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Man AM, Piffer A, Simonetti GD, Scoglio M, Faré PB, Lava SAG, Bianchetti MG, Milani GP. Ibuprofen-Associated Hypokalemia and Metabolic Acidosis: Systematic Literature Review. Ann Pharmacother 2022; 56:10600280221075362. [PMID: 35135381 DOI: 10.1177/10600280221075362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Ibuprofen is a widely used nonsteroidal anti-inflammatory drug, which has been occasionally associated with hypokalemia and metabolic acidosis. The objective of this report is to analyze the literature on this issue and to address the underlying pathophysiology. DATA SOURCES Excerpta Medica, the National Library of Medicine, and Web of Science were searched from inception to July 16, 2021. STUDY SELECTION AND DATA EXTRACTION Papers reporting individually documented humans on ibuprofen with hypokalemia, acidosis, or both were retained. Data were extracted using a checklist. DATA SYNTHESIS For the final analysis, we evaluated 41 reports describing 50 cases (26 males and 24 females; 36 adults and 14 children) with often profound hypokalemia, acidosis, or both after ingestion of ibuprofen. Twenty-six cases were acute and 24 long term. Hypokalemia and acidosis occurred not only after ingestion of very high doses but also after ingestion of moderately high or even normal doses of ibuprofen. Laboratory values consistent with an excessive urinary potassium excretion or an altered urinary acidification were often disclosed in most cases. Discontinuation of ibuprofen resulted in a resolution of hypokalemia and acidosis within days in 47 cases. The course was lethal in 3 cases. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE This review highlights potentially fatal side effects of ibuprofen and can help doctors who are confronted with such a situation. CONCLUSIONS These data highlight the potential of ibuprofen to occasionally induce hypokalemia and acidosis of renal origin. Discontinuation of ibuprofen results in a resolution within days.
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Affiliation(s)
- Anca M Man
- Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Arianna Piffer
- Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Giacomo D Simonetti
- Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Università della Svizzera Italiana, Lugano, Switzerland
| | - Martin Scoglio
- Family Medicine Institute, Università della Svizzera Italiana, Lugano, Switzerland
| | - Pietro B Faré
- Department of Internal Medicine, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Sebastiano A G Lava
- Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Mario G Bianchetti
- Università della Svizzera Italiana, Lugano, Switzerland
- Family Medicine Institute, Università della Svizzera Italiana, Lugano, Switzerland
| | - Gregorio P Milani
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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2
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Physician Perspectives on Codeine Accessibility, Patterns of Use, Misuse, and Dependence in Saudi Arabia. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-021-00670-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AbstractIn Saudi Arabia, there are concerning rates of non-compliance with pharmaceutical regulations prohibiting the pharmacy dispensing of prescription-only medications without a physician prescription. This is the first study in the Middle East which examines physicians’ perceptions regarding misuse of codeine, listed as a narcotic, controlled, and prescription-only drug. The CODEMISUSED survey was adapted to the Saudi Arabian context and pilot tested, prior to cross-sectional administration to physicians in Riyadh, Jeddah, Abha, and Jazan (n = 105). Descriptive statistics (frequencies and percentage) present physician level of agreement, neutrality, and disagreement with statements regarding codeine prescribing, patient awareness and use, online and community pharmacy availability, and dependence. The study indicates concern by physicians regarding patient intentional use of codeine to enhance mood, misuse patterns, lack of awareness around habit-forming use and iatrogenic dependence, and sourcing via illegal dispensing. It underscores the imperatives to address pharmacy compliance with pharmaceutical regulatory controls, implement enhanced pharmacovigilance, and improve awareness around safe use.
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3
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Brennan R, Wazaify M, Shawabkeh H, Boardley I, McVeigh J, Van Hout MC. A Scoping Review of Non-Medical and Extra-Medical Use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). Drug Saf 2021; 44:917-928. [PMID: 34331260 PMCID: PMC8370940 DOI: 10.1007/s40264-021-01085-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 11/26/2022]
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used medications worldwide and have analgesic, antipyretic and anti-inflammatory properties. Although NSAIDs are recognised as generally safe and effective, non-medical and extra-medical use of these products can occur. Unlike the use of illegal and many prescription drugs, which are subject to extensive research attention, inappropriate use of NSAIDs has been less well investigated. This scoping review collates and describes what is known regarding non-medical and extra-medical use of NSAIDs. In total, 72 studies were included in this scoping review. Three themes emerged from the review: (1) indicative profile of people who engage in non-medical or extra-medical use of NSAIDs; (2) antecedents for non-medical or extra-medical use; and (3) adverse health effects of non-medical and extra-medical use of NSAIDs. The review concluded that there is a need for enhanced patient education, including among sports people; pharmacovigilance in terms of clinician recognition of aberrance; and prescriber and pharmacist awareness of the potential for extra-medical and non-medical use and the related health harms.
