Hypokalaemia in ibuprofen and codeine phosphate abuse

Abstract

Ibuprofen abuse may be more prevalent than generally considered. Although normally benign, serious complications have been documented. We report an unusual presentation of hypokalaemia and its associated symptoms as a result of Nurofen Plus (200 mg ibuprofen + 12.8 mg codeine phosphate) abuse. Ibuprofen is generally not included in a standard toxicology screen, but should be considered as a rare cause of hypokalaemia.

Misuse of non-prescription codeine containing products: Recommendations for detection and reduction of risk in community pharmacies

“…Adverse health consequences relate particularly to excessive or long term misuse of products containing non-opioid analgesics (ibuprofen, paracetamol, aspirin) and codeine contributing to medication overuse headache, paracetamol hepatotoxicity, gastrointestinal hemorrhage, nephrotoxicity, hypokalemia, acute hemorrhagic necrotizing pancreatitis and opioid dependence, and often in individuals with no history of substance use disorders and co-morbidity (Dyer, Martin, Mitchell, Sauven, & Gazzard, 2004;Dutch, 2008;Ernest, Chia, & Corallo, 2010;Evans & Gearry, 2010;Frei, Nielsen, Dobbin, & Tobin, 2010;McDonough, 2011;Pilgrim, Dobbin, & Drummer, 2013;Pilgrim & Drummer, 2014).…”

Over-the-counter medicine abuse – a review of the literature

“…In relation to harms from other ingredients, two analgesic combination products – paracetamol and codeine (co-codamol) and ibuprofen and codeine – were considered problematic, with ibuprofen-containing medicine being particularly highlighted (Chetty et al, 2003; Dyer et al, 2004; Lambert & Close, 2005; Ford & Good, 2007; Dobbin & Tobin, 2008; Dutch, 2008; Ernest et al, 2010; Frei et al, 2010; Robinson et al, 2010). Dutch (2008) and Ford and Good (2007) reported on two hospital and three primary care presentations, respectively, of patients who had used a combination analgesic containing ibuprofen and codeine.…”

An ecological study of the extent and factors associated with the use of prescription and over-the-counter codeine in Australia

“…Misuse and associated harms from the use of prescription and OTC codeine have been widely reported [7][8][9][10][11][12][13][14][15]. In recent years, there has also been an increase in the number of individuals presenting to addiction treatment services with codeine dependence, including those dependent on OTC codeine preparations [6,16,17].…”