From the 1st of August 2010 many popular painkillers such as Solpadeine and Nurofen Plus are no longer visible on the pharmacy shelves. This comes on foot of the new statutory guidelines published by the Pharmaceutical Society of Ireland (PSI) concerning the supply of non-prescription medicinal products containing codeine.

The guidelines state that "Codeine is a narcotic analgesic and it is important that the recommended dose should not be exceeded in any 24-hour period. Consumption of quantities in excess of the recommended dose, or consumption over a prolonged period of time, may cause tolerance and dependence and may result in withdrawal symptoms such as restlessness and irritability upon cessation of the medicine. If a patient needs to use codeine medicines for periods longer than the three days, it is considered important that they consult their doctor to investigate unresolved symptoms and the most appropriate treatment."

As such "Codeine medicines should only be supplied when the pharmacist deems such a supply is necessary and only when a non-opioid analgesic, e.g. paracetamol, aspirin or ibuprofen, has not proven sufficient to relieve the patient’s symptoms. If recommended, codeine medicines should be used for the shortest time possible and for no longer than three days without medical supervision."

Due to codeine's potential for misuse, it is regulated as a controlled drug under the Misuse of Drugs Acts 1977 and 1984. In low dose preparations such as combination products with other analgesics codeine is classified as a Schedule 5 controlled drug.

Under the The Pharmacy Act 2007 and the Regulation of Retail Pharmacy Businesses
Regulations 2008 (S.I. No. 488 of 2008) pharmacist are required to personally supervise all medicines supplied through a retail pharmacy business and to ensure that all non-prescription medicines are supplied subject to appropriate counselling. The new guidance is intended to assist pharmacists in meeting their professional and legal responsibilities in the supply of codeine-containing medicines.

In relation to the storage of codeine-containing medicines within the pharmacy the guidelines state that: "...any medicinal product containing a prescription-only medicine or a CD5 medicine must not be accessible to the public for self-selection. Therefore codeine medicines must be in an area of the retail pharmacy business under the pharmacist’s direct management and supervision, out of the sight of the public."

For full guidance see page 6 of the PSI Codeine Guidelines.

L.G.