Find out more about how health professionals and communities are managing this transition. List of available resources to help support GPs and their patients with the change to codeine becoming prescription only. Codeineis being rescheduled to a prescription-only medicine from 1 February Whyis this happening and what are the implications? Read more on Australian Prescriber website. The rescheduling of pharmaceuticals that include codeine will tighten access to these drugs from 1 February.
This makes now a timely moment to consider some of the wider measures that GPs can take to improve patient outcomes and avoid the over-prescription of some medications.
Pharmacotherapy, in the form of opioid replacement therapy ORT , is the replacement of a drug of dependence, such as heroin, codeine and OxyContin, with a legally prescribed substitute. Naloxone nasal spray is a fast-acting opioid antagonist now PBS-listed for use in the community.
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Key facts Codeine is an opioid pain-relief medicine used for the short-term relief of mild to moderate pain. From 5 November, , all codeine-containing products previously available over-the-counter OTC will become prescription-only medicines.
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 listed in Table 1 as some pharmacies may still have stock of these formulations.
It is likely that some codeine-containing products that are currently available OTC may be withdrawn from the New Zealand market due to a lack of demand once a prescription is required.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 request medicines for the relief of mild to moderate acute pain associated with headache and migraine, dental issues, back injuries, menstruation and musculoskeletal conditions.
The reclassification of codeine will limit the number of products pharmacists are able to sell to people with 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 purchase 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:. Additional factors that may influence pain 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, people should be advised to consult their general practitioner if their pain has not improved significantly in an agreed time frame or if their pain is increasing.
It may be appropriate to consider the possibility 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 regimen 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 people 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.
Codeine is a painkiller. It's used to treat pain, for example after an operation or an injury. It's also used for long-standing pain when everyday painkillers, such as paracetamol , ibuprofen and aspirin have not worked. Codeine is also used to treat diarrhoea. Codeine is available on prescription. It comes as tablets, a liquid to swallow and as an injection. Codeine injections are usually only given in hospital. You can buy lower-strength codeine from a pharmacy.
It comes mixed with paracetamol co-codamol or with aspirin co-codaprin or with ibuprofen Nurofen Plus. You can also buy codeine from a pharmacy as a syrup linctus to treat dry coughs. Take our survey. Only give codeine to children aged 12 to 18 years if everyday painkillers such as paracetamol and ibuprofen haven't worked.
Codeine is not suitable for some people. Tell your doctor before starting the medicine if you have:. Do not give codeine to children who are under 18 years old and have had their tonsils or adenoids removed because of a sleep problem called obstructive sleep apnoea.
Codeine is not generally recommended in pregnancy. Tell your doctor before taking codeine if you're trying to get pregnant, are already pregnant or if you are breastfeeding. Follow your doctor's instructions about how to use this medicine. This is particularly important because codeine can be addictive. Take codeine with, or just after, a meal or snack so it's less likely to make you feel sick.
You can take codeine at any time of day but try to take it at the same times every day and space your doses evenly. If you're taking codeine as a liquid, it will come with a plastic spoon or syringe to help you measure the correct amount. Ask your pharmacist for one if you don't have it. Do not measure the liquid with a kitchen teaspoon because it won't give the right amount.
If your symptoms don't go away, your dose might go up or you may be prescribed a different medicine. Talk to your doctor if your pain or diarrhoea isn't relieved by the dose of codeine prescribed for you, or if side effects bother you or don't go away.
Sometimes, you may need to take codeine for longer. But usually a different medicine will be prescribed for long term pain or diarrhoea, especially if you have side effects like constipation.
If you forget to take a dose, check the information on the patient information leaflet inside the packaging or ask your pharmacist or doctor for advice on what to do. If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to remember your medicine. If you need to take codeine for a long time your body can become tolerant to it. This isn't usually a problem but you could get unpleasant withdrawal symptoms if you stop taking it suddenly.
If you want to stop taking codeine, talk to your doctor first. Your dose can be reduced gradually so you don't get unpleasant withdrawal symptoms. If you stop taking it suddenly it can cause unpleasant withdrawal symptoms such as:. If you have been taking codeine for more than a few weeks do not stop taking it without speaking to your doctor first. It's important not to take more than your prescribed dose, even if you think it's not enough to relieve your pain.
Speak to your doctor first, if you think you need a different dose. If you've taken an accidental overdose you may feel very sleepy, sick or dizzy.
You may also find it difficult to breathe. In serious cases you can become unconscious and may need emergency treatment in hospital. The amount of codeine that can lead to an overdose varies from person to person.
Take the codeine box or leaflet inside the packet plus any remaining medicine with you. If you've been prescribed codeine, it's particularly important that you:. It's safe to take codeine with paracetamol , ibuprofen or aspirin aspirin is suitable for most people aged 16 years and over. Some painkillers that you can buy without a prescription from pharmacies contain codeine.
They include co-codamol , ibuprofen and codeine such as Nurofen Plus and Solpadeine. Do not take painkillers that you buy with codeine in alongside prescribed codeine. You'll be more likely to get side effects. Like all medicines, codeine can cause side effects in some people - but many people have no side effects or only minor ones.
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