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Co-codamol
📘 About
- Always check the BNF entry for the most up-to-date prescribing advice.
- Co-codamol combines codeine phosphate (opioid) with paracetamol for analgesia.
- Available in OTC low-strength (8/500) and prescription-only high-strength (30/500) formulations.
⚙️ Mode of Action
- Paracetamol: central analgesic/antipyretic effect via COX inhibition in CNS.
- Codeine: weak opioid, prodrug metabolised by CYP2D6 → morphine (analgesic effect).
- Combination gives additive analgesia, often used for moderate pain.
🎯 Indication & Dosing
| Strength | Usual Adult Dose | Max Dose (24 h) | Route |
|---|---|---|---|
| Co-codamol 8/500 mg (OTC) | 2 tablets every 4–6 h as required | 8 tablets | Oral |
| Co-codamol 30/500 mg (Rx) | 2 tablets every 4–6 h as required | 8 tablets | Oral |
⚠️ Do not exceed 4 g paracetamol in 24 h (including other paracetamol products). Consider starting laxatives with prolonged courses.
🔀 Interactions
- See BNF.
- Other CNS depressants (alcohol, benzodiazepines, opioids) → ↑ risk of sedation & respiratory depression.
- Drugs affecting CYP2D6 metabolism → variable codeine response.
⚠️ Cautions
- Respiratory disease (COPD, asthma, sleep apnoea).
- Renal or hepatic impairment (↑ risk of paracetamol toxicity).
- Elderly or frail patients (↑ risk of delirium, falls, constipation).
🚫 Contraindications
- Acute respiratory depression.
- Paralytic ileus.
- Children <12 years (risk of respiratory depression from codeine).
- Breastfeeding (risk of morphine toxicity in infants from maternal ultra-rapid CYP2D6 metabolism).
💥 Side Effects
- Nausea, vomiting, constipation (very common).
- Drowsiness, confusion, delirium (esp. elderly).
- Dependence with prolonged use (codeine component).
- Risk of hepatotoxicity from paracetamol overdose.
📚 References
- BNF – Co-codamol
- NICE guidance on analgesia in primary care
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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