Analgesics are medicines designed to relieve pain. Last month, we discussed anti-inflammatories, this month will focus on paracetamol and codeine.
Analgesics, such as paracetamol and codeine work by altering the pain nerves and receptors in the brain and spinal cord to disable their ability to send pain messages to the brain. They don’t have anti-inflammatory properties.
Paracetamol
Paracetamol can provide relief for mild to moderate pain like headaches, rheumatic pains, post-operative pain and injuries. Paracetamol products are also very effective for bringing down high temperatures and relieving aches and pains. It is often combined with decongestant ingredients to help relieve symptoms associated with colds, influenza and sinusitis.
Classified under several schedules, these medicines will be located in the pharmacy according to the rules and regulations of that schedule. For example, a 24-pack of paracetamol can be bought in a supermarket, while larger packets are classified as scheduled products and can only be bought in a pharmacy.
While paracetamol is the preferred pain medication for asthma sufferers, there are a number of people who can’t take it, including people with liver or kidney disease. It is also important to understand the consequences of on-going use or exceeding the maximum dose. Paracetamol can cause liver toxicity, liver failure and even death – as with this sad story from last week.
Because paracetamol is often considered a harmless painkiller by the general public, it is important to educate customers on the following:
- Ongoing and simultaneous use of high dose paracetamol and alcohol or anticonvulsant medicines (for epilepsy/neuropathic pain) may increase the risk of long term liver damage.
- Paracetamol can be toxic to young children if given at the wrong dose. It is essential that customers know the correct dose and have a suitable measuring device.
- Taking only the correct dose for their medical condition. Ensure you explain dosages and refer to the directions on the package.
- Customers on a restricted sodium/salt diet should be aware that soluble preparations of paracetamol may have a high sodium level.
- More than eight tablets within 24 hours can be harmful to adults, this includes combination products such as cold and flu medicines.
Codeine
Codeine is a strong opioid product that increases tolerance to pain. It also causes sedation and drowsiness. You may find codeine in a number of products, including Nurofen Plus, Panadeine and Mersyndol. Like paracetamol, you can find it in a number of schedules so it is important to have a good understanding of what products are available in your pharmacy. Unlike paracetamol, codeine is only available as Schedule 3 medicine or higher.
Because products containing codeine are Pharmacist Only or Prescription Only Medicines, you will always need to refer a customer requesting a codeine product to the pharmacist. You can still ask the protocol questions so you can let the pharmacist know if the customer has any of the conditions listed below as it is likely they should not be taking codeine:
- Codeine allergy
- Acute breathing problems
- Chronic constipation
- Liver problems
- Pregnant or breastfeeding
- Taking other medications
What else can you offer?
As with anti-inflammatory products (creams/rubs), you are not limited to medicines. You can recommend a number of companion products and offer lifestyle advice to your customers depending on the type and severity of the pain.
Companion products:
- Heat packs
- Braces and supports
- Purchasing home health aids, such as telescopic hands
- Heat rubs/herbal essential oils
- Vitamins, such as magnesium to help with muscle relaxation or cramps
Lifestyle advice:
- Light exercise
- Discussing a pain management plan with their pharmacist or doctor
- Advice on other health practitioners in the area, for example an optometrist could assist with headache causes (i.e. eye strain)
Do you know how to manage a pain enquiry? We’ve put together a scenario in this month’s brain tweezers so you can test yourself.
Sources:
SIRCPPK310 – Assist customers with analgesic and anti-inflammatory products