Call for ban on codeine - health

THE widely used painkiller codeine doesn't work in some people and can be fatal in others, so its use should be halted, say researchers at the University of British Columbia in Vancouver, Canada.

Codeine works by being metabolised to morphine in the body, but the extent of that metabolism depends on a person's genetic make-up, so the amount of morphine produced varies.

In an editorial published in the Canadian Medical Association Journal this week, Stuart MacLeod and Noni MacDonald say the problem is especially relevant for infants, citing examples of two children who died after being given codeine following a tonsillectomy, and two studies that show non-fatal toxicity to infants being breastfed by mothers taking codeine.

The Hospital for Sick Children in Toronto, Canada, has stopped using codeine. The authors are calling for others to follow suit.

The UK Medicines and Healthcare Products Regulatory Agency currently has no plans to stop codeine being sold over the counter. "As only 1 to 2 per cent of the population has an enhanced metabolism most patients could continue to take codeine," says Florence Palmer of the MHRA.

Paracetamol Causes Acute Liver Damage

PARACETAMOL (acetaminophen) is an effective painkiller but a risky one. It is the leading cause of acute liver damage in the US.

Now there are two ways it could get a whole lot safer. A US Food and Drug Administration panel wants to slash the recommended dosage and now a safer alternative can be made cheaply for the first time.

When used as directed paracetamol is safe, but it doesn't take much more than the recommended dose to cause permanent, possibly fatal, liver damage.

Among over-the-counter drugs, "it probably has the smallest difference between how much it takes to be effective and how much it takes to cause damage", says Sidney Wolfe of the watchdog group Public Citizen in Washington DC.

Because paracetamol is an ingredient of numerous preparations, from cold medicines to prescription narcotics such as Vicodin, it's easy to double-dose by mistake.

Last month the FDA's advisory panel recommended specifying smaller doses of paracetamol and clearer labelling of medications that contain it. More controversially, the panel recommended removing it entirely from prescription narcotics. The FDA usually follows its panel's recommendations.

A more comprehensive solution may be on the horizon, in the form of drugs such as SCP-1, which is made up of a molecule of paracetamol joined to a saccharin molecule. In early tests in people SCP-1 does not seem to produce the same toxic by-products as paracetamol.

Now Mark Trudell and colleagues at the University of New Orleans, Louisiana, together with the New Orleans company St Charles Pharmaceuticals, which ran the tests, have reported a way to synthesise SCP-1 cheaply and in large quantities (Organic Process Research and Development, DOI: 10.1021/op900113b).