Combination drugs, a dangerous yet popular choice in SA
Two combination painkilling medications both containing propoxyphene - an opiate drug that was withdrawn from use in Great Britain in 2005 as a result of its addictive properties - are among the top 50 products reimbursed by medical schemes in South Africa.
This is according to Mediscor's 2008 Medicines Review, an annual synopsis of drug utilisation trends in South Africa among the medically insured. According to Dr Elsa Badenhorst, head of medical affairs, Mediscor, Great Britain is not the only country to be concerned about the use of propoxyphene. In 2009, the FDA's advisory committee on pain medications recommended banning products containing propoxyphene, which has been on the market in the USA since 1957.
The FDA's recommendations followed a number of reports of fatal and serious non-fatal overdoses. The FDA panel further recommended that propoxyphene be withdrawn gradually in recognition of the large number of patients who are dependent on it.
Dr Badenhorst says South Africans should not necessarily be alarmed by these developments, but should take care to note that some painkilling combination medications contain ingredients that are extremely habit forming and should not be used for long periods of time, and certainly not without close medical supervision.
She also explains that medicine manufacturers often combine different analgesics or painkillers in one commercial preparation (combination analgesic, also referred to as ‘cocktail preparations') with the aim of blocking pain at two or three different brain receptor sites with one tablet or capsule. One product, for example, is a combination of paracetamol, propoxyfene, caffeine and diphenhydramine, while another contains paracetamol, ibuprofen and codeine.
“Codeine and propoxyfene are both opiate analgesics,” suggests Bester. “These drugs may cause euphoria and should therefore not be prescribed for long periods, as they have the potential for abuse and dependence. In addition to other side-effects, they may also cause sedation, dizziness and constipation.”
Another very commonly prescribed class of painkiller is the NAISDs, (Non-Steroidal Anti-Inflammatory Drug), which is used to treat all manner of ailments including arthritis and headache. Dr Badenhorst warns that even this widely used medication can be harmful if used over long periods of time. NAISDs may have gastrointestinal side effects such as nausea and vomiting, diarrhoea, dyspepsia and even gastric ulceration and bleeding. NSAIDs also decrease blood flow to the kidneys, causing increase in blood pressure, and should therefore be taken cautiously by people who suffer from hypertension. Long-term use of NSAIDs may cause kidney damage, especially in middle-aged women. NSAIDs may also cause prolonged bleeding as these drugs inhibit platelet function.
“Drugs invariably have side-effects and if used incorrectly, can even be dangerous,” she warns. “If you are finding that you are needing to take a medication for more than a week, consult a medical practitioner to ensure that it is safe to do so.”