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Affiliation(s)
- Rebekah Brennan
- School of Applied Social Studies, University College Cork, Cork, Ireland.
| | - Mayyada Wazaify
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman, Jordan
| | - Haneen Shawabkeh
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman, Jordan
| | - Ian Boardley
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Jim McVeigh
- Substance Use & Associated Behaviours, Department of Sociology, Manchester Metropolitan University, Manchester, UK
| | - Marie Claire Van Hout
- Faculty of Health, Public Health Institute, Liverpool John Moore's University, Liverpool, UK
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Thammineni N, Kathi PR, Sharma A, Jawed A. Ibuprofen Overuse Leading to Life-threatening Hypokalemia Associated with Renal Tubular Acidosis in Two Patients. Cureus 2019; 11:e6404. [PMID: 31970034 PMCID: PMC6964961 DOI: 10.7759/cureus.6404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Ibuprofen is a commonly used medication in the United States and is used both by prescription and over the counter, while hypokalemia is a life-threatening condition caused by various etiologies, one of which is the side effect of medications. Ibuprofen is well-known for its various nephrotoxic side effects, including hyperkalemia as a common electrolyte abnormality, however, renal tubular acidosis leading to hypokalemia with the use of ibuprofen has been reported rarely. We present here two cases of life-threatening hypokalemia due to over-the-counter use of large doses of ibuprofen and describe its management.
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Affiliation(s)
| | - Pradeep R Kathi
- Internal Medicine / Gastroenterology, University of Arizona, Tucson, USA
| | - Aditi Sharma
- Internal Medicine, Wayne State University School of Medicine, Detroit, USA
| | - Areeba Jawed
- Internal Medicine / Nephrology, Wayne State University, Detroit, USA
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5
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Knapp J, Zylla M, Schaper A, Michalski D, Hartwig S, Bernhard M. Energydrinks in der Notfallmedizin – verleihen nicht nur Flügel. Notf Rett Med 2018. [DOI: 10.1007/s10049-017-0386-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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6
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Bichard L, Toh D. Ibuprofen-induced distal (type 1) renal tubular acidosis and hypokalaemia: the dangers of ibuprofen-codeine combination over-the-counter preparations. Intern Med J 2018; 47:707-709. [PMID: 28580738 DOI: 10.1111/imj.13436] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 12/13/2016] [Accepted: 12/13/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Lisa Bichard
- Division of General Internal Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Dylan Toh
- Division of General Internal Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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7
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Mill D, Dawson J, Johnson JL. Managing acute pain in patients who report lactose intolerance: the safety of an old excipient re-examined. Ther Adv Drug Saf 2018; 9:227-235. [PMID: 29796247 DOI: 10.1177/2042098617751498] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 12/08/2017] [Indexed: 11/16/2022] Open
Abstract
Lactose intolerance is exceedingly common, reportedly affecting up to 70% of the world's population, leading to both abdominal and systemic symptoms. Current treatment focuses predominantly on restricting dietary consumption of lactose. Given lactose is one of the most commonly used excipients in the pharmaceutical industry, consideration must be given to the lactose content and therefore safety of pharmaceutical preparations prescribed for patients with lactose intolerance. This article summarizes the current literature examining the likelihood of inducing adverse effects through the administration of lactose-containing pharmaceutical preparations in patients reporting lactose intolerance, describes how to assess this risk on an individual patient basis and reviews suitable analgesic options for this population. A case study is presented detailing a patient reporting lactose intolerance who insists on treatment with the lactose-free product codeine/ibuprofen (Nurofen Plus) rather than other codeine-free analgesics. It is important to assess the likelihood of lactose as an excipient inducing symptoms in this scenario, as reluctance to cease codeine could suggest codeine dependence, an issue that is becoming increasingly common in countries such as Australia and Canada. Given codeine dependence is associated with serious sequelae including hospitalization and death, the patient must either be reassured the lactose component in their prescribed analgesics will not induce symptoms or an alternative treatment strategy must be confirmed. General recommendations applying theory from the literature to the management of acute pain in lactose-intolerant patients are discussed and specific treatment options are outlined. Although large inter-individual variability is reported, most lactose-intolerant patients can tolerate the small quantities of lactose found in pharmaceutical preparations. Cumulative lactose exposure can be assessed in patients taking multiple medications while also consuming lactose in the diet. In those sensitive to small quantities of lactose, lactase supplements can be trailed. Additionally, for the analgesic drug classes employed for the management of acute pain, lactose-free formulations, including most oral liquids and dispersible tablets and some oral tablets and capsules, are available.
