Ridol

Codeine (Ridol) sulfate is an opioid analgesic indicated for the management of mild to moderately severe pain where the use of an opioid analgesic is appropriate.

Ophthalmic

Mydriasis and cycloplegia for refraction

Adult: Instill 1 or 2 drops of 2% solution, or 1 drop of 5% solution immediately before the procedure, repeat at 5-10-minute intervals if necessary.

Child: Instill 1 drop of 2% soln immediately before the procedure, repeat at 10-min intervals if necessary.

Ophthalmic

Uveitis

Adult: Instill 1-2 drops of 2% or 5% solution bid-tid up to every 3-4 hr as needed.

Child: 3 mth- 2 yr: instill 1 drop of 0.5% soln once daily or on alternate days. >2 yr: instill 1 drop of 1% or 2% soln bid.

Metamizole (Ridol) tablets are used for the treatment of pains of different origin and variable intensity: toothache, headache, arthralgia, neuralgia, myositis, mild to moderate visceral pain, high fever, not responding to other drugs.

Codeine (Ridol) is an opioid pain medication. An opioid is sometimes called a narcotic.

Codeine (Ridol) is used to treat mild to moderately severe pain.

Codeine (Ridol) may also be used for purposes not listed in this medication guide.

Widening (dilating) the pupils for an eye exam or to treat certain inflammatory conditions of the eye. It may also be used for other conditions as determined by your doctor.

Homatropine (Ridol) drops is an anticholinergic agent. It works by blocking the chemical acetylcholine, which relaxes the ciliary muscle of the eye and causes the pupil to dilate.

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet,

Oral, as sulfate:

Generic: 15 mg, 30 mg, 60 mg

Dosing: Adult

Pain management (analgesic):

Injection [Canadian product]:

Opioid-naive patients: IM, SubQ: 30 to 60 mg every 4 to 6 hours as needed (use the lowest effective dose for the shortest period of time necessary)

Conversion from oral Codeine (Ridol) or another opioid: IM, SubQ: Refer to product labeling for dose conversions.

Oral: Note:

Immediate release (tablet, oral solution [Canadian product]): Initial: 15 to 60 mg every 4 hours as needed; maximum total daily dose: 360 mg/day; patients with prior opioid exposure may require higher initial doses. Note: The American Pain Society recommends an initial dose of 30 to 60 mg for adults with moderate pain (American Pain Society 2016).

Controlled release: Codeine (Ridol) Contin [Canadian product]: Note: Titrate at intervals of ≥48 hours until adequate analgesia has been achieved. Daily doses >600 mg/day should not be used; patients requiring higher doses should be switched to an opioid approved for use in severe pain. In patients who receive both Codeine (Ridol) Contin and an immediate release or combination Codeine (Ridol) product for breakthrough pain, the rescue dose of immediate release Codeine (Ridol) product should be ≤12.5% of the total daily Codeine (Ridol) Contin dose.

Opioid-naive patients: Initial: 50 mg every 12 hours

Conversion from immediate release Codeine (Ridol) preparations: Immediate release Codeine (Ridol) preparations contain ~75% Codeine (Ridol) base. Therefore, patients who are switching from immediate release Codeine (Ridol) preparations may be transferred to a ~25% lower total daily dose of Codeine (Ridol) Contin, equally divided into 2 daily doses every 12 hours.

Conversion from a combination Codeine (Ridol) product (eg, Codeine (Ridol) with acetaminophen or aspirin): See table:

Conversion from another opioid analgesic: Using the patient's current opioid dose, calculate an equivalent daily dose of immediate release Codeine (Ridol). A ~25% lower dose of Codeine (Ridol) Contin should then be initiated, equally divided into 2 daily doses.

