OTC codeine ineffective?
April 19, 2016
THEO Theodorou, pharmacist-in-
charge at a large pharmacy in
Western Sydney, has proffered
a well-documented summary of
issues around over the counter
products for dental pain relief.
With ongoing discussions
surrounding the use of OTC
codeine-containing products and
their potential upscheduling (PD 29
Mar), Theodorou has put forward
a cogent argument against the use
of codeine in the doses currently
available for OTC dispensing.
Theodorou says that he has
seen “confusion among my
colleagues and customers about
what pain killers to recommend
for both effectiveness and safety”,
prompting him to write a review
of evidence as it applies to
dental pain, but explains that it is
“probably just as relevant for other
types of pain such as arthritis”.
The review looks at the data
relating to the options of
combination non steroidal anti-inflammatory
drugs (NSAIDs) with
paracetamol, combination NSAIDs
or paracetamol with codeine or
single ingredient medication for
patients complaining of dental pain.
With dental pain in the
musculoskeletal pain category
NSAIDs and paracetamol in
combination are “generally are
equivalent or superior to opioids”,
Theodorou writes, adding that
the combination provides greater
efficacy than either agent alone,
obviating the need for codeine.
Studies have shown that at
least 30mg of codeine is needed
for moderate dental pain, but
frequently 60mg would be needed.
Given the risks of codeine misuse,
Theodorou sumarises that NSAID/
paracetamol combinations should
be first choice for dental pain.
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