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 period pain, muscle pain and toothache.

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

This medicine comes as tablets and capsules, including soluble tablets that you dissolve in water.

Co-codamol tablets and capsules come in 3 strengths. You can buy the lowest strength from pharmacies but the higher strengths are only available on prescription.

Most adults can take co-codamol.

Most children and young people aged from 12 to 17 years old can take it but it's only recommended if other painkillers have not worked.

Co-codamol is not suitable for some people. To make sure it's safe for you, tell your doctor before starting to take it 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 sleep apnoea

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

Adults can take 1 or 2 tablets (of any strength) up to 4 times in 24 hours. It's important to leave a gap of at least 4 to 6 hours between doses of co-codamol.

The maximum dose is 8 co-codamol tablets in 24 hours.

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 more than 2 tablets at once, even if your pain is very bad. Talk to a pharmacist or doctor if you think the dose is not enough to help your pain.

The maximum dose of co-codamol for adults is 8 tablets in 24 hours.

Swallow co-codamol tablets or capsules whole with a drink of water.

Co-codamol also comes as soluble (effervescent) tablets that you dissolve in a glass of water to make a drink.

You can take co-codamol with or without food.

If your doctor has prescribed co-codamol for you, they'll tell you how long to take it for.

For example, if you're in pain after an injury or operation you may need to take it for a few days or weeks. You may need to take it for longer if you have a long-term condition that causes pain.

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

If you've been taking co-codamol for more than a few weeks, do not stop taking it without speaking to your doctor first.

Taking 1 or 2 extra tablets is unlikely to harm you. Do not take more than 8 tablets in 24 hours.

Taking too much co-codamol can be dangerous and you may need treatment. Too much co-codamol can cause liver damage.

• you take more than the recommended dose of co-codamol and are finding it difficult to breathe

• you take more than the recommended dose of co-codamol, even if you feel well

Go to 111 online or call 111

If you need to go to A&E, do not drive. Ask someone to drive you or call 999 and ask for an ambulance.

Bring the co-codamol packet or leaflet inside it, any remaining medicine, and any other medicines you take.

These common side effects of co-codamol happen in more than 1 in 100 people. There are things you can do to help cope with them:

Get more fibre into your diet such as fresh fruit, 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.

Take co-codamol with or just after a meal or snack. Stick to simple meals and do not eat rich or spicy food.

If you're being sick, try small frequent sips of water to avoid dehydration. Signs of dehydration include peeing less than usual or having strong-smelling pee.

If you take the combined contraceptive pill or progestogen-only pill and you're being sick, your contraception may not protect you from pregnancy. Check the pill packet for advice.

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.

If co-codamol makes you feel dizzy when you stand up, try getting up very slowly or stay sitting down until you feel better. If you begin to feel dizzy, lie down so that you do not faint, then sit until you feel better.

Do not drive, cycle or use tools or machinery if you're feeling dizzy.

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.

Make sure you rest and drink plenty of fluids. Do not drink too much alcohol. Talk to your doctor if the headaches do not go away or are severe.

Speak to a doctor or pharmacist if the advice on how to cope does not help and a side effect is still bothering you or does not go away.

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

Call a doctor or call 111 now if you have:

• a skin rash
• difficulty peeing
• changes in your eyesight
• muscle stiffness
• symptoms of low blood pressure, which include feeling dizzy and tired

• you have breathing difficulty or short, shallow breathing
• you have a fit or seizure

Find your nearest A&E

Do not drive to A&E. Ask someone to drive you or call 999 and ask for an ambulance.

Bring all the medicines you take with you.

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

Call 999 now if:

• your lips, mouth, throat or tongue suddenly become swollen
• you're breathing very fast or struggling to breathe (you may become very wheezy or feel like you're choking or gasping for air)
• your throat feels tight or you're struggling to swallow
• your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
• you suddenly become very confused, drowsy or dizzy
• someone faints and cannot be woken up
• a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)

You or the person who's unwell may also have a rash that's swollen, raised, itchy, blistered or peeling.

These can be signs of a serious allergic reaction and may need immediate treatment in hospital.

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 a pharmacist or doctor.

If you need to take co-codamol for a long time, your body can become tolerant to the codeine in it. That means you need higher doses to control your pain over time.

Some people can become more sensitive to pain (hyperalgesia). If this happens, your doctor will reduce your dose gradually to help these symptoms.

It's possible to become addicted to the codeine in co-codamol. For this reason, your dose will be reviewed to make sure you're only taking the amount you need to control your pain.

Your treatment plan may include details of how and when you'll stop taking co-codamol.

If you're having treatment for cancer pain or other severe pain, your pain control will be carefully monitored. Speak to your doctor if you're worried about tolerance, hyperalgesia or becoming addicted.

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

Co-codamol can be taken in pregnancy, although taking it long-term is not recommended.

Co-codamol contains paracetamol and codeine. Paracetamol is safe to take in pregnancy, but codeine can affect your baby.

If you take codeine at the end of pregnancy then there's a risk that your baby may become used to having codeine. They may be drowsy or have withdrawal symptoms after they're born. If this happens, your baby may need extra time in hospital for observation.

It's important to treat pain in pregnancy. If you have severe pain, co-codamol might sometimes be the best option. Your doctor can help you decide what's right for you and your baby.

Do not take co-codamol if you're breastfeeding.

Small amounts of the codeine in co-codamol get into breast milk. This could harm your baby, for example by causing breathing problems.

Paracetamol is the best painkiller to take if you're breastfeeding.

If you're breastfeeding and think you need co-codamol, discuss this with your doctor first. They can advise you on other pain relief options.

Taking co-codamol for a short time at normal doses is unlikely to affect fertility in either men or women.

However, if you've been taking it for a long time or you're having difficulty in trying for a baby, speak to a pharmacist or doctor.

Tell your doctor if you're:

• trying to get pregnant
• pregnant
• breastfeeding

Some medicines affect the way co-codamol works. Co-codamol can also 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
• medicines that help to prevent blood clots (anticoagulants) such as warfarin
• medicines to treat infections, particularly rifampicin or ciprofloxacin
• epilepsy medicines

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

Do not take co-codamol with paracetamol, or other medicines that contain paracetamol, unless you've been advised to by a doctor. 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 like Lemsip and Night Nurse.

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

There's not enough information to say that complementary medicines, herbal remedies and supplements 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.

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