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Affiliation(s)
- Deanna Mill
- University of South Australia, Adelaide, South Australia, Australia
| | - Jessica Dawson
- Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Jacinta Lee Johnson
- University of South Australia Division of Health Sciences, City East Campus, Corner Frome Rd and North Tce, Adelaide, South Australia, 5001, Australia
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Affiliation(s)
- A Paul Lambert
- Division of Medicine, Taunton and Somerset Hospital, Musgrove Park, Taunton TA1 5DA, UK.
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9
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McCoy J, Bruno R, Nielsen S. Attitudes in Australia on the upscheduling of over-the-counter codeine to a prescription-only medication. Drug Alcohol Rev 2017; 37:257-261. [DOI: 10.1111/dar.12568] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 03/20/2017] [Accepted: 04/11/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Jacqui McCoy
- School of Medicine (Psychology), Faculty of Health; University of Tasmania; Hobart Australia
| | - Raimondo Bruno
- School of Medicine (Psychology), Faculty of Health; University of Tasmania; Hobart Australia
| | - Suzanne Nielsen
- National Drug and Alcohol Research Centre; University of New South Wales; Sydney Australia
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10
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Medicines containing codeine: perspectives of medical professionals in the Republic of Ireland. Ir J Med Sci 2017; 186:555-563. [DOI: 10.1007/s11845-016-1546-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 12/25/2016] [Indexed: 01/31/2023]
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Nielsen S, Van Hout MC. Over-the-Counter Codeine-from Therapeutic Use to Dependence, and the Grey Areas in Between. Curr Top Behav Neurosci 2017; 34:59-75. [PMID: 26768736 DOI: 10.1007/7854_2015_422] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Codeine is a widely used analgesic, that is available for sale in pharmacies over the counter (OTC) in a number of countries including the UK, South Africa, Ireland, France and Australia. In these countries with OTC codeine sales there has been emerging concerns about misuse of and dependence on codeine containing combination analgesics, with increasing numbers of people presenting for help with codeine dependence at primary care and addiction treatment services. This has led to many countries reviewing availability of codeine in OTC available preparations, and considering possible measures to reduce harms from misuse of OTC codeine containing combination analgesics.
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Affiliation(s)
- Suzanne Nielsen
- National Drug and Alcohol Research Centre, UNSW, 22-32 King Street, Randwick, NSW, 2031, Australia.
- South East Sydney Local Health District (SESLHD) Drug and Alcohol Services, 591-623 S Dowling Street, Surry Hills, NSW, 2010, Australia.
| | - Marie Claire Van Hout
- Department of Health, Sport and Exercise Science, School of Health Sciences, Waterford Institute of Technology, Waterford, Ireland
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12
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Gibbins AK, Wood PJ, Spark MJ. Managing inappropriate use of non-prescription combination analgesics containing codeine: A modified Delphi study. Res Social Adm Pharm 2016; 13:369-377. [PMID: 27084506 DOI: 10.1016/j.sapharm.2016.02.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 02/29/2016] [Accepted: 02/29/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Misuse and/or dependence upon non-prescription combination analgesics containing codeine (NP-CACC) can result in serious physiological and psychological harms. OBJECTIVE To explore pharmacists' and other health care professionals' ideas and views on strategies for managing NP-CACC misuse and/or dependence in a community pharmacy setting. METHODS A 3-iteration modified Delphi study was conducted to gain the consensus view of panelists. Forty experts within the fields of pharmacy and drug misuse and/or dependence agreed to be on the panel. Questionnaires explored opinions on issues and possible strategies that could be used to manage NP-CACC misuse and/or dependence. Responses from the first-round questionnaire were summarized and reported back to panelists through the second-round questionnaire for further reflection and evaluation using a 6-point, Likert-type scale. Strategies included in the third-round questionnaire had agreement by more than 80% of panelists. Panelists provided feedback on effectiveness using a 6-point, Likert-type scale for impact. RESULTS The response rates for the 3 rounds were 65%, 67.5% and 55%, respectively. Panelists provided 54 strategies in round 1. In round 2 there was consensus agreement with 31 of these strategies. In round 3 there was consensus that 21 strategies were expected to be effective (>80% of panelists expected the strategy to be effective, median above Somewhat Effective (4), IQD ≤1). Of these, 8 were expected to have the most impact if implemented into clinical practice (chosen by 5 or more panelists in their Top 5 for impact). The strategies identified as effective and likely to have the most impact on NP-CACC misuse/dependence in a community pharmacy setting were: utilization of a national real-time database to monitor product sales to aid identification of at-risk people (100% effectiveness, rank 1 for impact); development of a referral pathway for management of people whom pharmacists have identified as at-risk (95.2% effectiveness, rank 2 for impact), and training to improve pharmacist communication with people (95% effectiveness, rank 2 for impact). CONCLUSIONS The high level of consensus achieved indicates that the strategies generated represent useful approaches which could be utilized to manage NP-CACC misuse and/or dependence within community pharmacy in the future.
