Serious morbidity associated with misuse of over‐the‐counter codeine–ibuprofen analgesics: a series of 27 cases

Abstract

Objective: To investigate morbidity related to misuse of over‐the‐counter (OTC) codeine–ibuprofen analgesics. Design and setting: Prospective case series collected from Victorian hospital‐based addiction medicine specialists between May 2005 and December 2008. Main outcome measures: Morbidity associated with codeine–ibuprofen misuse. Results: Twenty‐seven patients with serious morbidity were included, mainly with gastrointestinal haemorrhage and opioid dependence. The patients were taking mean daily doses of 435–602 mg of codeine phosphate and 6800–9400 mg ibuprofen. Most patients had no previous history of substance use disorder. The main treatment was opioid substitution treatment with buprenorphine–naloxone or methadone. Conclusions: Although codeine can be considered a relatively weak opioid analgesic, it is nevertheless addictive, and the significant morbidity and specific patient characteristics associated with overuse of codeine–ibuprofen analgesics support further awareness, investigation and monitoring of OTC codeine–ibuprofen analgesic use.

Misuse and Dependence on Non-Prescription Codeine Analgesics or Sedative H1 Antihistamines by Adults: A Cross-Sectional Investigation in France

“…However, in Norway, codeine is not available without a medical prescription form in community pharmacies. In contrast, in Australia, where codeine analgesics can be obtained OTC, warnings have been recently given on dependence on codeine [21]. Between September 2005 and September 2010, 18% of all patients referred to the Drug and Alcohol Services at the Western Hospital of Melbourne were diagnosed with opioid dependence and had medical and psychiatric problems linked to their excessive use of codeine analgesics.…”

Over-the-counter medicine abuse – a review of the literature

“…In relation to harms from other ingredients, two analgesic combination products – paracetamol and codeine (co-codamol) and ibuprofen and codeine – were considered problematic, with ibuprofen-containing medicine being particularly highlighted (Chetty et al, 2003; Dyer et al, 2004; Lambert & Close, 2005; Ford & Good, 2007; Dobbin & Tobin, 2008; Dutch, 2008; Ernest et al, 2010; Frei et al, 2010; Robinson et al, 2010). Dutch (2008) and Ford and Good (2007) reported on two hospital and three primary care presentations, respectively, of patients who had used a combination analgesic containing ibuprofen and codeine.…”

Complications related to chronic supratherapeutic use of codeine containing compound analgesics in a cohort of patients presenting for codeine withdrawal

“…Over recent years, there has been growing concern regarding medical complications related to the supratherapeutic use of codeine containing compound analgesics [1][2][3][4][5][6]. Complications occur in codeinedependent individuals due to co-formulation of codeine with paracetamol or ibuprofen.…”

“…Complications occur in codeinedependent individuals due to co-formulation of codeine with paracetamol or ibuprofen. There is however evidence available documenting medical complications due to supratherapeutic ibuprofen/codeine containing compound analgesic use [1][2][3][4][5][6]. Complications arising due to chronic paracetamol use are less well understood and there is very little available evidence detailing complications due to the chronic supratherapeutic use of paracetamol/codeine containing compound analgesics.…”