A systematic review 1 including 24 studies was abstracted in DARE. Only single-dose studies could be combined to assess efficacy. These showed that codeine added to paracetamol provided a 5% increase in analgesia on the sum pain intensity difference. This was comparable to the analgesic effect between codeine and placebo. The combination remained more effective than paracetamol alone at different dosages of the two drugs. In single-dose studies there was no difference in side effects, but the multi-dose studies showed an increase in reported side effects with combination therapy.
Comment: The level of evidence is downgraded by a lack of information on the characteristics or quality of individual studies.
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