Check for pholcodine use before general anaesthesia
Summary
Health professionals are reminded to check whether patients scheduled to undergo general anaesthesia with neuromuscular blocking agents (NMBAs) have used products containing pholcodine in the previous 12 months. This is due to a suspected link to an increased risk of potentially life-threatening anaphylactic reactions.
Pholcodine has been used in adults and children to treat non-productive cough and is most commonly used in non-prescription cough syrups and lozenge products. It has also been used in combination with other active substances in products that treat the symptoms of cold and flu.
What's new in this article
The Therapeutic Goods Administration (TGA) has recently made a decision to cancel the registration of pholcodine-containing medicines in Australia. All stock of pholcodine-containing products remaining on pharmacy shelves has also been recalled.
The TGA decision followed a review by the European Medicines Agency - external site (EMA) recommending the withdrawal of marketing authorisations for these products in Europe.
Further information about this cancellation was published in a safety alert on our website, including a list of the 44 pholcodine-containing products on pharmacy shelves when the decision was made.
What should health professionals do
Health professionals are encouraged to discuss this safety issue with patients and to advise them to stop taking any pholcodine-containing medicines that they have. Recommend appropriate alternatives to treat cough and other cold and flu symptoms.
If a patient is scheduled to undergo general anaesthesia with NMBAs, check whether they have used pholcodine in the previous 12 months. Be aware of the risk of anaphylactic reactions in these patients.
It's important to reassure patients this risk only applies to general anaesthesia containing neuromuscular blocking agents and not to local anaesthetics.
To see a list of the all the recalled products, go to our System for Australian Recall Actions (SARA) database - external site. Select the product type 'Medicine' from the drop-down menu and search using the term 'pholcodine'.
What to report? You don't need to be certain, just suspicious!
The TGA encourages the reporting of all suspected adverse reactions to medicines, including vaccines, over-the-counter medicines, herbal, traditional or alternative remedies.
We particularly request reports of:
- all suspected reactions to new medicines (look for the Black Triangle ▼ in PI and CMI documents - this symbol identifies medicines that are new or being used differently)
- all suspected medicines interactions
- suspected reactions causing death, admission to hospital or prolongation of hospitalisation, increased investigations or treatment, or birth defects.
To report a suspected side effect of for more information about reporting, go to our To report a suspected side effect of for more information about reporting, go to our 'Report problem or side effect' webpage or contact the TGA's Pharmacovigilance Branch ADR.Reports@health.gov.au.
Disclaimer
Medicines Safety Update is aimed at health professionals. It is intended to provide practical information to health professionals on medicine safety, including emerging safety issues. The information in Medicines Safety Update is necessarily general and is not intended to be a substitute for a health professional's judgment in each case, taking into account the individual circumstances of their patients. Reasonable care has been taken to ensure that the information is accurate and complete at the time of publication. The Australian Government gives no warranty that the information in this document is accurate or complete, and shall not be liable for any loss whatsoever due to negligence or otherwise arising from the use of or reliance on this document.
© Commonwealth of Australia 2023
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For correspondence or further information about Medicines Safety Update, contact the TGA's Pharmacovigilance Branch at ADR.Reports@tga.gov.au.
Medicines Safety Update is written by staff from the Pharmacovigilance Branch.
Editor: Ms Elspeth Kay
Deputy Editor: Dr Fiona Mackinnon
Contributors: Mr Michael Pittman
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Pholcodine cough medicines cancelled by the TGA and recalled from pharmacies for safety reasons
Following a safety investigation into pholcodine the TGA are cancelling 55 products (from the ARTG) and recalling them from pharmacy shelves due to an increased risk of anaphylactic reactions. -
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