Codeine: the 70 drugs under medical prescription

To great ills, great remedies. Since July 12, opioid-based drugs are no longer directly available in French pharmacies. The Minister of Health, Agnès Buzyn, signed an order which places codeine, as well as 3 other morphine derivatives (dextromethorphan, ethylmorphine, noscapine), on the list of drugs subject to prescription.

The tenant of avenue Duquesne wasted no time in implementing this decree. It is immediately effective. This decision marks the culmination of growing concerns on the part of health authorities.

Codoliprane, Migralgine, Humex dry cough dextromethorphan or Dextrussil. You will now have to go to your doctor before buying these drugs for the treatment of cough, pain and fever. This Tuesday, the National Medicines Safety Agency (ANSM) published the exhaustive list of the drugs concerned.

Growing misuse

At the origin of this decree, a fashion from the United States. Teenagers, sometimes as young as 12, prepare a cocktail called Purple drank, in homage to its purplish color. Its composition: soda, antihistamines and codeine. But the drugged high turns bitter. Since the start of the year, 5 cases of serious poisoning have been reported, including two fatalities.

From 2016, the National Medicines Safety Agency (ANSM) is alarmed by this trend and calls on health professionals to be cautious. In June, she sounded the alarm, and considered questioning the method of delivery. In fact, the report is probably lower than the actual development.

In the Midi-Pyrénées region alone, 5 pharmacies reported regular – sometimes daily – requests from young people. On the three hospitalizations analyzed, for the occasion, by the regional pharmacovigilance center none had been the subject of a report.

Cases of addiction

Beyond this recreational use, the molecule is also highly addictive, and can cause dependence. “At the pain centers, we often have to take care of painful patients who are dependent on morphine”, confirms to Why actor Dr Christian Gov, algologist at the pain center of the CHU de Lyon (Rhône).

In addition to these “classic” dependencies, there are substitution approaches. “Heroin users thus manage periods of withdrawal, by taking Neocodion for example”, illustrates Professor Nicolas Authier, from the medical pharmacology service at Clermont-Ferrand University Hospital (Puy-de-Dôme), interviewed by Slate.

A molecule at risk

The abuse of codeine worries, and with good reason. Like morphine, this substance is an opiate – that is, a product derived from the opium extracted from a type of poppy. If it is a minor opioid drug, it should not be taken lightly.

“Codeine passes into the liver, where it is transformed into morphine,” explains Dr. Christian Gov. Not many people know it, but 10% of people will metabolize it very quickly. They then have a large amount of morphine in the blood. »Overdose problems can therefore occur.

These risks are what prompted the European authorities to review the indications for codeine in 2015. Throughout the European Union, the molecule can only be prescribed after 12 years. Before this age, the risk of serious respiratory problems is considered too high.

The following drugs, previously optional medical prescription, now require a prescription (indicative list as of June 30, 2017)

In the cough

ATUXANE, syrup

BIOCADEXTRO 1 mg / ml CHILDREN WITHOUT SUGAR, syrup sweetened with sodium saccharin and maltitol

CLARIX DRY COUGH CODETHYLINE 0.1% SUGAR-FREE, oral solution

CLARIX DRY COUGH DEXTROMETHORPHANE 15 mg / 5 ml ADULTS WITHOUT SUGAR, oral solution in sachet sweetened with sodium saccharin

CLARIX DRY COUGH DEXTROMETHORPHANE MEPYRAMINE ADULTS, syrup

CODEDRILL WITHOUT SUGAR 0.1 PERCENT, oral solution sweetened with saccharin

DEXTROCIDINE 0.3%, syrup

DEXTROMETHORPHANE ELERTE 1.5 mg / ml, syrup

DEXTUSSIL 0.2%, syrup

DINACODE ADULTS, syrup

DRILL DRY COUGH DEXTROMETHORPHANE ADULTS 15 mg / 5 ml WITHOUT SUGAR, syrup sweetened with liquid maltitol

DRILL DRY COUGH DEXTROMETHORPHANE CHILDREN 5 mg / 5 ml WITHOUT SUGAR, syrup sweetened with liquid maltitol

ERGIX 20 mg DRY COUGH, capsule

ERGIX ADULTS DRY COUGH, syrup

EUCALYPTINE LE BROWN, syrup

EUPHON, syrup

EUPHONYLL DRY COUGH DEXTROMETORPHANE 15 mg / 5 ml ADULTS WITHOUT SUGAR, syrup sweetened with sodium saccharin and sorbitol