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Affiliation(s)
- Amanda K Gibbins
- School of Pharmacy and Applied Science, La Trobe Institute for Molecular Science, La Trobe University, P.O. Box 199, Bendigo, Victoria 3552, Australia
| | - Penelope J Wood
- School of Pharmacy and Applied Science, La Trobe Institute for Molecular Science, La Trobe University, P.O. Box 199, Bendigo, Victoria 3552, Australia
| | - M Joy Spark
- School of Pharmacy and Applied Science, La Trobe Institute for Molecular Science, La Trobe University, P.O. Box 199, Bendigo, Victoria 3552, Australia.
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13
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Ter A, Salha R, Vadamalai V, Soper C. Ibuprofen codeine combination precipitating severe hypokalaemia in a patient with pre-existing type 1 renal tubular acidosis. NDT Plus 2015; 1:270-1. [PMID: 25983902 PMCID: PMC4421206 DOI: 10.1093/ndtplus/sfn025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Adeline Ter
- School of Medicine , King's College , London
| | - Rami Salha
- School of Medicine , King's College , London
| | - Vivek Vadamalai
- Department of Renal Medicine , Mayday University Hospital , Thornton Heath , UK
| | - Charles Soper
- Department of Renal Medicine , Mayday University Hospital , Thornton Heath , UK
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14
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Nod and wave: An Internet study of the codeine intoxication phenomenon. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:67-77. [DOI: 10.1016/j.drugpo.2014.06.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 06/18/2014] [Accepted: 06/23/2014] [Indexed: 11/21/2022]
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Nielsen S, Murnion B, Dunlop A, Degenhardt L, Demirkol A, Muhleisen P, Lintzeris N. Comparing treatment-seeking codeine users and strong opioid users: Findings from a novel case series. Drug Alcohol Rev 2014; 34:304-11. [DOI: 10.1111/dar.12224] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 09/25/2014] [Indexed: 02/05/2023]
Affiliation(s)
- Suzanne Nielsen
- National Drug and Alcohol Research Centre; University of New South Wales; Sydney Australia
- Royal Prince Alfred Hospital; University of Sydney; Sydney Australia
- Drug and Alcohol Services; South Eastern Sydney Local Health District; Sydney Australia
| | - Bridin Murnion
- Royal Prince Alfred Hospital; University of Sydney; Sydney Australia
| | - Adrian Dunlop
- Drug and Alcohol Services; Hunter New England Local Health District; Newcastle Australia
- School of Medicine and Public Health; Faculty of Health; University of Newcastle; Newcastle Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre; University of New South Wales; Sydney Australia
- School of Population and Global Health; University of Melbourne; Melbourne Australia
- Murdoch Children's Research Institute; Royal Children's Hospital; Melbourne Australia
- Department of Global Health; School of Public Health; University of Washington; Seattle USA
| | - Apo Demirkol
- Drug and Alcohol Services; South Eastern Sydney Local Health District; Sydney Australia
- School of Public Health and Community Medicine; University of New South Wales; Sydney Australia
| | - Peter Muhleisen
- Drug and Alcohol Services; Hunter New England Local Health District; Newcastle Australia
| | - Nicholas Lintzeris
- Royal Prince Alfred Hospital; University of Sydney; Sydney Australia
- Drug and Alcohol Services; South Eastern Sydney Local Health District; Sydney Australia
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16
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Claire Van Hout M. “Doctor shopping and pharmacy hopping”: practice innovations relating to codeine. DRUGS AND ALCOHOL TODAY 2014. [DOI: 10.1108/dat-03-2014-0014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The misuse of pharmaceutical opioid analgesics is identified as a global public health concern. Codeine represents an interesting quandary in terms of its regulated status, with individuals varying in their metabolism of codeine, estimation of safe dosages, risk of adverse health consequences and abuse potential. Efforts to quantify and address hidden non-compliant medical codeine use, overuse and intentional misuse is compromised by availability to the public in prescribed and over the counter forms. The paper aims to discuss these issues.
