Misuse of over-the-counter codeine-containing analgesics: dependence and other adverse effects

To review cases of codeine dependency from over-the-counter (OTC) combination analgesics admitted to a hospital detoxification unit.

Case records of all admissions following an index case were reviewed over a 2-year period.

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).

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.