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Fatal misuse of codeine–ibuprofen analgesics in Victoria, Australia

Jennifer L Pilgrim, Malcolm Dobbin and Olaf H Drummer
Med J Aust 2013; 199 (5): 329-331.

To the Editor: Morbidity and mortality in cases where codeine from over-the-counter (OTC) combination analgesics is detected are usually secondary to codeine addiction and are the result of exposure to supratherapeutic doses of simple analgesics containing codeine. Toxicity from the accompanying analgesic, such as paracetamol, ibuprofen or aspirin, can lead to paracetamol hepatotoxicity, or non-steroidal anti-inflammatory

Jennifer L Pilgrim, Postdoctoral Research Fellow1
Malcolm Dobbin, Senior Medical Advisor2
Olaf H Drummer, Head1,3
1 Department of Forensic Medicine, Monash University, Melbourne, VIC.
2 Alcohol and Drugs, Department of Health, Melbourne, VIC.
3 Forensic Scientific Services, Victorian Institute of Forensic Medicine, Melbourne, VIC.
Article References: 
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Dutch MJ. Nurofen Plus misuse: an emerging cause of perforated gastric ulcer. Med J Aust 2008; 188: 56-57.
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Ng JL, Morgan DJ, Loh NK, et al. Life-threatening hypokalaemia associated with ibuprofen-induced renal tubular acidosis. Med J Aust 2011; 194: 313-316.
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Frei MY, Nielsen S, Dobbin MD, Tobin CL. Serious morbidity associated with misuse of over-the-counter codeine-ibuprofen analgesics: a series of 27 cases. Med J Aust 2010; 193: 294-296.
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Reference Text: 
Nielsen S, Tobin C, Dobbin M. OTC codeine: examining the evidence for and against. Aust Pharm 2012; 31: 236-240.
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