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Review
. 2020 Jun;9(1):171-194.
doi: 10.1007/s40122-020-00162-8. Epub 2020 Mar 14.

Resolving Issues About Efficacy and Safety of Low-Dose Codeine in Combination Analgesic Drugs: A Systematic Review

Ivan Ćelić  1 , Lidija Bach-Rojecky  2 , Iveta Merćep  3   4 , Ana Soldo  5 , Anja Kos Petrak  6 , Ana Bučan  6
Affiliations
Review

Resolving Issues About Efficacy and Safety of Low-Dose Codeine in Combination Analgesic Drugs: A Systematic Review

Ivan Ćelić et al. Pain Ther. 2020 Jun.

Abstract

Introduction: The objective of this systematic review is to reflect on assumptions in relation to codeine use in combination with other analgesics.

Methods: MEDLINE was searched according to the predetermined keywords and criteria. Only English language studies were taken into consideration and the outcome data of the final studies were extracted by two reviewers independently from each other and were checked by the third reviewer. Additionally, the available codeine-related Individual Case Safety Reports (ICSRs) retrieved from EudraVigilance were reviewed.

Results: Sixteen placebo-controlled studies that involved 3378 subjects suffering from acute pain were analyzed for the efficacy of low-dose codeine (≤ 30 mg) combination products. Twelve of them found low-dose codeine combinations more efficient in relieving pain than the assigned comparator. According to 20 randomized clinical trials which included at least one dose of codeine (from 30 to 240 mg daily), the vast majority of reported side-effects were mild or moderate in severity. A total of 20 ICSRs for dependence were identified in the EudraVigilance database with codeine as a suspect drug for the 10-year time period for the European region.

Conclusions: Low-dose codeine combinations are effective after a single application in treating acute pain. Codeine in doses ≤ 30 mg and higher was considered safe since only mild to moderate side-effects were observed. There is no indication in the available sources which clearly links low doses of codeine to substance use disorder in non-dependent subjects.

Keywords: Acute pain; Clinical studies; Combination analgesic drugs; Efficacy; Low-dose codeine; Review; Safety; Substance-use disorder.

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Conflict of interest statement

Lidija Bach-Rojecky is a member of the Advisory Board at Alkaloid AD Skopje. Lidija Bach-Rojecky reports personal fees from Alkaloid AD Skopje, PLIVA Hrvatska, Sandoz Hrvatska, and Medis Adria for giving lectures, outside the submitted work. Ivan Ćelić reports speaking fees for the following companies: Alkaloid AD Skopje and Sandoz. Iveta Merćep, Anja Kos Petrak, Ana Soldo and Ana Bučan have nothing to disclose. Anja Kos Petrak is now affiliated with Makpharm Ltd., Pharmacovigilance Department, Zagreb, Croatia.

Figures

Fig. 1
Fig. 1
Search strategy summary for efficacy and safety as per the predetermined inclusion and exclusion criteria
See this image and copyright information in PMC

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