Fatal misuse of codeine–ibuprofen analgesics in Victoria, Australia

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