Co-codamol for adults: painkiller containing paracetamol and codeine - NHS

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Co-codamol for adults

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  1. About co-codamol for adults
  2. Key facts
  3. Who can and cannot take co-codamol
  4. How and when to take co-codamol
  5. Taking co-codamol with other painkillers
  6. Side effects
  7. How to cope with side effects of co-codamol
  8. Pregnancy and breastfeeding
  9. Cautions with other medicines
  10. Common questions

1. About co-codamol for adults

Co-codamol is a mixture of 2 different painkillers – paracetamol and codeine. It's used to treat aches and pains including headaches, muscular pain, migraines and toothache.

It may help to take co-codamol if everyday painkillers, such as aspirin, ibuprofen or paracetamol on their own, have not worked.

This medicine comes as tablets and capsules.

For children under 16 years of age, read our information on .

2. Key facts

  • Co-codamol tablets and capsules come in 3 strengths. You can buy the lowest strength co-codamol from pharmacies but the higher strengths are only available on prescription.
  • The most common side effects of co-codamol are constipation and feeling sick (nausea) or sleepy.
  • Taking too much co-codamol can be harmful. Do not be tempted to increase the dose or take a double dose if your pain is very bad.
  • It's possible to become addicted to the codeine in co-codamol, but this is rare if you're taking it as a painkiller and your doctor is reviewing your treatment regularly.
  • Co-codamol is also known by many different brand names. Talk to your pharmacist if you have any questions about different brands.

3. Who can and cannot take co-codamol

Adults and children aged 12 years or over can take co-codamol. However, it is only recommended for under-18s if other painkillers have not worked.

Co-codamol is not suitable for some people. Tell your doctor before starting the medicine if you:

  • have lung problems or breathing difficulties
  • have a head injury
  • have adrenal gland problems
  • have a condition that causes fits or seizures
  • regularly drink more than the maximum recommended amount of alcohol (14 units a week)
  • are trying to get pregnant, are already pregnant or are breastfeeding
  • have liver problems – you may need to take a lower dose
  • are under 18 years old and have had your tonsils or adenoids removed because of a sleep problem called obstructive sleep apnoea

4. How and when to take co-codamol

Co-codamol comes as tablets and capsules. Swallow them whole with a drink of water.

Co-codamol also comes as soluble tablets that dissolve in water to make a drink.

You can take co-codamol with or without food.

Different co-codamol strengths

Co-codamol tablets and capsules come in 3 different strengths.

They contain 8mg, 15mg or 30mg of codeine.

All 3 strengths contain 500mg of paracetamol – the same as in a standard paracetamol tablet or capsule.

The strength of co-codamol appears as 2 numbers on the packet. For example, 8/500 means each tablet or capsule contains 8mg of codeine and 500mg of paracetamol.

You can buy the lowest strength of co-codamol (8/500) without a prescription but only from a pharmacy. The higher strengths (15/500 and 30/500) are only available on prescription from a doctor.

Dosage

Adults aged 16 years and older can take 1 or 2 tablets (of any strength) up to 4 times in 24 hours. Always leave at least 6 hours between doses. The maximum dose is 8 co-codamol tablets in 24 hours.

It's important to leave a gap between doses of co-codamol. Taking too much co-codamol can be very dangerous. That's because the paracetamol in it can cause liver damage.

Do not increase the dose of co-codamol or take a double dose even if your pain is very bad.

Important

The maximum dose of co-codamol for adults and young people aged 16 years and over is 8 tablets in 24 hours.

How long to take it for

If your doctor has prescribed co-codamol for you, take it as you've been advised.

If you've bought co-codamol from a pharmacy, do not use it for more than 3 days. If you still have pain, talk to your pharmacist or doctor.

What if I take too much?

If you take 1 or 2 extra tablets of co-codamol by accident on a single occasion, it's unlikely to be harmful. If this happens, wait at least 24 hours before you take any more.

Immediate action required: Call 999 or go to A&E now if:

  • you take too much co-codamol and are finding it difficult to breathe

Urgent advice: Contact 111 for advice now if:

  • you take more than 2 extra tablets of co-codamol
  • you take more than 8 tablets of co-codamol in 24 hours

Go to or call 111

If you need to go to hospital, take the co-codamol packet or leaflet inside it plus any remaining medicine with you.

5. Taking co-codamol with other painkillers

It's safe to take co-codamol with ibuprofen and aspirin.

Do not take co-codamol with paracetamol, or other medicines that contain paracetamol. Co-codamol already contains paracetamol so you could be at risk of paracetamol overdose.

Medicines that have paracetamol in them include painkillers like Tramacet and co-dydramol, migraine remedies, and some cough and cold remedies (Lemsip and Night Nurse).

Important

Before taking co-codamol with any other medicines, check the label to see whether they contain paracetamol.