FLUIMUCIL DRY COUGH DEXTROMETHORPHANE 15 mg / 5 ml ADULTS WITHOUT SUGAR, oral solution in sachet sweetened with sodium saccharin

FLUIMUCIL DRY COUGH DEXTROMETHORPHANE 2 mg / ml ADULTS WITHOUT SUGAR, syrup sweetened with sodium saccharin and liquid maltilol

HUMEX ADULTS DRY COUGH DEXTROMETHORPHANE WITHOUT SUGAR 15 mg / 5 ml, oral solution in sachet sweetened with sodium saccharin

HUMEX ADULTS DRY COUGH DEXTROMETHORPHANE, syrup

HUMEX CHILDREN DRY COUGH DEXTROMETHORPHANE, syrup

NEO-CODION, coated tablet

NEO-CODION ADULTS, syrup

NEO-CODION CHILDREN, syrup

NODEX ADULTS, syrup in single-dose container

PADERYL 19.5 mg, coated tablet

PADERYL 0.1 PERCENT, syrup

POLERY ADULTS, syrup

POLERY ADULTS WITHOUT SUGAR, syrup sweetened with sodium saccharin and sodium cyclamate

PULMODEXANE 300 mg / 100 ml WITHOUT SUGAR, oral solution sweetened with liquid maltitol and sodium saccharin

PULMODEXANE 30 mg film-coated tablets

PULMOSERUM, oral solution

PETER’S SYRUP 0.049 PERCENT, syrup

THIOPECTOL ADULTS, syrup

TUSSIDANE 30 mg, film-coated tablet

TUSSIDANE 1.5 mg / ml, syrup

TUSSIDANE 1.5 mg / ml WITHOUT SUGAR, oral solution sweetened with liquid maltitol and sodium saccharin

TUSSISEDAL, syrup

TUSSIPAX, film-coated tablet

TUSSIPAX, syrup

VICKS DRY COUGH DEXTROMETHORPHANE 7.33 mg ADULTS HONEY, lozenge

VICKS 0.133% ADULTS DRY COUGH HONEY, syrup

ADULT VEGETOSERUM, syrup

In pain (and fever)

ALGISEDAL, tablet

ALGICALM, 400 mg / 25 mg, tablet

CLARADOL CODEINE 500 mg / 20 mg, tablet

CODOLIPRANE ADULTS 400 mg / 20 mg, scored tablet

COMPRALGYL 400 mg / 20 mg, scored tablet

GAOSEDAL CODEINE, tablet

KLIPAL CODEINE 300 mg / 25 mg, tablet

LINDILANE 400 mg / 25 mg, tablet

MIGRALGINE, capsule

NOVACETOL (ASPIRINE PARACETAMOL), tablet

PARACETAMOL CODEINE ARROW 400 mg / 20 mg, scored tablet

PRONTALGINE, tablet

SEDASPIR, tablet

The following drugs containing codeine, indicated in pain, already require a prescription (indicative list as of June 30, 2017)

In pain (and fever)

ANTARENE CODEINE 200 mg / 30 mg, film-coated tablet

ANTARENE CODEINE 400 mg / 60 mg film-coated tablets

CODOLIPRANE 500 mg / 30 mg, tablet

CODOLIPRANE 500 mg / 30 mg, effervescent tablet

DAFALGAN CODEINE, film-coated tablet

DAFALGAN CODEINE, effervescent tablet

DOLIPRANE CODEINE 400 mg / 20 mg, scored tablet

KLIPAL CODEINE 600 mg / 50 mg, tablet

PARACETAMOL CODEINE ARROW 500 mg / 30 mg, effervescent tablet

PARACETAMOL CODEINE BIOGARAN 500 mg / 30 mg, effervescent tablet

PARACETAMOL CODEINE CRISTERS 500 mg / 30 mg, effervescent tablet

PARACETAMOL CODEINE EG 500 mg / 30 mg, effervescent tablet

PARACETAMOL CODEINE MYLAN 500 mg / 30 mg, effervescent tablet

PARACETAMOL CODEINE SANDOZ 500 mg / 30 mg, effervescent tablet

In the cough

No specialty concerned

Source: ANSM