Indications And Dose
Mild to moderate pain | Pyrexia ▶BY MOUTH ▶Adult: 1–2 tablets every 4–6 hours as required, dose to be dispersed in water; maximum 8 tablets per day
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Drug reference
Mild to moderate pain | Pyrexia ▶BY MOUTH ▶Adult: 1–2 tablets every 4–6 hours as required, dose to be dispersed in water; maximum 8 tablets per day
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When co- codaprin tablets or dispersible tablets are prescribed and no strength is stated, tablets or dispersible tablets, respectively, containing codeine phosphate 8 mg and aspirin 400 mg should be dispensed. l LESS SUITABLE FOR PRESCRIBING Aspirin with codeine is less suitable for prescribing. The Faculty of Pain Medicine has produced resources for healthcare professionals around opioid prescribing: www.fpm.ac.uk/ faculty-of-pain-medicine/opioids-aware
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Aspirin with codeine can be sold to the public provided packs contain no more than 32 capsules or tablets; pharmacists can sell multiple packs up to a total quantity of 100 capsules or tablets in justifiable circumstances.
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Acute respiratory depression. comatose patients. head injury (opioid analgesics interfere with pupillary responses vital for neurological assessment) . raised intracranial pressure (opioid analgesics interfere with pupillary responses vital for neurological assessment) . risk of paralytic ileus
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Adrenocortical insufficiency (reduced dose is recommended). asthma (avoid during an acute attack). convulsive disorders. debilitated patients (reduced dose is recommended) (in adults). diseases of the biliary tract. elderly (reduced dose is recommended). hypotension. hypothyroidism (reduced dose is recommended). impaired respiratory function (avoid in chronic obstructive pulmonary disease). inflammatory bowel disorders. myasthenia gravis. obstructive bowel disorders. prostatic hypertrophy (in adults). shock. urethral stenosis (in adults) CAUTIONS, FURTHER INFORMATION ▶Dependence Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence. ▶Palliative care In the control of pain in terminal illness, the cautions listed should not necessarily be a deterrent to the use of opioid analgesics. ▶Elderly Prescription potentially inappropriate (STOPP criteria): . if prescribed a strong, oral or transdermal opioid (i.e. morphine, oxycodone, fentanyl, buprenorphine, diamorphine, methadone, tramadol, pethidine, pentazocine) as first-line therapy for mild pain (WHO analgesic ladder not observed) . if used regularly without concomitant laxative (risk of severe constipation) . if prescribed a long-acting (modified-release) opioid without a short-acting (immediate-release) opioid for breakthrough pain (risk of persistence of severe pain) See also Prescribing in the elderly p. 33.
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→Appendix 1: aspirin. opioids
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MHRA/CHM ADVICE: BENZODIAZEPINES AND OPIOIDS: REMINDER OF RISK OF POTENTIALLY FATAL RESPIRATORY DEPRESSION (MARCH 2020) The MHRA reminds healthcare professionals that opioids co-prescribed with benzodiazepines and benzodiazepine-like drugs can produce additive CNS depressant effects, thereby increasing the risk of sedation, respiratory depression, coma, and death. Healthcare professionals are advised to only co-prescribe if there is no alternative and, if necessary, the lowest possible doses should be given for the shortest duration. Patients should be closely monitored for signs of respiratory depression at initiation of treatment and when there is any change in prescribing, such as dose adjustments or new interactions. If methadone is co- prescribed with a benzodiazepine or benzodiazepine-like drug, the respiratory depressant effect of methadone may be delayed; patients should be monitored for at least 2 weeks after initiation or changes in prescribing. Patients should be informed of the signs and symptoms of respiratory depression and sedation, and advised to seek urgent medical attention should these occur. Nervous system
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▶Common or very common Arrhythmias. confusion. constipation. dizziness. drowsiness. dry mouth. euphoric mood. flushing. hallucination. headache. hyperhidrosis. hypotension (with high doses). miosis. nausea (more common on initiation). palpitations. respiratory depression (with high doses). skin reactions. urinary retention. vertigo. visual impairment. vomiting (more common on initiation). withdrawal syndrome ▶Uncommon Drug dependence. dysphoria SIDE-EFFECTS, FURTHER INFORMATION Respiratory depression Respiratory depression is a major concern with opioid analgesics and it may be treated by artificial ventilation or be reversed by naloxone. Dependence and withdrawal Psychological dependence rarely occurs when opioids are used therapeutically (e.g. for pain relief), but tolerance can develop during long-term treatment. Overdose Opioids (narcotic analgesics) cause coma, respiratory depression, and pinpoint pupils. For details on the management of poisoning, see Opioids, under Emergency treatment of poisoning p. 1430 and consider the specific antidote, naloxone hydrochloride.
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Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour.
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There can be variation in the licensing of different medicines containing the same drug. Dispersible tablet CAUTIONARY AND ADVISORY LABELS 13, 21, 32 ▶Codis (Reckitt Benckiser Healthcare (UK) Ltd) Codeine phosphate 8 mg, Aspirin 500 mg Codis 500 dispersible tablets sugar-free | 32 tablet p £3.23 m Tablet ▶Aspirin with codeine (Non-proprietary) Codeine phosphate 8 mg, Aspirin 400 mg Boots Aspirin and Codeine tablets | 32 tablet p s m ANALGESICS › OPIOIDS Opioids f
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Avoid abrupt withdrawal after long-term treatment; they should be withdrawn gradually to avoid abstinence symptoms.
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Driving and skilled tasks Drowsiness may affect performance of skilled tasks (e.g. driving); effects of alcohol enhanced. Driving at the start of therapy with opioid analgesics, and following dose changes, should be avoided. For information on 2015 legislation regarding driving whilst taking certain controlled drugs, including opioids, see Drugs and driving under Guidance on prescribing p. 1. eiiii F 467
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1–2 tablets every 4–6 hours as required, dose to
First-line fragment. Read the complete Indications and Dose section above.
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