title: Misuse of over-the-counter codeine-containing analgesics: dependence and other adverse effects.
abstract: OBJECTIVE
  To review cases of codeine dependency from over-the-counter (OTC) combination analgesics admitted to a hospital detoxification unit.
  
  
  METHODS
  Case records of all admissions following an index case were reviewed over a 2-year period.
  
  
  RESULTS
  There were 7 cases reporting chronic excess of Nurofen Plus, of which 6 had prior or current histories of alcohol dependency. Complications which were likely contributed by excessive ibuprofen consumption included: gastric ulcer (4 patients), gastrointestinal bleeding (3), hepatotoxicity (1), and inflammatory bowel conditions (2).
  
  
  CONCLUSIONS
  This pattern of admissions is new to the detoxification unit, and may relate to higher codeine content in the combination product, and marketing strategies. These cases likely represent the severer end of the spectrum of codeine dependency acquired from OTC pharmacy sources. The paucity of evidence to support additional benefit from the inclusion of codeine in analgesic combination products is concerning. There is a need for increased pharmacovigilance around these and other OTC medications.
authors.forename: Geoffrey M
authors.initials: GM
authors.lastname: Robinson
authors.forename: Sophie
authors.initials: S
authors.lastname: Robinson
authors.forename: Patrick
authors.initials: P
authors.lastname: McCarthy
authors.forename: Christina
authors.initials: C
authors.lastname: Cameron
mesh_terms: D000328:Adult; D000700:Analgesics / Q000506:poisoning*; D003061:Codeine / Q000506:poisoning*; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000506:poisoning*; D004366:Nonprescription Drugs / Q000506:poisoning*; D012189:Retrospective Studies; D016060:Sorption Detoxification / Q000379:methods; D019966:Substance-Related Disorders / Q000209:etiology* / Q000628:therapy
chemical_list: D000700:Analgesics; D004338:Drug Combinations; D009294:Narcotics; D004366:Nonprescription Drugs; D003061:Codeine