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Feature Article

Farewell over-the-counter codeine: the TGA’s upscheduling of low-dose codeine

JACINTA JOHNSON

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© NASTASIC/ISTOCKPHOTO.COM

Abstract

Low-dose codeine is now a prescription-only medication in Australia. We are highlighting this article, which featured in a recent Medicine Today supplement, as it includes practical tips for managing patients with codeine dependence.

 

Key Points

  • Over-the-counter analgesics and cold and flu preparations that contain low-dose codeine were upscheduled by the TGA to Schedule 4 ‘Prescription Only’ from 1 February 2018.
  • Codeine alone is a poor analgesic, and there is little evidence to show adding low-dose codeine (<30 mg) to nonopioid analgesics provides additional pain relief.
  • Combining simple analgesics (e.g. paracetamol plus ibuprofen) may provide more effective pain relief than adding codeine at higher doses (30 to 60 mg) to paracetamol.
  • Codeine dependence is a well-recognised problem in Australia, and can cause serious gastrointestinal, renal and hepatic problems, usually due to excessive intake of ibuprofen and paracetamol in codeine-containing combination analgesics.
  • Codeine dependence can be identified by careful questioning regarding recent codeine use patterns, reasons for use and withdrawal symptoms on cessation, and surveillance for signs and symptoms of complications due to overuse of secondary nonopioid analgesics.
  • The TGA resource ‘Tips for talking about codeine: guidance for health professionals with prescribing authority’ provides practical guidance for health professionals when talking to patients about codeine, including tips for discussing rescheduling, ongoing pain management options and codeine dependence.

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© NASTASIC/ISTOCKPHOTO.COM
© NASTASIC/ISTOCKPHOTO.COM