NEWS Role of codeine questioned The role of codeine in managing acute pain has been questioned in this month’s edition of Australian Prescriber. In the article, Dr Bridin Murnion, from the Drug Health Service at Royal Prince Alfred Hospital, Sydney, reviews the evidence around combinations of different painkillers in the same tablet (e.g. ibuprofen or paracetamol with codeine). She explains in many cases pain relief is not increased by using two different painkillers. Dr Murnion said: ’Codeine is often an ingredient in combination painkillers, however there is not much evidence for its effectiveness and the role of codeine in managing acute pain is unclear.’ A review of evidence by the National Prescribing Service (NPS) shows that studies in acute pain suggest only modest additional pain relief is achieved when codeine is added to paracetamol, and the risk of side effects increases after repeated doses. As an opioid, codeine can be addictive. When people take it in higher doses than recommended, they are also taking high doses of the other pain relief ingredients, such as paracetamol or ibuprofen. When misused, these ingredients can cause serious adverse events such as stomach and liver damage. A National Health and Medical Research Council review found insufficient evidence to recommend the use of paracetamol/codeine combinations in acute low back pain, acute neck pain, acute shoulder pain or acute knee pain. While there is a significant body of evidence identifying the efficacy of NSAIDs (e.g. ibuprofen, aspirin, diclofenac) in acute pain, there are limited data on combining them with opioids. These findings are in line with NPS reviews of evidence that show when treating acute pain, only modest additional pain relief is achieved when codeine is added to other analgesics. Karen Kaye, NPS acting CEO, said: ’As a weak opioid, codeine can be addictive but because it can’t be purchased without either paracetamol, aspirin or ibuprofen, people end up consuming more than they need of these products too. ’Taking more than the recommended maximum amount of these products can result in serious side effects. Overuse or misuse of products containing aspirin or ibuprofen can result in gastric ulcer perforation, or in products containing paracetamol, liver toxicity or death.’ Dr Murnion said the recent rescheduling of these products is unlikely to impact significantly on people’s pain relief options but may reduce the harms from overuse. The full article can be viewed at: www.australianprescriber.com Malaria treatment now on PBS Patients with malaria due to Plasmodium falciparum can receive subsidised medical treatment via the Pharmaceutical Benefits Scheme (PBS). Riamet® (artemether 20mg with lumefantrine 120mg) combines two anti-malarials to treat acute, uncomplicated malaria caused by the parasite Plasmodium falciparum. In clinical studies, the 28-day cure rate was 96 per cent 1 . The World Health Organization (WHO) has certified Australia as free of malaria; however, returning travellers and refugees from malariaendemic countries require treatment. PBS listing will allow those who are not ill enough to warrant hospitalisation, to be effectively managed in the community. Approximately half of the 600–700 cases of malaria reported each year in Australia are due to Plasmodium falciparum 2 . Riamet® tablets are indicated for patients 12 years and older, weighing at least 35 kg 1 . The medication, manufactured by Novartis, is available at the dispensed price of $96.90 for a 24 tablet pack. Registration and reimbursement of a dispersible tablet for infants and children has recently been approved and PBS listing is expected later this year. References 1. Riamet Approved Product Information. 2. Liu C, Begg K, Johansen C , Whelan P, Kurucz N, Melville L and the National Arbovirus and Malaria Advisory Committee. Communicable Diseases Network Australia National Arbovirus and Malaria Advisory Committee Annual Report, 2006–07. Communicable Diseases Intelligence. 2008; 32: 31–47. PBS information: Authority required Treatment of suspected or confirmed malaria due to Plasmodium falciparum. Note: Artemether with lumefantrine is not PBS-subsidised for prophylaxis of malaria. Minimum Product Information • RIAMET® 20 mg/120 mg tablets (artemether/lumefantrine) • RIAMET® 20 mg/120 mg dispersible tablets (artemether/ lumefantrine) See approved Product Information before prescribing. Approved Product Information available on request. Worked overseas Have you worked overseas as a nurse in general practice If so, we would like to hear from you. Our December issue of the Primary Times will look at practice nursing around the world. The issue will explore the major differences between each country’s use of nurses in general practice. If you would like to be part of this issue, please email some basic details of your experience in working overseas to: editor@apna.asn.au 28 Primary Times <strong>September</strong> 2010
Think all infant formulas are the same Think again. Nothing compares to breast milk. It strengthens the developing immune system, protecting against allergy and infection. 1,2 If a mother decides to mix feed or move on from breast feeding, the choice of formula matters. Only Karicare Immunocare ® nutritionally supports the infant’s developing immune system through a patented blend of prebiotic oligosaccharides inspired by breast milk, helping to provide long-term protection against allergy and infection. Compared to a standard formula, this provides: • 51% less incidence of atopic dermatitis (p
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