Pharmacy Daily | Codeine called into question

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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