Discontinuation of therapy: When discontinuing chronic opioid therapy, the dose should be gradually tapered down. An optimal universal tapering schedule for all patients has not been established (CDC [Dowell 2016]). Proposed schedules range from slow (eg, 10% reductions per week) to rapid (eg, 25% to 50% reduction every few days) (CDC 2015). Tapering schedules should be individualized to minimize opioid withdrawal while considering patient-specific goals and concerns as well as the pharmacokinetics of the opioid being tapered. An even slower taper may be appropriate in patients who have been receiving opioids for a long duration (eg, years), particularly in the final stage of tapering, whereas more rapid tapers may be appropriate in patients experiencing severe adverse events (CDC [Dowell 2016]). Monitor carefully for signs/symptoms of withdrawal. If the patient displays withdrawal symptoms, consider slowing the taper schedule; alterations may include increasing the interval between dose reductions, decreasing amount of daily dose reduction, pausing the taper and restarting when the patient is ready, and/or coadministration of an alpha-2 agonist (eg, clonidine) to blunt withdrawal symptoms (Berna 2015; CDC [Dowell 2016]). Continue to offer nonopioid analgesics as needed for pain management during the taper; consider nonopioid adjunctive treatments for withdrawal symptoms (eg, GI complaints, muscle spasm) as needed (Berna 2015; Sevarino 2018).

Cough in select patients (off-label use):

Oral: Reported doses vary with a range of 7.5 to 120 mg/day as a single dose or in divided doses; however, evidence is of low quality (ACCP [Bolser 2006]; Smith 2010). Some experts recommend 30 to 60 mg 4 times daily in specific patient populations (eg, lung cancer) (ACCP [Molassiotis 2017]). Additional data may be necessary to further define the role of Codeine (Ridol) in this condition.

Diarrhea (persistent) (palliative care) (off-label use):

Oral: 15 to 30 mg every 4 hours as needed (von Gunten 2013). Additional data may be necessary to further define the role of Codeine (Ridol) in this condition.

Restless leg syndrome (off-label use):

Oral: Initial: 30 mg once daily at bedtime or during the night; may increase to 60 mg if needed; maximum dose: 180 mg in 2 to 3 divided doses. May be used alone or in combination with other medications used to treat RLS (Earley 2003; Sandyk 1987; Silbers 2013; Walters 2001).

Dosing: Geriatric

Refer to adult dosing. Use with caution and consider initiation at the low end of the dosing range; reduced initial dosages may be necessary.

Dosing: Pediatric

Note: Codeine (Ridol) 30 mg/5 mL oral solution has been discontinued in the US for more than 1 year. Doses should be titrated to appropriate analgesic effect; use the lowest effective dose for the shortest period of time:

Pain management; analgesia: Limited data available: Note: Use is contraindicated in pediatric patients <12 years of age and for postoperative management in pediatric patients 12 to 18 years of age who have undergone tonsillectomy and/or adenoidectomy. Avoid Codeine (Ridol) use in all pediatric patient populations in which it is contraindicated and in pediatric patients 12 to 18 years of age who have other risk factors that increase risk for respiratory depression associated with Codeine (Ridol) (eg, conditions associated with hypoventilation like postoperative status, obstructive sleep apnea, obesity, severe pulmonary disease, neuromuscular disease, use of other medications known to depress respiratory drive); in rare cases in which Codeine (Ridol)-containing product is the only option, consider genotype testing prior to use; use extra precaution; monitor closely for adverse effects. Codeine (Ridol) has been associated with reports of life-threatening or fatal respiratory depression in children and adolescents; multifactorial causes have been identified; of primary concern are unrecognized ultrarapid metabolizers of CYP2D6 who may have extensive conversion of Codeine (Ridol) (prodrug) to morphine and thus increased opioid-mediated effects. Avoid Codeine (Ridol) use in pediatric patient populations in which it is contraindicated; in rare cases in which Codeine (Ridol)-containing product is the only option, consider genotype testing prior to use; use extra precaution; monitor closely for adverse effects (AAP [Tobias 2016]; Dancel 2017; Gammal 2016; Goldschneider 2017; Poonai 2015).

Children and Adolescents:

Oral: 0.5 to 1 mg/kg/dose every 4 to 6 hours as needed; maximum single dose: 60 mg/dose (APS 2016)

Usual Adult Dose for Refraction

Instill 1 to 2 drops in the eye once. May repeat in 5 to 10 minutes if necessary. The lacrimal sacs should be compressed by digital pressure for a few minutes after instillation.

Usual Adult Dose for Uveitis

Instill 1 to 2 drops into the affected eye up to every 3 to 4 hours. The lacrimal sacs should be compressed by digital pressure for a few minutes after instillation.

Usual Pediatric Dose for Refraction

Only the 2% strength should be used in children:

Instill 1 to 2 drops in the eye once. May repeat in 5 to 10 minutes if necessary. The lacrimal sacs should be compressed by digital pressure for a few minutes after instillation.

