promethazine codeine for sale Pain is very common in patients with cancer. Opioid analgesics, including codeine, play a significant role in. Major guidelines on the management of cancer pain, particularly for mild to moderate pain. Codeine is widely available and inexpensive, which may make it a good choice, promethazine codeine for sale especially in low‐resource settings. Its use is controversial, in part because codeine is not effective in a minority of patients who cannot. Convert it to its active metabolite (morphine), and also because of concerns about potential abuse, and safety in children.
To determine the efficacy and safety of codeine used alone or in combination with paracetamol for relieving cancer pain.
We sought randomised, double‐blind, controlled trials using single or multiple doses. Codeine, with or without paracetamol, for the treatment of cancer pain. Trials could have either parallel or cross‐over design, with at least 10 participants per treatment group. Studies in children or adults reporting on any type, grade, and stage of cancer were eligible. promethazine codeine for sale we accepted any formulation, dosage regimen, and route of administration of codeine, and both placebo and active controls.
Data collection and analysis
Two review authors independently read the titles and abstracts of all studies identified by the searches and excluded those that clearly did not meet the inclusion criteria. For the remaining studies, two authors read the full manuscripts and assessed them for inclusion. We resolved discrepancies between review authors by discussion. Included studies were described qualitatively, since no meta‐analysis was possible because of the small amount of data identified, and clinical and methodological between‐study heterogeneity.
We identified only a small amount of data in studies that were both randomised and double‐blind. Studies were small, of short duration, and most had significant shortcomings in reporting. The available evidence indicates that codeine is more effective against cancer pain than placebo, but with increased risk of nausea, vomiting, and constipation. Uncertainty remains as to the magnitude and time‐course of the analgesic effect and the safety and tolerability in longer‐term use. There were no data for children.
Codeine, alone and with paracetamol (acetaminophen), for cancer pain
In this review we set out to estimate how well codeine worked, how many people had side effects, and how severe those side effects were ‐ for example, whether they were so severe that participants stopped taking their oral codeine. We included 15 studies with 721 participants. The studies we found had methodological shortcomings: they were small and of short duration. They also reported results in different ways, so that it was not possible to combine results. In seven of the eight studies that compared codeine with placebo, codeine was better than placebo. In studies that compared codeine with another drug, the results were similar. Codeine at
Implications for practice
The limited evidence available indicates that codeine may provide good levels of pain relief for some adults with cancer pain. While it is not generally a first line drug in this context in many countries, it is an inexpensive and widely available drug with well‐known adverse effects.
Implications for research
It is unlikely, for ethical and financial reasons, that randomised controlled trials of adequate size and duration will be carried out to clarify any benefit of codeine compared with placebo. We require good quality trials (randomised, double‐blind, and of adequate size and duration) comparing codeine with alternative interventions, such as step II or low dose step III opioids, using patient‐centred responder outcomes (participants with at least 50% (or 30%) pain relief or participants with a VAS pain score below 30 mm, or no worse than mild pain). The role of codeine in mild cancer pain, in addition to moderate to severe cancer pain, should be investigated; future studies could increase our understanding by performing separate analyses by baseline pain intensity.