Design/methodology/approach
– A review of literature on codeine use, misuse and dependence, and associated innovative medical and pharmacy interventions is presented, and was conducted as part of a larger scoping review on codeine.
Findings
– The review highlights the complexities associated with monitoring public health awareness of codeine's abuse potential, and customer/patients trends in non-compliant codeine use for therapeutic and recreational purposes. Aberrant codeine behaviours centre on visiting multiple doctors for prescriptions, repeated lost or stolen prescriptions, forging prescriptions and use of multiple pharmacies. Innovations to monitor misuse of codeine include national prescription databases and recent developments in real-time monitoring of dispensing activity.
Practical implications
– Further development of real-time monitoring processes with process evaluation is advised.
Originality/value
– This viewpoint is intended to demonstrate how efforts to quantify and address codeine use are compromised by its availability. It intends to encourage further policy and practitioner dialogue on how to monitor, support and intervene with consumers misusing codeine.
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Hamer AM, Spark MJ, Wood PJ, Roberts E. The upscheduling of combination analgesics containing codeine: The impact on the practice of pharmacists. Res Social Adm Pharm 2014; 10:669-78. [DOI: 10.1016/j.sapharm.2013.08.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 08/17/2013] [Accepted: 08/18/2013] [Indexed: 11/26/2022]
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Tobin CL, Dobbin M, McAvoy B. Regulatory responses to over-the-counter codeine analgesic misuse in Australia, New Zealand and the United Kingdom. Aust N Z J Public Health 2013; 37:483-8. [DOI: 10.1111/1753-6405.12099] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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Cusack L, de Crespigny C, Wilson C. Over-the-counter analgesic use by urban Aboriginal people in South Australia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2013; 21:373-380. [PMID: 23387500 DOI: 10.1111/hsc.12023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/20/2012] [Indexed: 06/01/2023]
Abstract
Despite recent health gains for Australian Aboriginal people their significantly poorer health status compared with that of non-Aboriginal Australians remains significant. Within the context of high levels of mortality and morbidity, research highlights significant barriers to timely health-care, access and safe use of prescribed and over-the-counter medicines. The risks to Aboriginal people's health due to unsafe medication use are preventable. The purpose of this article is to present the findings from qualitative research focused on Aboriginal people's knowledge, use and experience of over-the-counter analgesics. The study was conducted in the north-western metropolitan area of Adelaide, which has the largest urban Aboriginal population in South Australia. The employment of an Aboriginal Elder as Cultural Advisor enabled engagement with Aboriginal participants. Purposive 'snow ball' sampling was used to recruit participants for four focus groups [n = 30] and one participant opting for a personal semi-structured interview. Participants worked with the researchers to develop the findings and formulate recommendations. The 25 women and 6 men, aged 20-80 years reported various chronic medical conditions. Focus groups/interview elicited accounts of critical issues concerning safe selection and use of over-the-counter analgesics. Serious health risks were evident due to limited knowledge about safe analgesic use and over-reliance on information from family, friends and advertising. Extremely poor access was reported by participants to culturally and linguistically appropriate information, education and advice from a range of doctors and other health professionals including Aboriginal health workers.
