To the Editor: Frei and colleagues recently drew our attention to combination analgesic misuse-related morbidity.1 The same phenomenon has also been reported in New Zealand.2 About 50 years ago, analgesic misuse was widespread in Australia and commonly involved chronic, excessive use of combination analgesics (including the aspirin–phenacetin–caffeine [APC] products, Bex and Vincent’s Powders). After many years, some people who used APC developed “analgesic nephropathy”, which made up 12%–15% of dialysis cases.3
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- Western Hospital, Melbourne, VIC.
- 1. Frei MY, Nielson S, Dobbin MD, Tobin CL. Serious morbidity associated with misuse of over-the-counter codeine–ibuprofen analgesics: a series of 27 cases. Med J Aust 2010; 193: 294-296. <MJA full text>
- 2. Robinson GM, Robinson S, McCarthy P, Cameron C. Misuse of over-the-counter codeine-containing analgesics: dependence and other adverse effects. N Z Med J 2010; 123: 59-64.
- 3. Kincaid-Smith P. Analgesic nephropathy. Kidney Int 1978; 13: 1-4.
- 4. Coroner’s case finding. Melbourne: Coroners Court of Victoria, November 2006.
- 5. Larson AM, Polson J, Fontana RJ, et al. Acetaminophen-induced acute liver failure: results of a United States multicenter, prospective study. Hepatology 2005; 42: 1364-1372.
- 6. Curhan SG, Eavey R, Shargorodsky J, Curhan GC. Analgesic use and the risk of hearing loss in men. Am J Med 2010; 123: 231-237.