AC&C
Place in Therapy
Unfortunately, the literature does not greatly support the use of AC&C (Acetylsalicylic acid, caffeine, and codeine) for the treatment of osteoarthritis. It is far more commonly used for various headache syndromes.
There are several studies demonstrating the use of ASA in the treatment of osteoarthritis; however, the vast majority of these studies were conducted between 1960 and 1970, and many of them support the use of other NSAIDs as well. Furthermore, due to the increase in demand for well-designed and unbiased clinical trials over the last few decades, many of the relevant ASA trials involving osteoarthritis therapy tend to lack high degrees of internal and/or external validity.
Both e-Therapeutics and Patient Self-Care 2nd Edition list ASA as an option for the treatment of osteoarthritis; however, it is quite clearly stated to be either uncommonly used or a last line option. With respect to combination products including caffeine and codeine, Patient Self-Care 2nd Edition only lists the combination product containing acetaminophen (not ASA) as an option. Opioids are generally reserved for use when extra analgesia is required and they are only recommended for short term use.
Although ASA remains a last line option, it is believed to possess a higher risk of bleeding due to its unique mechanism of action, which involves the irreversible inhibition of platelets. This is likely the reason that other NSAIDs (ibuprofen and naproxen) which lack this mechanism of action are used ahead of ASA as options for the treatment of osteoarthritis.
References:
1. Harth M. & D. C. Bondy (1969). Indomethacin and acetylsalicylic acid in the treatment of osteoarthritis of the hips and knees. The Canadian Medical Association Journal; 101(6): 311-316.
2. Grindrod, K. & C. Marra. Osteoarthritis. Patient Self-Care 2nd ed. Ottawa, ON: Canadian Pharmacists Association, 2010.
3. Davis, P., & Juby, A. (2012, August). Musculoskeletal Disorders: Osteoarthritis. Retrieved March 7, 2014, from https://www.e-therapeutics.ca/tc.showChapter.action?documentId=c0059Source
4. Lorenzo, L. D., Goglia, C. & M. Pappagallo (2011). Managing osteoarthritis and joint pain at work: heling the primary care physician educate patients who rely on non-prescription NSAIDs. Giornale Italiano di medicina del lavoro ed ergonomia; 33(2): 193-200.
There are several studies demonstrating the use of ASA in the treatment of osteoarthritis; however, the vast majority of these studies were conducted between 1960 and 1970, and many of them support the use of other NSAIDs as well. Furthermore, due to the increase in demand for well-designed and unbiased clinical trials over the last few decades, many of the relevant ASA trials involving osteoarthritis therapy tend to lack high degrees of internal and/or external validity.
Both e-Therapeutics and Patient Self-Care 2nd Edition list ASA as an option for the treatment of osteoarthritis; however, it is quite clearly stated to be either uncommonly used or a last line option. With respect to combination products including caffeine and codeine, Patient Self-Care 2nd Edition only lists the combination product containing acetaminophen (not ASA) as an option. Opioids are generally reserved for use when extra analgesia is required and they are only recommended for short term use.
Although ASA remains a last line option, it is believed to possess a higher risk of bleeding due to its unique mechanism of action, which involves the irreversible inhibition of platelets. This is likely the reason that other NSAIDs (ibuprofen and naproxen) which lack this mechanism of action are used ahead of ASA as options for the treatment of osteoarthritis.
References:
1. Harth M. & D. C. Bondy (1969). Indomethacin and acetylsalicylic acid in the treatment of osteoarthritis of the hips and knees. The Canadian Medical Association Journal; 101(6): 311-316.
2. Grindrod, K. & C. Marra. Osteoarthritis. Patient Self-Care 2nd ed. Ottawa, ON: Canadian Pharmacists Association, 2010.
3. Davis, P., & Juby, A. (2012, August). Musculoskeletal Disorders: Osteoarthritis. Retrieved March 7, 2014, from https://www.e-therapeutics.ca/tc.showChapter.action?documentId=c0059Source
4. Lorenzo, L. D., Goglia, C. & M. Pappagallo (2011). Managing osteoarthritis and joint pain at work: heling the primary care physician educate patients who rely on non-prescription NSAIDs. Giornale Italiano di medicina del lavoro ed ergonomia; 33(2): 193-200.