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Affiliation(s)
- Lynette Cusack
- Faculty of Health Science, School of Nursing and Midwifery, Flinders University, Adelaide, SA, Australia
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Abstract
BACKGROUND The sale of over-the-counter (OTC) medicines from pharmacies can help individuals self-manage symptoms. However, some OTC medicines may be abused, with addiction and harms being increasingly recognised. This review describes the current knowledge and understanding of OTC medicine abuse. APPROACH Comprehensive search of international empirical and review literature between 1990 and 2011. FINDINGS OTC MEDICINE ABUSE WAS IDENTIFIED IN MANY COUNTRIES AND ALTHOUGH IMPLICATED PRODUCTS VARIED, FIVE KEY GROUPS EMERGED: codeine-based (especially compound analgesic) medicines, cough products (particularly dextromethorphan), sedative antihistamines, decongestants and laxatives. No clear patterns relating to those affected or their experiences were identified and they may represent a hard-to-reach group, which coupled with heterogeneous data, makes estimating the scale of abuse problematic. Associated harms included direct physiological or psychological harm (e.g. opiate addiction), harm from another ingredient (e.g. ibuprofen-related gastric bleeding) and associated social and economic problems. Strategies and interventions included limiting supplies, raising public and professional awareness and using existing services and Internet support groups, although associated evaluations were lacking. Terminological variations were identified. CONCLUSIONS OTC medicine abuse is a recognised problem internationally but is currently incompletely understood. Research is needed to quantify scale of abuse, evaluate interventions and capture individual experiences, to inform policy, regulation and interventions.
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Affiliation(s)
- Richard J Cooper
- School of Health and Related Research (ScHARR), University of Sheffield , Sheffield , UK
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21
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McWhirter KA, Jones RB. Accidental overdose of proprietary branded, combination analgesics available over the counter. Br J Hosp Med (Lond) 2012; 73:650-1. [DOI: 10.12968/hmed.2012.73.11.650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- KA McWhirter
- Department of Gastroenterology, University Hospital of South Manchester, Manchester M23 9LT and
| | - RB Jones
- Department of Gastroenterology, University Hospital of South Manchester, Manchester M23 9LT
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22
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Nielsen S, Cameron J, Pahoki S. Opportunities and challenges: over-the-counter codeine supply from the codeine consumer's perspective. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2012; 21:161-8. [PMID: 23419000 DOI: 10.1111/j.2042-7174.2012.00247.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 08/21/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study aimed to gain a better understanding on perspectives of over-the-counter (OTC) codeine users and issues relating to codeine dependence in the community pharmacy setting. Examining OTC codeine users' experiences aimed to promote better understanding of OTC codeine dependence, and inform pharmacy practices. METHODS Utilising a qualitative research methodology we conducted interviews with 20 participants who were OTC codeine users and met DSM IV criteria for codeine dependence. KEY FINDINGS Key themes identified included experience of participants acquiring OTC codeine and participants' interactions with pharmacists. The OTC codeine-dependent participants found it generally easy to access OTC codeine, describing 'standard' questioning, minimal intervention from pharmacists and only occasional refusal to supply. A better appearance and presentation was generally linked to easy codeine supply. CONCLUSIONS The experiences of participants suggest a number of barriers exist to effective intervention for OTC codeine dependence in the community pharmacy setting. Identification of these barriers will provide an opportunity to more effectively target interventions to reduce harm related to OTC codeine products. Increased involvement of pharmacists in OTC codeine sales was associated with help-seeking by codeine users.
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Affiliation(s)
- Suzanne Nielsen
- Eastern Health, Turning Point Alcohol and Drug Centre, Melbourne, Victoria, Australia.
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Hypokalaemia and Renal Tubular Acidosis due to Abuse of Nurofen Plus. Case Rep Crit Care 2012; 2012:141505. [PMID: 24826329 PMCID: PMC4010031 DOI: 10.1155/2012/141505] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 08/22/2012] [Indexed: 02/05/2023] Open
Abstract
Nurofen Plus is a common analgesic containing ibuprofen and codeine. We present a case of a 38-year-old lady who developed renal tubular acidosis with severe hypokalaemia, after chronic abuse of Nurofen Plus tablets. She presented with confusion and profound biochemical abnormalities requiring critical care admission for electrolyte replacement. Ibuprofen causes renal tubular acidosis due to its effects on carbonic anhydrase activity.
