Who needs to take action?
This HSE National Patient Safety Alert (NPSA) is for action by all Health Service personnel involved in caring for patients suspected to have experienced harm arising from dependence on codeine-containing products, including toxicities associated with the analgesic component of combination products.
What is the issue?
Regular or prolonged use of codeine-containing products may produce psychological and physical dependence. For combination products, use of higher doses and/or for a longer duration than that recommended, can also lead to serious adverse clinical outcomes arising from exposure to the analgesic component (e.g. paracetamol or ibuprofen). These include hepatotoxicity, gastrointestinal and renal toxicities, such as gastrointestinal haemorrhage and perforation and renal failure (1).
What action is required?
- Circulate this NPSA to all clinical staff who provide care for patients who may be impacted by the use of codeine-containing products, particularly in the specialities of Gastroenterology, Nephrology, Gynaecology, General Practice, Pharmacy and Psychiatry and Addiction Services.
- Staff should report cases of suspected harm (past or current) to the Health Products Regulatory Authority (HPRA) via the HPRA’s online adverse reaction report form or by phone on 01 676 4971.
- It is not necessary to complete all fields of the online form, however, as much information as is known should be provided. Include the brand name(s) of the suspect medicine(s), or if unknown, state all active ingredient(s) (e.g. ibuprofen codeine combination product). Provide a summary of available information on the circumstances of use (e.g. if use was prescribed and/or accessed over the counter ‘OTC’, duration and quantity), details of any suspected dependence or misuse, and any associated suspected reactions (i.e. adverse clinical outcomes).
When does the action need to be completed by?
Please circulate this HSE NPSA to relevant staff by 21 October 2022.