Home > Pharmacy guidelines on safe supply of codeine-based products.

Walsh, Simone (2010) Pharmacy guidelines on safe supply of codeine-based products. Drugnet Ireland, Issue 35, Autumn 2010, p. 28.

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The Pharmacy Act 2007 and the Regulation of Retail Pharmacy Businesses Regulations 2008 require that all codeine-based products are dispensed under the supervision of a pharmacist, and that individuals in receipt of the product should receive appropriate counselling. In May 2010, the Pharmaceutical Society of Ireland published guidelines on the safe dispensing of non-prescription products containing codeine.1 Codeine is an opiate-based analgesic which is controlled under the Misuse of Drugs Acts 1977 and 1984 and is most often sold as a combination drug in non-prescription medication. It is well established that codeine-based medications have the potential to be abused and, if used for long periods, psychological and physical dependence can occur. Withdrawal of codeine in individuals who have taken excess doses over long periods of time may result in restlessness and irritability.

Codeine is used in many popular over-the-counter painkillers (e.g. Solpadeine), often in combination with other non-prescription painkillers such as paracetamol or ibuprofen (e.g. Nurofen Plus). Certain cough medicines and flu remedies also contain codeine.2 An individual who takes excess amounts of a combination drug is at risk of the toxic effects of both drugs.

The guide aims to ensure the safe supply of medicines and to support pharmacists in their legal obligation to dispense non-prescription products containing codeine. The main points in the guide are:

  • Products containing codeine cannot be displayed in the ‘self-selection’ area of the pharmacy.
  • Codeine-based products should only be dispensed under the supervision of the pharmacist, who should be in a position to consult with the patient so as to determine the appropriateness of the request. Each repeated request should have a separate consultation.
  • Education should be provided to the individual in receipt of codeine-based products, including dosage regime, overdose risk, drug interactions, side effects and safe storage.
  • Pharmacists should be alert to the possibility that some patients may request codeine-based medicines for symptoms that are in fact secondary to excess codeine consumption.
  • Products containing codeine are a second-line treatment and should only be considered when the likes of paracetamol, aspirin and ibuprofen have not been successful in pain management.
  • It is the responsibility of the pharmacist to manage the supply and ensure suitable controls are in place for the management of dispensing codeine-based products.
  • If a pharmacist suspects that an individual is abusing or dependant on codeine, she/he is obliged to make a reasonable attempt to facilitate the individual in accessing treatment services.
  • Advertising medication containing codeine is prohibited; this includes window displays, in-pharmacy promotions, promotional displays and leaflets and stickers.
  1. Pharmaceutical Society of Ireland (2010) Non-prescription medicinal products containing codeine: guidance for pharmacists on safe supply to patients. Dublin: Pharmaceutical Society of Ireland. Available at www.drugsandalcohol.ie/13191
  2. Irish Medicines Board (2010) Human medicine product list: codeine. Accessed 30 July 2010 at www.imb.ie

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