Usual Pediatric Dose for Uveitis

Only the 2% strength should be used in children:

Instill 1 to 2 drops into the affected eye up to every 3 to 4 hours. The lacrimal sacs should be compressed by digital pressure for a few minutes after instillation.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Dialysis

Data not available

The dosing regimen of Metamizole (Ridol) is individual. When this medication is administered orally of the single dose is 20-40 mg. The daily dose is 20-80 mg, the frequency of use is 1-2 times / day. The duration of treatment is 2-8 weeks.

See also:
What is the most important information I should know about Codeine (Ridol)?

Codeine (Ridol) Sulfate is contraindicated for postoperative pain management in children who have undergone tonsillectomy and/or adenoidectomy​​.

Codeine (Ridol) Sulfate is contraindicated in patients with known hypersensitivity to Codeine (Ridol) or any components of the product. Persons known to be hypersensitive to certain other opioids may exhibit cross-sensitivity to Codeine (Ridol).

Codeine (Ridol) Sulfate is contraindicated in patients with respiratory depression in the absence of resuscitative equipment​​.

Codeine (Ridol) Sulfate is contraindicated in patients with acute or severe bronchial asthma or hypercarbia.

Codeine (Ridol) Sulfate is contraindicated in any patient who has or is suspected of having paralytic ileus.

See also:
What is the most important information I should know about Homatropine (Ridol)?

Contraindicated in persons with primary glaucoma or a tendency toward glaucoma, e.g., narrow anterior chamber angle, and in those persons showing hypersensitivity to any component of this preparation.

Active gastroduodenal ulcer, liver failure, hepatitis, nephritis, blood dyscrasias, cardiac failure, oliguria. Do not be administered for prolonged periods. Metamizole (Ridol) magnesium (Metamizole (Ridol)) has not administered in case of allergy to pyrazolone (eg, hypersensitivity to drugs with Metamizole (Ridol) magnesium, isopirina, propyphenazone, phenazone or phenylbutazone), and certain metabolic disorders (hepatic porphyria, congenital deficiency of glucose-6-phosphate dehydrogenase), patients with hypersensitivity to analgesics (pain relievers asthma) infants during the first three months and less than 5 kg of weight, patients with blood pressure below 100 mm Hg or movement unstable hematopoiesis and injured patients.

Use Homatropine (Ridol) drops as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• An extra patient leaflet is available with Homatropine (Ridol) drops. Talk to your pharmacist if you have questions about this information.
• To use Homatropine (Ridol) drops in the eye, first, wash your hands. Tilt your head back. Using your index finger, pull the lower eyelid away from the eye to form a pouch. Drop the medicine into the pouch and gently close your eyes. Immediately use your finger to apply pressure to the inside corner of the eyelid for 1 to 2 minutes. Do not blink. Remove excess medicine around your eye with a clean, dry tissue, being careful not to touch your eye. Wash your hands to remove any medicine that may be on them.
• To prevent germs from contaminating your medicine, do not touch the applicator tip to any surface, including the eye. Keep the container tightly closed.
• If you miss a dose of Homatropine (Ridol) drops, use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not use 2 doses at once.

Ask your health care provider any questions you may have about how to use Homatropine (Ridol) drops.

Use: Labeled Indications

Pain management: Management of mild- to moderately-severe pain

Limitations of use: Reserve Codeine (Ridol) for use in patients for whom alternative treatment options (eg, nonopioid analgesics, opioid combination products) are ineffective, not tolerated, or would be otherwise inadequate.

Off Label Uses

Cough in select patients

In a metaanalysis of trials evaluating the treatment of chronic cough, the use of Codeine (Ridol) demonstrated efficacy in patients with this condition.

Homatropine (Ridol) is used to widen the pupil before eye examination, before and after certain eye surgeries, and to treat certain eye conditions.

Metamizole (Ridol) is used to treat pain of different origins such as toothache, headache, visceral pain or high fever. It is also used to treat severe pain associated with surgeries, cancer or stomach problems.

See also:
What other drugs will affect Codeine (Ridol)?

When this drug applied simultaneously with:

- drugs have a depressing effect on the central nervous system (including those with opioid analgesics, barbiturates, benzodiazepines, clonidine) it is possible an increase the action of Codeine (Ridol).