6. Side effects

Like all medicines, co-codamol can cause side effects although not everyone gets them. Many people have no side effects or only minor ones.

You're more likely to have side effects if you take the higher strengths of co-codamol.

Common side effects

These common side effects happen in more than 1 in 100 people.

Tell your doctor if the side effects bother you or do not go away:

  • constipation
  • feeling or being sick (nausea or vomiting)
  • feeling sleepy
  • headaches

Serious side effects

Serious side effects are rare and happen in less than 1 in 100 people.

Tell a doctor straight away if you have:

  • a skin rash
  • difficulty peeing
  • changes in your eyesight
  • dizziness

Serious allergic reaction

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to co-codamol.

Immediate action required: Call 999 or go to A&E if:

  • you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
  • you're wheezing
  • you get tightness in the chest or throat
  • you have trouble breathing or talking
  • your mouth, face, lips, tongue or throat start swelling

You could be having a serious allergic reaction and may need immediate treatment in hospital.

These are not all the side effects of co-codamol. For a full list, see the leaflet inside your medicine packet.

You can report any suspected side effect to the .

7. How to cope with side effects of co-codamol

What to do about:

  • constipation – eat more high-fibre foods such as fresh fruit and vegetables and cereals. Try to drink several glasses of water or another non-alcoholic liquid each day. If you can, it may also help to do some gentle exercise.
  • feeling or being sick (nausea or vomiting) – take co-codamol with or just after a meal or snack. Have small, frequent sips of water if you're being sick. Feelings of sickness should normally wear off after a few days. Talk to your doctor about taking an anti-sickness medicine if it carries on for longer.
  • feeling sleepy or tired – do not drive, cycle or use tools or machinery if you're feeling this way. Do not drink any alcohol as this will make you feel more tired.
  • headaches – make sure you rest and drink plenty of fluids. Do not drink too much alcohol. Talk to your doctor if the headaches last longer than a week or are severe.

8. Pregnancy and breastfeeding

Co-codamol in pregnancy

Co-codamol is not generally recommended during pregnancy. There may be safer medicines you can take.

Co-codamol contains paracetamol and codeine. While paracetamol is safe to take in pregnancy, codeine may not be the best choice of painkiller for you.

In early pregnancy, codeine has been linked to some problems in the unborn baby. If you take codeine at the end of pregnancy there's a risk that your baby may get withdrawal symptoms after birth. Your baby may also get breathing problems.

However, it's important to treat pain in pregnancy. For some pregnant women with severe pain, codeine might be the best option. Your doctor can help you decide what's right for you and your baby.

Co-codamol and breastfeeding

It's not generally recommended for women to take co-codamol while breastfeeding.

This is because small amounts of the codeine in co-codamol get into breast milk and can cause breathing problems in your baby.

If you are taking co-codamol and want to breastfeed, discuss this with your doctor first. They can advise you on pain relief options.

Non-urgent advice: Tell your pharmacist or doctor if you're:

  • trying to get pregnant
  • pregnant
  • breastfeeding

For more information about how codeine can affect you and your baby during pregnancy see the .

9. Cautions with other medicines

Some medicines affect the way co-codamol works. Equally co-codamol can stop some medicines working as well as they should.

Tell your doctor if you're taking:

  • sleeping pills or tranquillisers – particularly benzodiazepines such as diazepam, temazepam or lorazepam
  • antidepressants – some types do not mix with co-codamol
  • medicines to stop you feeling or being sick such as domperidone or metoclopramide
  • blood-thinning medicines (anticoagulants) such as warfarin
  • medicines to treat infection, particularly rifampicin or ciprofloxacin
  • epilepsy medicines

Mixing co-codamol with herbal remedies and supplements

It's not possible to say whether complementary medicines and herbal teas are safe to take with co-codamol.

They're not tested in the same way as pharmacy and prescription medicines. They're generally not tested for the effect they have on other medicines.

Important

Tell your pharmacist or doctor if you're taking any other medicines, including herbal remedies, vitamins or supplements.

10. Common questions

How does co-codamol work?

Co-codamol contains paracetamol and codeine. These 2 painkillers work in different ways to relieve pain.

Paracetamol seems to work by blocking "chemical messengers" in the brain that tell us we have pain. It also reduces a high temperature by affecting the chemical messengers in an area of your brain that controls body temperature.

Codeine belongs to a group of medicines called opiates. It affects pain receptors in the central nervous system and the brain to block pain signals to the rest of the body. When codeine blocks the pain receptors, there are other unwanted effects – for example slow and shallow breathing. It can also slow down digestion, which is why codeine can cause constipation.

When will I feel better?

Co-codamol takes up to 1 hour to work. It keeps on working for about 5 hours.

How long can I take co-codamol for?

If you've bought co-codamol from a pharmacy, do not use it for more than 3 days. If your pain has not gone away, talk to your pharmacist or doctor.

