · Codefen · Pycdol · Winadeine 
. · Asparcod · Chemists' Own Tabsules · Co-codamol · Co-Codamol Forte · Codalgin · Codcomol · Codimyl · Codral · Codral New · Codricare · Day · Lemsip · Mersyndol · Mersyndol Day · Mersyndol Forte · Pain Relief Plus · Painstop Day-time · Pamol Plus · Panadeine · Panadeine Extra · Panadeine Plus · Panadeine Tension · Panalgesic · Paracetamol & Codeine · Paracetamol + Codeine · Paracetamol Plus · ParaCode · Paracodeine · Paracotene · pc · Pharmacist's Own · Pharmacist's Own Plus · Pirophen · Solpadeine · Veganin 
Acetaminophen · Acetaminophen Codeine · Emtec · Lenoltec · Triatec 
Parkódín · Parkódín forte 
Panacod · Paracetamol / Codeine · Paramax-Cod 
CoCodamol · Codeine hemihydrate / Paracetamol · Ultracod 
Co-Codamol · Paracetamol / codeine · Ultracod 
Algocalm · co-Codamol · Paracetamol / Codeine 
Korylan · Talvosilen · Talvosilen Forte · Ultracod