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Ramírez E, Rossignoli T, Campos AJ, Muñoz R, Zegarra C, Tong H, Medrano N, Borobia AM, Carcas AJ, Frías J. Drug-induced life-threatening potassium disturbances detected by a pharmacovigilance program from laboratory signals. Eur J Clin Pharmacol 2012; 69:97-110. [PMID: 22648277 DOI: 10.1007/s00228-012-1303-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 04/26/2012] [Indexed: 12/13/2022]
Abstract
PURPOSE Detection and reporting of drug-induced life-threatening potassium disturbances and the study of associated factors under a Pharmacovigilance Program using Laboratory Signals at a Hospital (PPLSH) during a 2-year period. METHODS All serum potassium levels <2 mmol/l or >7 mmol/l detected at admission to the hospital, including those of patients who died in the emergency ward or during hospitalization, were monitored prospectively from January 2009 through to December 2010. The incidence rate of each etiology of potassium disturbances was calculated. Factors associated with drug-induced potassium disturbances were detected using a multiple logistic regression model. RESULTS The incidence of true life-threatening drug-induced hyper- and hypokalemia events was 3 and 4.32 (Poisson 95 % confidence interval 1.62-10.24), respectively, per 10,000 admissions. Of the severe potassium disturbances, 32.3 % were drug-induced, and 23 % were lethal. We identified previously undescribed pharmacological causes of hyperkalemia (risedronate, doxazosin) and hypokalemia (acyclovir, teicoplanin, cefepime, meropenem, dexketoprofen colistimethate). Significant predictor factors associated with drug-induced hyperkalemia were the use of polypharmacy (>5 drugs), age (>74 years), sex (female) and kidney disease (glomerular filtration rate <60 ml/min) with the presence of ≥4 comorbid conditions. The only predictor of drug-induced hypokalemia was the use of >5 drugs. The triggering factor associated with drug-induced hyperkalemia and hypokalemia was azotemia and hypoalbuminemia, respectively. CONCLUSIONS Drug-induced life-threatening potassium disturbances remain a relevant problem. Potential strategies for prevention are to avoid polypharmacy, early discontinuation of treatment of drugs causing hyperkalemia or nephrotoxicity in cases of various clinical situations (cardiac descompensation, infection, hypovolemia) or obstructive causes, and insistence on albumin control during hospitalization.
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Affiliation(s)
- Elena Ramírez
- Clinical Pharmacology Deparment, Hospital Universitario La Paz (IdiPaz), School of Medicine, Universidad Autónoma de Madrid, Arzobispo Morcillo s/n, 28029 Madrid, Spain.
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25
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Glassock RJ, Bleyer AJ, Hricik DE, Palmer BF. The 2010 nephrology quiz and questionnaire: part 1. Clin J Am Soc Nephrol 2012; 6:2318-27. [PMID: 21896834 DOI: 10.2215/cjn.00900111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Presentation of the Nephrology Quiz and Questionnaire (NQQ) has become an annual "tradition" at the meetings of the American Society of Nephrology. It is a very popular session judged by consistently large attendance. Members of the audience test their knowledge and judgment on a series of case-oriented questions prepared and discussed by experts. They can also compare their answers in real time, using audience response devices, to those of program directors of nephrology training programs in the United States, acquired through an Internet-based questionnaire. As in the past, the topics covered were transplantation, fluid and electrolyte disorders, end-stage renal disease and dialysis, and glomerular disorders. Two challenging cases representing each of these categories along with single best answer questions were prepared by a panel of experts (Drs. Hricik, Palmer, Bargman, and Fervenza, respectively). The "correct" and "incorrect" answers then were briefly discussed, after the audience responses and the results of the questionnaire were displayed. The 2010 version of the NQQ was exceptionally challenging, and the audience, for the first time, gained a better overall correct answer score than the program directors, but the margin was small. In this issue we present the transplantation and fluid and electrolyte cases; the remaining end-stage renal disease and dialysis, and glomerular disorder cases will be presented next month. These articles try to recapitulate the session and reproduce its educational value for a larger audience--the readers of the Clinical Journal of the American Society of Nephrology. Have fun.
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The 2010 Nephrology Quiz and Questionnaire. Clin J Am Soc Nephrol 2011. [DOI: 10.2215/01.cjn.0000927132.17218.3b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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27
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Mallett A, Lynch M, John GT, Healy H, Lust K. Ibuprofen-related renal tubular acidosis in pregnancy. Obstet Med 2011; 4:122-4. [PMID: 27579107 DOI: 10.1258/om.2011.110041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2011] [Indexed: 11/18/2022] Open
Abstract
Ibuprofen-related renal tubular acidosis (RTA) has not been previously described in pregnancy but its occurrence outside of pregnancy is being increasingly described. In this case, a 34-year-old woman presented in the third trimester of pregnancy with Type 1 or distal RTA related to ibuprofen and codeine abuse. It was complicated by acute on chronic renal dysfunction and hypokalemia. Delivery at 37 weeks gestation due to concerns of evolving preeclampsia resulted in the birth of a healthy neonate. RTA and hypokalemia were remediated and ibuprofen and codeine abuse ceased. Some renal dysfunction however continued. Thorough and repeated history taking as well as vigilance for this condition is suggested.
