Painkiller combinations cost more but are less effective: Report

By Dr. Ananya Mandal, MDAug 1 2010

In a new article in the journal Australian Prescriber, there is a warning that combination painkillers cause more side effects and may not provide the relief promised. This comes from the National Prescribing Service (NPS), Australia's medicine review body.

The article says that the fever medicine Paracetamol combined with certain levels of codeine can be effective for people in acute pain after operations in some cases. But authors write that Paracetamol is more effective on its own than when it is combined with lower doses of codeine. Most of these combinations they write contain less than 30 milligrams of codeine, the minimum amount for a painkiller to take effect.

For acute post-operative pain, evidence suggests a 60mg codeine dose is required. There are pain relievers for toothache, migraine and back pain that contain as little as 8 milligrams of codeine per pill but cost two to three times more, according to the review. One pack of Paracetamol costs $2 or less while codeine combinations cost between $6 and $12 depending on strength the article says.

According to review author Bridin Murnion, staff specialist at Sydney's Royal Prince Alfred Hospital moves to limit the availability of codeine preparations would reduce harm without limiting patients' options significantly. NPS acting chief executive Karen Kaye also pointed out that codeine could be addictive but because it was available only in combination with paracetamol, aspirin or ibuprofen, people could be consuming more than needed of these products too. “Overuse or misuse of products containing aspirin or ibuprofen can result in gastric ulcer perforation or, in products containing paracetamol, liver toxicity or death,” she said.

The report brings to notice that there are 40 different combination painkillers are available in Australia. Many of these are available over the counter without a prescription. There is also a risk of overdose if more than one product is taken at once. The review concluded that government limitation on codeine preparations would reduce harm to patients without limiting their options. Products containing less than 12mg of codeine per pill have faced tougher restrictions since May 1 this year.