- derivatives of morphine it may increased the inhibitory action on the respiratory center; ibuprofen - analgesic effect is enhanced; carbamazepine - it may increased the analgesic effect is apparently due to increased formation of Codeine (Ridol) metabolite normorphine, which has a stronger effect.

- quinidine the analgesic effect of Codeine (Ridol) decreased or almost disappeared.

- Codeine (Ridol) increases the effect of ethanol on psychomotor function.

When atropine and pralidoxime are used together, the signs of atropinization (flushing, mydriasis, tachycardia, dryness of the mouth and nose) may occur earlier than might be expected than when atropine is used alone because pralidoxime may potentiate the effect of atropine.

The following precautions should be kept in mind in the treatment of anticholinesterase poisoning although they do not bear directly on the use of atropine and pralidoxime. Since barbiturates are potentiated by the anticholinesterases, they should be used cautiously in the treatment of convulsions.

With the simultaneous use with inducers of microsomal liver enzymes, means having hepatotoxic effect, increasing the risk of hepatotoxic action of paracetamol.

With the simultaneous use of anticoagulants may be slight to moderate increase in prothrombin time.

With the simultaneous use of anticholinergics may decrease absorption of paracetamol.

With the simultaneous use of oral contraceptives accelerated excretion of paracetamol from the body and may reduce its analgesic action.

With the simultaneous use with urological means reduced their effectiveness.

With the simultaneous use of activated charcoal reduced bioavailability of paracetamol.

When Metamizole (Ridol) Mount Mettur Pharmaceuticals applied simultaneously with diazepam may decrease excretion of diazepam.

There have been reports about the possibility of enhancing mielodepression effect of zidovudine while applying with paracetamol. A case of severe toxic liver injury.

Described cases of toxic effects of paracetamol, while the use of isoniazid.

When applied simultaneously with carbamazepine, phenytoin, phenobarbital, primidonom decreases the effectiveness of paracetamol, which is caused by an increase in its metabolism and excretion from the body. Cases of hepatotoxicity, while the use of paracetamol and phenobarbital.

In applying cholestyramine a period of less than 1 h after administration of paracetamol may decrease of its absorption.

At simultaneous application with lamotrigine moderately increased excretion of lamotrigine from the body.

With the simultaneous use of metoclopramide may increase absorption of paracetamol and its increased concentration in blood plasma.

When applied simultaneously with probenecid may decrease clearance of paracetamol, with rifampicin, sulfinpyrazone - may increase clearance of paracetamol due to increasing its metabolism in the liver.

At simultaneous application of Metamizole (Ridol) Mount Mettur Pharmaceuticals with ethinylestradiol increases absorption of paracetamol from the gut.

Enhances the effect of indirect anticoagulants (coumarin derivatives and indandione). Antipyretic and analgesic activity of caffeine increases, reduce - rifampicin, phenobarbital and alcohol (accelerated biotransformation, inducing microsomal liver enzymes).

See also:
What are the possible side effects of Codeine (Ridol)?

Applies to Codeine (Ridol): oral solution, oral syrup, oral tablet, oral tablet extended release

In addition to its needed effects, some unwanted effects may be caused by Codeine (Ridol). In the event that any of these side effects do occur, they may require medical attention.

Major Side Effects

You should check with your doctor immediately if any of these side effects occur when taking Codeine (Ridol):

Incidence not known:

• Bloating
• blurred vision
• chills
• cold, clammy skin
• confusion
• constipation
• darkened urine
• difficult or troubled breathing
• dizziness
• dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
• fainting
• fast, irregular, pounding, or racing heartbeat or pulse
• fast, weak pulse
• feeling of warmth
• fever
• indigestion
• irregular, fast or slow, or shallow breathing
• lightheadedness
• loss of appetite
• nausea
• no blood pressure or pulse
• no breathing
• pains in the stomach, side, or abdomen, possibly radiating to the back
• pale or blue lips, fingernails, or skin
• redness of the face, neck, arms, and occasionally, upper chest
• shortness of breath
• stopping of the heart
• sweating
• unconsciousness
• unusual tiredness or weakness
• vomiting
• wheezing
• yellow eyes or skin

If any of the following symptoms of overdose occur while taking Codeine (Ridol), get emergency help immediately:

Symptoms of overdose:

