Paracetamol/ibuprofen has become the most popular replacement for OTC codeine for patients with arthritis, according to anecdotal reports by pharmacists.
The up-scheduling of low-dose codeine medicines, which came into effect on February 1, was hailed as a win for evidence-based medicine but there were predictions of short-term fall out for some rhuematology patients, such as the one in four with rheumatoid arthritis who report using opioids despite DMARD therapy.
Pharmacists have told the limbic most customers with arthritis who used to buy these products have adapted to the changes, although it’s possible some are still using products they purchased over the counter before February.
Sydney pharmacist Nick Logan said one surprising outcome had been how a proportion of people with arthritis who were OTC codeine customers had stopped coming to his pharmacy.
“Before February 1 we had people who were using it and had a monitoring system in place so they couldn’t abuse it. A lot of them have not returned for alternative painkillers, we just don’t see them anymore,” he told the limbic. “Theoretically they are having alcohol or some have got prescriptions for 30 mg (codeine). Some doctors prescribe low dose codeine despite the TGA argument it was sub-therapeutic.”
For arthritis patients who do continue to shop at his pharmacy the “number one swap over we have seen from people who used to take codeine/paracetamol over the counter is ibuprofen/paracetamol combination”.
Jason Harvey, a pharmacy owner in Broken Hill in regional NSW, has seen a similar trend; since February 1 the pharmacy has sold more ibuprofen/paracetamol combination analgesics, Voltaren and Nurofen.
But he said a key observation was that patients who previously bought codeine over the counter were not bringing in prescriptions for the same medication.
“Beforehand we had lots of sales of OTC products and that has translated to very few prescriptions for codeine products,” he said.
“My best guess is that arthritis patients have gone to see their doctor and have come across an alternative treatment with their doctor.”
There have been reports of GPs being pushed into prescribing tramadol to patients who previously sourced OTC codeine. But both pharmacists said while they had not seen a big upswing in dispensing.
“GPs are wary of the interactions and side effects associated with tramadol,” Mr Logan said.