Fatal misuse of codeine–ibuprofen analgesics in Victoria, Australia

Jennifer L Pilgrim, Malcolm Dobbin and Olaf H Drummer
Med J Aust 2013; 199 (5): . || doi: 10.5694/mja12.11843
Published online: 2 September 2013

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 drug (NSAID) toxicity such as gastrointestinal ulcers and haemorrhage,1 or renal tubular acidosis.2

  • 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.


Competing interests:

No relevant disclosures.

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  • 2. 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. <MJA full text>
  • 3. 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. <MJA full text>
  • 4. Nielsen S, Tobin C, Dobbin M. OTC codeine: examining the evidence for and against. Aust Pharm 2012; 31: 236-240.


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