• Bluish lips or skin
• change in consciousness
• chest pain or discomfort
• constricted, pinpoint, or small pupils (black part of the eye)
• decreased awareness or responsiveness
• extreme sleepiness or unusual drowsiness
• loss of consciousness
• no blood pressure or pulse
• severe sleepiness
• slow or irregular heartbeat

Minor Side Effects

Some of the side effects that can occur with Codeine (Ridol) may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

More common:

• Drowsiness
• relaxed and calm

• Abdominal or stomach pain or cramps
• blurred or loss of vision
• diarrhea
• disturbed color perception
• double vision
• dry mouth
• false or unusual sense of well-being
• fear or nervousness
• feeling of constant movement of self or surroundings
• halos around lights
• headache
• hives or welts
• itching skin
• night blindness
• overbright appearance of lights
• redness of the skin
• sensation of spinning
• shakiness
• skin rash
• sleeplessness
• trouble sleeping
• tunnel vision
• unable to sleep
• weight loss

See also:
What are the possible side effects of Homatropine (Ridol)?

Transient symptoms of stinging and burning may occur. Prolonged use may produce local irritation characterized by follicular conjunctivitis, vascular congestion, edema, exudate, and an eczematoid dermatitis. Thirst or dryness of mouth, eye irritation not present before therapy, or increased sensitivity of eyes to light may occur.

Overdose for Homatropine (Ridol)

Systemic Homatropine (Ridol) toxicity is manifested by flushing and dryness of the skin (a rash may be present in children), blurred vision, a rapid and irregular pulse, fever, abdominal distention in infants, mental aberration (hallucinosis) and loss of neuro-muscular coordination. Atropine poisoning, although distressing, is rarely fatal even with large doses of atropine, and is self-limited if the cause is recognized and the Homatropine (Ridol) medication is discontinued. Treatment includes supportive measures including maintaining a patent airway and assisting respiration if needed. Treat hyperthermia, coma and seizures if they occur (1). In infants and children, the body surface must be kept moist. Excitement may be controlled by diazepam or a short-acting barbiturate. For ingestion, activated charcoal can be used to prevent drug absorption. If necessary, ipecac or another cathartic may be useful for drug removal during initial treatment (1, 2). Physostigmine is used as an antidote to the systemic effects of atropine and may be administered parenterally to provide more prompt relief of intoxication.

Parenteral physostigmine may be particularly useful in cases of pronounced hallucinations, agitation in which a patient may be dangerous to himself or others, arrhythmias resulting in uncontrolled hemodynamic instability, and intractable seizures.

May be nausea, vomiting, diarrhea or constipation, urticaria, hypersensitivity to the drug. Rarely granulocytopenia, epigastric pain, stomatitis. Regardless of the dose, Metamizole (Ridol) magnesium (Metamizole (Ridol)) can occasionally determine hypersensitivity, externalized, such as rash, leukopenia and rarely agranulocytosis, as well as fragments of impact or shock. Presented unfamiliar or unpleasant sensations impaired skin and mucous membranes, will need to stop and seek medical preparations.

If it had been observed previously and phenomena of intolerance to other analgesics or anti-flu preparations, consult your doctor before applying Metamizole (Ridol) magnesium (Metamizole (Ridol)). After intravenous injection, there may be dizziness, feeling of oppression and demonstrations by the CNS, without allergic genesis. After intravenous injection, there may be dizziness, feeling of oppression and demonstrations by the CNS, without allergic genesis. These side effects are largely avoided by slow injection (1 to 1.5 ml per minute). Rarely, injection Metamizole (Ridol) magnesium (Metamizole (Ridol)), depending on the dose may lead to hypotension, without hypersensitivity reactions.

An opioid analgesic related to morphine but with less potent analgesic properties and mild sedative effects. It also acts centrally to suppress cough. [PubChem]

Homatropine (Ridol) methylbromide is a quaternary ammonium muscarinic acetylcholine receptor antagonist belonging to the group of medicines called anti-muscarinics. Homatropine (Ridol) is used to treat duodenal or stomach ulcers or intestine problems. It can be used together with antacids or other medicine in the treatment of peptic ulcer. It may also be used to prevent nausea, vomiting, and motion sickness.

A thioureylene antithyroid agent that inhibits the formation of thyroid hormones by interfering with the incorporation of iodine into tyrosyl residues of thyroglobulin. This is done by interfering with the oxidation of iodide ion and iodotyrosyl groups through inhibition of the peroxidase enzyme.