@article{ref1,
title="Lack of respiratory depression in paracetamol-codeine combination overdoses",
journal="British journal of clinical pharmacology",
year="2016",
author="Heppell, Simon P. E. and Isbister, Geoffrey K.",
volume="83",
number="6",
pages="1273-1278",
abstract="BACKGROUND: Codeine containing analgesics are commonly taken in overdose, but the frequency of respiratory depression is unknown. We investigated whether paracetamol-codeine combination overdoses caused respiratory depression more than paracetamol alone. <br><br>METHODS: We reviewed deliberate self-poisoning admissions with paracetamol (>2 g) and paracetamol-codeine combinations presenting to a tertiary toxicology unit (1987-2013). Demographic information, clinical effects, treatment (naloxone, length of stay[LOS], mechanical ventilation) were extracted from a prospective database. Primary outcome was naloxone requirement or ventilation for respiratory depression. <br><br>RESULTS: From 4488 presentations, 1376 admissions were included with paracetamol alone (929), paracetamol-codeine combinations (346) or paracetamol-codeine-doxylamine combinations (101) without co-ingestants. Median age was 23y (12-89y); 1002 (73%) were female. Median dose was 12 g (interquartile range [IQR]:7.5-20 g). Median LOS was 16 h (IQR:6.5-27 h) and 564 (41%) were given acetylcysteine. Significantly larger paracetamol doses were ingested and more acetylcysteine given in paracetamol alone versus paracetamol combination overdoses. Seven patients were intubated or received naloxone, 7/1376 (0.5%; 95% CI:0.2-1.1%); three intubated, three given naloxone and one both. 3/929 patients ingesting paracetamol alone (0.3%;95%CI:0.1-1%) required intubation or naloxone, compared to 2/346 ingesting paracetamol-codeine combinations (0.6%;95%CI:0.1-2.3%; absolute difference, 0.26%; 95%CI: -0.7%-1.2%;p = 0.62). 2/101 patients ingesting paracetamol-codeine-doxylamine combinations (2%; 95%CI:0.3-8%) required intubation or naloxone. Four patients were intubated for reasons other than respiratory depression: hepatotoxicity[2], retrieval[1], no data[1]. 2/929 (0.2%) paracetamol alone overdoses had a Glasgow coma score <9 compared to 3/346 (0.9%) in the paracetamol-codeine group. <br><br>CONCLUSIONS: Paracetamol-codeine combination overdoses are rarely associated with severe respiratory depression, with only two given naloxone and none intubated for respiratory depression.<br><br>This article is protected by copyright. All rights reserved.<p /> <p>Language: en</p>",
language="en",
issn="0306-5251",
doi="10.1111/bcp.13224",
url="http://dx.doi.org/10.1111/bcp.13224"
}