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Affiliation(s)
- Andrew Mallett
- Department of Renal Medicine; Department of Obstetric Medicine, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, Queensland, 4029, Australia
| | | | | | | | - Karin Lust
- Department of Obstetric Medicine , Royal Brisbane and Women's Hospital , Butterfield Street, Herston, Brisbane, Queensland, 4029 , Australia
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Ng JL, Morgan DJR, Loh NKM, Gan SK, Coleman PL, Ong GSY, Prentice D. Life‐threatening hypokalaemia associated with ibuprofen‐induced renal tubular acidosis. Med J Aust 2011; 194:313-6. [DOI: 10.5694/j.1326-5377.2011.tb02982.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Accepted: 11/21/2010] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | - Seng K Gan
- Royal Perth Hospital, Perth, WA
- University of Western Australia, Perth, WA
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29
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Frei MY, Nielsen S, Dobbin MDH, Tobin CL. Serious morbidity associated with misuse of over‐the‐counter codeine–ibuprofen analgesics: a series of 27 cases. Med J Aust 2010; 193:294-6. [DOI: 10.5694/j.1326-5377.2010.tb03911.x] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Accepted: 03/16/2010] [Indexed: 02/05/2023]
Affiliation(s)
- Matthew Y Frei
- Turning Point Alcohol and Drug Centre, Eastern Health, Melbourne, VIC
- South East Alcohol and Drug Service, Southern Health, Melbourne, VIC
- School of Psychology and Psychiatry, Monash University, Melbourne, VIC
| | - Suzanne Nielsen
- Turning Point Alcohol and Drug Centre, Eastern Health, Melbourne, VIC
- Eastern Health Clinical School, Monash University, Melbourne, VIC
| | - Malcolm D H Dobbin
- Mental Health, Drugs and Regions Division, Victorian Department of Health, Melbourne, VIC
| | - Claire L Tobin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC
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Medani S, Short S, Wall C. Nurofen Plus toxicity-what should nephrologists be alert to? Rare complications of an increasingly misused medication. NDT Plus 2010; 3:343-5. [PMID: 25949426 PMCID: PMC4421510 DOI: 10.1093/ndtplus/sfq079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2010] [Accepted: 04/12/2010] [Indexed: 11/12/2022] Open
Abstract
We report the staggered clinical course of a young Caucasian female who suffered rare deleterious effects of Nurofen Plus misuse with a near fatal outcome. Several life-threatening events intervened before the underlying problem of serious dependency was identified. Effects on renal tubular acidification and bone marrow function as well as the commoner complications of acute kidney injury and peptic ulceration are described. In addition, this is the first case report in which the syndrome of reversible posterior leucoencephalopathy is linked to analgesic misuse, occurring after recovery of renal function. Recommendations for restricting availability of codeine-based analgesics are made.
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Affiliation(s)
- Samar Medani
- Department of Nephrology , The Adelaide and Meath Hospital, Dublin , Ireland
| | - Sarah Short
- Department of Nephrology , The Adelaide and Meath Hospital, Dublin , Ireland
| | - Catherine Wall
- Department of Nephrology , The Adelaide and Meath Hospital, Dublin , Ireland
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Dutch MJ. Nurofen Plus misuse: an emerging cause of perforated gastric ulcer. Med J Aust 2008; 188:56-7. [DOI: 10.5694/j.1326-5377.2008.tb01509.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2007] [Accepted: 10/04/2007] [Indexed: 11/17/2022]
Affiliation(s)
- Martin J Dutch
- Emergency Department, The Angliss Hospital, Melbourne, VIC
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32
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Affiliation(s)
- A Paul Lambert
- Division of Medicine, Taunton and Somerset Hospital, Musgrove Park, Taunton TA1 5DA, UK.
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Abstract
Ibuprofen abuse may be more prevalent than generally considered. Although normally benign, serious complications have been documented. We report an unusual presentation of hypokalaemia and its associated symptoms as a result of Nurofen Plus (200 mg ibuprofen + 12.8 mg codeine phosphate) abuse. Ibuprofen is generally not included in a standard toxicology screen, but should be considered as a rare cause of hypokalaemia.
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Affiliation(s)
- B T Dyer
- Chelsea & Westminster Hospital, London, UK
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