Latest edition of Australian Prescriber out now

4 OCTOBER 2011

The October 2011 edition of Australian Prescriber is out now and includes the following articles:

Cautions with codeine (including dental notes)

There have been calls to withdraw codeine from the market. Dr Joel Iedema of the Royal Brisbane and Women’s Hospital writes that the efficacy of the weak opioid analgesic in clinical trials is generally modest, and serious adverse events, including death, have occurred. As individuals metabolise codeine at different rates, there can be a wide range of responses. Some patients will get little pain relief. The potential for drug dependence and misuse, and the risk of toxicity especially if combination products containing codeine and other drugs are misused, raise concerns about the availability of codeine in the community, according to the author. Care should be taken when recommending or prescribing codeine, and treatment with other analgesics provides a more predictable response, Dr Iedema writes.

Surgery for patients taking antiplatelet drugs and anticoagulants

The increased risk of bleeding when patients who take anticoagulants or antiplatelet drugs require surgery must be balanced against the risk of harm if treatment is stopped, according to Dr Eileen Merriman and Dr Huyen Tran of Monash Medical Centre. The authors discuss the risks of stopping or continuing medicines including aspirin, warfarin and clopidogrel around the time of minor procedures and major surgery. They say that consultation with a cardiologist is particularly recommended if a patient with a coronary stent requires surgery.

Medicines labelling

People can be confused by poor labelling on their medicines. The design and content of labels can have a significant impact on the quality and safety of medicines use, says Daniel Lalor of the Clinical Excellence Commission in Sydney. Researchers, health professionals, manufacturers and the TGA must work together to improve labelling by applying knowledge from other fields such as graphic design and ergonomics to develop labels and packaging that are distinct and easily identifiable, reducing the risks associated with product confusion and product selection errors.

Managing low back pain in primary care

Routine imaging is not usually needed for patients with back pain. The majority of adults with low back pain can be effectively managed in primary care, beginning with advice and simple analgesics, according to Professor Chris Maher and associates from the George Institute for Global Health and the University of Sydney. Bed rest is no longer recommended. As part of the initial advice, patients should be encouraged to remain as physically active as possible. If this approach provides insufficient pain relief, more complex treatments including stronger analgesics and referral for physical therapies may be considered. Interdisciplinary rehabilitation is also an option.

Other articles in this issue include:

  • The right to prescribe: towards core prescribing competencies for all prescribers
  • Medical management of mesothelioma

To read the full articles and more visit


Australian Prescriber is an independent peer-reviewed journal providing critical commentary on therapeutic topics for health professionals, particularly doctors in general practice. It is published by NPS, an independent, not-for-profit organisation for quality use of medicines funded by the Australian Government Department of Health and Ageing. Australian Prescriber is published every two months, in hard copy that is distributed to health professionals free of charge, and online in full text at