Do codeine and caffeine enhance the analgesic effect of aspirin?-A systematic overview

Abstract

SUMMARYObjective: To assess whether codeine and caffeine enhance the analgesic effect of aspirin in postoperative pain. Method: Systematic overview of the literature and meta-analysis of published randomized controlled trials (RCTs). Results: Codeine 60 mg leads t o a small increase in the analgesic effect of 6 5 0 -m g of aspirin when total pain relief score (TOTPAR%) is used as an efficacy end-point. This increased effect was not seen when sum of pain intensity (SPID%) and proportion of patients responding with moderate t o excellent pain relief were used as outcome measures. Caffeine did not enhance the analgesic effect of aspirin. Conclusion: Codeine 6 0 m g may produce a small increase in the analgesic effect of aspirin 6 5 0 mg.However, this effect is not clinically meaningful. Caffeine has n o adjuvant analgesic effect. At overthe-counter (OTC) doses, caffeine and codeine are not useful in aspirin formulations.

Counting the cost of over‐the‐counter codeine containing analgesic misuse: A retrospective review of hospital admissions over a 5 year period

“…Such an assessment relies upon literature evaluating the efficacy of low‐dose codeine as an analgesic (less than 30 mg), which is scarce . It appears from the limited data available that the lower doses of codeine found in OTC combination products provide little additional pain relief compared to the co‐analgesic (for example ibuprofen) administered alone . Concerns regarding ongoing OTC codeine supply have now been raised in Australia, Canada, Ireland and South Africa .…”

Methylxanthines and Pain

“…Further meta-analysis indicates that adding caffeine to analgesics increases the number of patients who experience pain relief from headache (rate ratio 1.36); it also leads to more patients with nervousness and dizziness (relative risk 1.60) (Zhang 2001). While there are some reports of adjuvant analgesic effects of caffeine in other pain conditions, meta-analysis shows no appreciable adjuvant effect with acetaminophen (Zhang and Po 1996), aspirin (Zhang and Po 1997) or ibuprofen (Po and Zhang 1998) for postoperative pain.…”

Use of codeine and NSAID combination in rhinogenic headache

“…Codeine and its combination with paracetamol is one of the mainly prescribed drugs in the management of headache, although there is no evidence for its effectiveness in headache disorders 6 . Even if codeine combinations with aspirin increase the analgesic effect, it is not thought to have any clinical benefits 33 .…”