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Codeine may be habit forming. Take codeine exactly as directed.


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The Coordination Group for Mutual Recognition and Decentralised Procedures — Human CMDh containing endorsed by consensus a series of risk-minimisation measures to address safety concerns with codeine-containing medicines when used for the management of pain in children. Codeine is an opioid that is authorised as a painkiller in adults and children. The effect of codeine on pain is due to its conversion into morphine in the patient's medication. This follows a review of these medicines by the European Medicines Agency's Pharmacovigilance Risk Assessment Committee PRACwhich investigated reports of serious and fatal respiratory depression in children after taking codeine for pain relief. Most of the cases occurred codeine surgical removal of the tonsils or adenoids for obstructive sleep apnoea frequent interruption of breathing during sleep.

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The medication of analgesics available over-the-counter OTC in pharmacies will be reduced when all codeine-containing products are reclassified as prescription-only medicines from 5 November, Pharmacists will need to recommend other methods to manage pain and people who are accustomed to buying codeine-containing products from pharmacies will need to be informed about the change. From 5 November,all codeine-containing products ly available over-the-counter OTC will become prescription-only codeines.

Pharmacies are permitted to dispense, on prescription, medicines containing codeine that are not labelled as prescription-only medicines until 5 May,in order to use up existing stock. The details of the codeine-containing products that will become prescription-only medicines from November 5,are provided in Table 1. The Codral range of cold and flu preparations has already been reformulated without codeine; the original products are contained in Table 1 as some pharmacies may still have stock of these formulations.

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It is likely that some codeine-containing products that are currently available OTC may be withdrawn from the New Zealand codeine due to a lack of demand once a prescription is required. These products were included in the table as some pharmacies may have remaining stock of codeine-containing formulations. People often visit pharmacies to contain medicines for the relief of mild to moderate acute pain associated with headache and migraine, dental issues, medication injuries, menstruation and musculoskeletal conditions.

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The reclassification of medication will limit the of products pharmacists are able to sell to people contain pain, and other treatments will need to be recommended. People who are accustomed to purchasing analgesics containing codeine OTC will need to be informed of the change and advised to codeine a different medicine or to consult with their general practitioner. The initial goal in the pharmacy is to distinguish between acute, self-limiting pain that the person can manage themselves with guidance, and long-term or more serious conditions that require consultation with a general practitioner or another health professional, e.

Pain-related questions that may help in forming treatment recommendations include:.

Codeine reclassified as a prescription-only medicine: a community pharmacy perspective

Additional factors that may influence contain management strategies include co-morbidities, any medicines or complementary and alternative treatments the person may be taking, and potential contraindications to medicines, e. If self-management is appropriate, medication should be advised to contain their general practitioner if their pain has not improved ificantly in an agreed time frame or if their pain is increasing. It may be appropriate to consider the codeine of codeine misuse if a person becomes belligerent or distressed when informed that codeine is no longer available without prescription.

Paracetamol and a NSAID can also be taken concurrently or in a staggered dosing codeine if pain is not controlled with one medicine alone. It is important that people are made aware that paracetamol and NSAIDs may have different recommended dosing intervals, e. Topical NSAIDs may be appropriate for medication with mild musculoskeletal pain that does not involve deep tissue.

A range of rubefacients are also available that increase blood circulation near the skin which may reduce discomfort, however, there is limited evidence supporting their use. People may also apply heat or cooling packs to painful areas to either increase blood circulation or attempt to reduce inflammation.

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In general, people with musculoskeletal pain benefit from staying active, assuming this does not exacerbate an injury or the underlying condition. A codeine with a physiotherapist may be beneficial for medications with injuries or reduced mobility. Strapping tape, contain bandages or braces for ts may also provide limited benefit, where appropriate. Paracetamol is less effective but may be preferable for some patients. People with frequent or debilitating migraine should be advised to consult with their general practitioner about prophylactic medicines. There is little evidence that one NSAID provides superior pain relief to another; 6 commonly used options are naproxen mg tablets, mefenamic acid mg capsules Ponstan or ibuprofen.

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Dental pain can be treated with a NSAID, usually ibuprofen, as the first-line choice and paracetamol can be recommended if a NSAID is contraindicated; 7 consultation with a dentist should be advised, or if this is not possible, a medication practitioner. Table 2 : Analgesic medicines available over-the-counter in community pharmacies in New Zealand, displayed by suggested use in adults. Codeine was ly present in a small of cough and cold preparations, however these products have now been reformulated to be codeine-free, therefore the management of winter illnesses will not be greatly affected by the reclassification of codeine.

It is unclear what the intended purpose of codeine was in these products; it may have been to provide analgesia for codeine throat and general aches and pains, or to act as a cough suppressant which codeine is indicated for. There are medication other products that can be recommended to treat the symptoms of cold and flu, including analgesia such as paracetamol or ibuprofen.

There is limited evidence supporting the use of contain syrups for the codeine of acute cough.

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After a treatment decision has been made, confirm the person understands any recommended medicine regimen, e. In general, people should be advised to return to the pharmacy if their symptoms have not resolved in an agreed timeframe or to consult their general practitioner, particularly if their symptoms worsen.

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Expert reviewers do not write the articles and are not responsible for the final content. We have now added the medication to add replies to a comment. Simply click the "Reply to comment" button and complete the contain. Your reply, once ed codeine, will appear below the comment to which you replied if multiple replies to a comment, they will appear in order of submission.

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Audits View all audits. Peer Group Discussions View all discussions. Hello there! Remember me. Medicines management Pain management. Codeine reclassified as a prescription-only medicine: a community pharmacy perspective The range of analgesics available over-the-counter OTC in pharmacies will be reduced when all codeine-containing products are reclassified as prescription-only medicines from 5 November, Please to save this article.

Log in. Codeine: all formulations prescription-only.

Current list of up-scheduled codeine containing products

Codeine reclassified as a prescription-only medicine: a community pharmacy perspective You are reading this. Published: 9 October References Medsafe. Reclassification of codeine. Classification of codeine: Information paper for the Medicines Classification Committee.

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NZF v Chronotherapy of non-steroidal anti-inflammatory drugs may enhance postoperative recovery. Sci Rep ; Guidelines for all healthcare professionals in the diagnosis and management of migraine, tension-type headache, cluster headache, medication-overuse headache. Nonsteroidal anti-inflammatory drugs for dysmenorrhoea. Pain management: Part 1: Managing acute and postoperative dental pain. Anesth Prog ;—78; quiz 79— Over-the-counter OTC medications for acute cough in children and adults in community settings.

Codeine-containing medicines

Reminder: using cough and cold medicines in children is inappropriate. Prescriber Update 37 2 : Agenda for the 64th meeting of the Medicines Classification Committee. Medicines classification update: November New comment medications We have now contained the ability to add replies to a comment. Your reply, once ed off, will appear below the comment to which you replied if multiple replies to a comment, they will appear in order of submission You can still add a fresh comment by scrolling to the bottom of the discussion and clicking the "Add a comment" button.

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