If your doctor has prescribed co-codamol for you, take it as you've been advised. Depending on why you're taking it, you may need to take it for a few days or weeks at most. For example, if you're in pain after an injury or operation.

You may need to take it for longer if you have a long-term condition such as back pain.

Talk to your doctor if you're not sure how long you need to take co-codamol for.

Is co-codamol addictive?

Yes, taking co-codamol regularly for a long time could make you addicted to the codeine in it. But in reality, if you're taking it as a painkiller under medical supervision, it's very unlikely you will get addicted to it.

People who take it as a recreational drug to get "high" are more likely to become addicted.

If you have been taking co-codamol for a long time, you can prevent withdrawal symptoms by reducing your dose gradually.

Talk to your doctor if you're worried about addiction.

How will I know if I'm addicted?

If you're addicted to co-codamol, you may find it difficult to stop taking it or feel you need to take it more often than necessary.

And if you stop taking co-codamol suddenly you may suffer from withdrawal symptoms.

These include:

  • feeling restless, agitated, anxious or nervous
  • panic attacks
  • difficulty sleeping
  • shaking
  • pins and needles
  • ringing in your ears

Talk to your doctor if you're worried about addiction.

Is it safe to take co-codamol for a long time?

You're generally not recommended to take co-codamol for longer than 3 days if you buy it from a pharmacy.

You're able to take co-codamol for longer if your doctor prescribes it for you. If you take co-codamol for a long time your body can become tolerant to it. That means you need higher doses to control your pain. For this reason your doctor will usually review your treatment regularly.

If you've been taking co-codamol for a long time and need to stop taking it, you can prevent withdrawal symptoms by reducing your dose gradually. Your doctor can help you do this.

Are there other painkillers I can try?

Yes, there are other painkillers you can try. Some painkillers work better than others for certain types of pain. For example, the best painkiller to ease your headache may not be the best one for your backache.

Before taking co-codamol, try taking paracetamol to see if that helps your pain. Paracetamol can relieve most types of pain.

Painkillers known as non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, can reduce inflammation as well as pain. These are good for joint, back and muscular pain. However, NSAIDs are not suitable for some people. This includes people with stomach ulcers or severe heart, kidney or liver problems. If you want to try NSAIDs, speak to your pharmacist or doctor.

Can I drink alcohol with co-codamol?

It's best to stop drinking alcohol during the first few days of treatment until you see how co-codamol affects you.

Drinking alcohol while you're taking co-codamol can make you feel more sleepy. It can also increase the risk of serious side effects.

If you feel sleepy with co-codamol, stop drinking alcohol while you're taking it.

Can I drive or ride a bike?

Do not drive a car or ride a bike (or use tools or machinery) if co-codamol makes you sleepy, gives you blurred vision or makes you feel dizzy, clumsy or unable to concentrate or make decisions. This may be more likely when you first start taking co-codamol but could happen at any time – for example when starting another medicine.

It's an offence to drive a car if your ability to drive safely is affected. It's your responsibility to decide if it's safe to drive. If you're in any doubt, do not drive.

Even if your ability to drive is not affected, the police have the right to request a saliva sample to check how much co-codamol is in your body. GOV.UK has more .

Talk to your doctor or pharmacist if you're unsure whether it's safe for you to drive while taking co-codamol.

Is there any food or drink I need to avoid?

Apart from avoiding alcohol, you can eat and drink normally while taking co-codamol.

Will co-codamol affect my contraception?

Co-codamol does not affect any type of contraception, including the combined pill or emergency contraception.

However, if co-codamol makes you vomit for more than 24 hours, your contraceptive pills may not protect you from pregnancy. Look on the pill packet to find out what to do.

Read more about what to do if you're on the pill and you're being sick or have diarrhoea.

Will co-codamol affect my fertility?

If you're taking co-codamol for a short time and at normal doses, there's no clear evidence that it can reduce fertility in either men or women.

However, if you take high doses of co-codamol for a long time, it can temporarily reduce fertility in men and women. It can cause a health problem called hypogonadism. Hypogonadism is where the body does not make enough sex hormones. This can make it more difficult for you to conceive.

If you're worried about co-codamol and your fertility, talk to your doctor.

Will recreational drugs affect it?

If you take recreational drugs, such as cannabis, cocaine and heroin, while you're taking co-codamol, you're more likely to get the serious side effects of the codeine in co-codamol. These include breathing difficulties, heart problems, fits and even going into a coma.

Some recreational drugs, such as cannabis, also increase common codeine side effects such as sleepiness and dizziness.

Taking heroin while you're on prescribed co-codamol is particularly dangerous. You're more likely to get all the side effects of the codeine in co-codamol, including addiction.

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Page last reviewed: 3 September 2020
Next review due: 3 September 2023