• Geoffrey M Robinson, Sophie Robinson, Patrick McCarthy, and Christina Cameron.
• N. Z. Med. J. 2010 Jun 25;123(1317):59-64.

AimTo review cases of codeine dependency from over-the-counter (OTC) combination analgesics admitted to a hospital detoxification unit.MethodCase records of all admissions following an index case were reviewed over a 2-year period.ResultsThere 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).ConclusionsThis 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.

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