title: Safety and efficacy of the combination acetaminophen-codeine in the treatment of pain of different origin.
abstract: BACKGROUND
  Pain is the most common reason people see doctors in developed Countries and a very common cause of access in Emergency Department (ED). The combination acetaminophen/codeine represents the standard medication in the second step of the WHO analgesic scale and codeine is one of the most commonly used opioid analgesic for a variety of pain conditions. However, many aspects related to safety and efficacy are still undefined.
  
  
  OBJECTIVE
  To summarize and review the results of the most relevant studies on the efficacy and safety profile of acetaminophen/codeine combination in the treatment of pain of different origin.
  
  
  METHODS
  We performed a literature search to identify and evaluate all relevant english-language randomized controlled trials (RCTs), meta-analyses and reviews about the codeine plus paracetamol combination in the treatment of pain from any source.
  
  
  RESULTS
  Acetaminophen/codeine combination is effective in the treatment of moderate to severe pain in all setting analyzed in this study, which include headache, postoperative, osteoarticular and post-traumatic. The best results in terms of safety and efficacy have been obtained in postoperative pain. Efficacy of acetaminophen/codeine combination is not inferior to NSAIDs.
  
  
  CONCLUSIONS
  Acetaminophen/codeine combination is effective in the treatment of pain, through a synergistic action of the two molecules, and is not inferior to NSAIDs. Side effects of acetaminophen/codeine are usually minor, differently from NSAIDs, which may induce some potentially life threatening conditions.
authors.affiliation: Department of Emergency Medicine, Catholic University of the Sacred Heart, Rome, Italy. francesco.franceschi@rm.unicatt.it  
authors.forename: F
authors.initials: F
authors.lastname: Franceschi
authors.forename: P
authors.initials: P
authors.lastname: Iacomini
authors.forename: D
authors.initials: D
authors.lastname: Marsiliani
authors.forename: C
authors.initials: C
authors.lastname: Cordischi
authors.forename: E Forte S
authors.initials: EF
authors.lastname: Antonini
authors.forename: A
authors.initials: A
authors.lastname: Alesi
authors.forename: D
authors.initials: D
authors.lastname: Giacobelli
authors.forename: G
authors.initials: G
authors.lastname: Zuccalà
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D003061:Codeine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004338:Drug Combinations; D004357:Drug Synergism; D006801:Humans; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D004338:Drug Combinations; C526278:acetaminophen, codeine drug combination; D000082:Acetaminophen; D003061:Codeine