Codeine called into question
August 2, 2010
PAIN relief may not be increased
enough through the use of two
painkillers in a one-tablet format to
justify potential side effects,
according to a report in the NPS’
Australian Prescriber.
“Codeine is often an ingredient in
combination painkillers, however
there is not much evidence for its
effectiveness and the role of
codeine in managing acute pain is
unclear,” Dr Bridin Murnion, from
the Drug Health Service at Royal
Prince Alfred Hospital Sydney said
in the report.
Adding further back-up to its
claim, the NPS said that evidence
gathered through its own analysis
of several acute pain studies found
that although modest pain relief is
achieved when codeine is added to
paracetamol, the risk of side effects
increases with repeated dosages.
“As an opioid, codeine can be
addictive,” a statement from the
NPS said.
“When people take it [codeine] in
higher doses than recommended,
they are also taking high doses of
the other pain relief ingredients,
paracetamol or ibuprofen, and it’s
these ingredients which, when
misused, can cause serious adverse
events such as stomach and liver
damage,” the statement added.
The NPS also cited a National
Health and Medical Research
Council review which found
insufficient evidence to recommend
the use of paracetamol/codeine
combinations in acute low back
pain, acute neck pain, acute
shoulder pain or acute knee pain,
adding that whilst there was
significant evidence that NSAIDs
(ibuprofen, aspirin, diclofenac)
worked well in treating acute pain,
there was limited data on
combining them with opiods.
“As a weak opioid, codeine can
be addictive but because it can’t be
purchased without either paracetamol,
aspirin or ibuprofen, people end up
consuming more than they need of
these products too,” said NPS
acting CEO, Karen Kaye.
“Taking more than the
recommended maximum amount
of these products can result in
serious side effects.
“The recent rescheduling of these
products ensures people using these
products will get the professional
advice from a pharmacist and
addictions will be identified,” she
added.
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