Drug reference

Co-codamol

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 496, 497

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

Moderate pain (using co-codamol 8/500 preparations only) ▶BY MOUTH ▶Adult: 8/500–16/1000 mg every 4–6 hours as required; maximum 64/4000 mg per day Moderate pain (using co-codamol 15/500 preparations only) ▶BY MOUTH ▶Adult: 15/500–30/1000 mg every 4–6 hours as required; maximum 120/4000 mg per day Moderate to severe pain (using co-codamol 30/500 preparations only) ▶BY MOUTH ▶Adult: 30/500–60/1000 mg every 4–6 hours as required; maximum 240/4000 mg per day KAPAKE ® 15/500 Mild to moderate pain ▶BY MOUTH ▶Adult: 2 tablets every 4–6 hours as required; maximum 8 tablets per day SOLPADOL ® CAPLETS Severe pain ▶BY MOUTH ▶Adult: 2 tablets every 4–6 hours as required; maximum 8 tablets per day SOLPADOL ® CAPSULES Severe pain ▶BY MOUTH ▶Adult: 2 capsules every 4–6 hours as required; maximum 8 capsules per day SOLPADOL ® EFFERVESCENT TABLETS Severe pain ▶BY MOUTH USING EFFERVESCENT TABLETS ▶Adult: 2 tablets every 4–6 hours as required, tablets to be dispersed in water; maximum 8 tablets per day

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Contra Indications

Acute ulcerative colitis. antibiotic- associated colitis. conditions where abdominal distention develops. conditions where inhibition of peristalsis should be avoided. known ultra-rapid codeine metabolisers

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Cautions

Acute abdomen. alcohol dependence. avoid abrupt withdrawal after long-term treatment. cardiac arrhythmias. chronic alcoholism. chronic dehydration. chronic malnutrition. convulsive disorders. gallstones. hepatocellular insufﬁciency CAUTIONS, FURTHER INFORMATION ▶Variation in metabolism The capacity to metabolise codeine to morphine can vary considerably between individuals; there is a marked increase in morphine toxicity in patients who are ultra-rapid codeine metabolisers (CYP2D6 ultra- rapid metabolisers) and a reduced therapeutic effect in poor codeine metabolisers.

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Prescribing And Dispensing Information

Co-codamol is a mixture of codeine phosphate and paracetamol; the proportions are expressed in the form x/y, where x and y are the strengths in milligrams of codeine phosphate and paracetamol respectively. When co-codamol tablets, dispersible (or effervescent) tablets, or capsules are prescribed and no strength is stated, tablets, dispersible (or effervescent) tablets, or capsules, respectively, containing codeine phosphate 8 mg and paracetamol 500 mg should be dispensed. The Drug Tariff allows tablets of co-codamol labelled ‘dispersible’ to be dispensed against an order for ‘effervescent’ and vice versa. l LESS SUITABLE FOR PRESCRIBING Co-codamol is less suitable for prescribing.

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Exceptions To Legal Category

Co-codamol 8/500 can be sold to the public in certain circumstances; for exemptions see Medicines, Ethics and Practice, London, Pharmaceutical Press (always consult latest edition).

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Safety

Interactions

→Appendix 1: opioids. paracetamol

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Side Effects

Abdominal pain. addiction. agranulocytosis. blood disorder. irritability. pancreatitis. restlessness. severe cutaneous adverse reactions (SCARs). thrombocytopenia Overdose Liver damage (and less frequently renal damage) following overdosage with paracetamol.

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Breast Feeding

Manufacturer advises avoid (recommendation also supported by MHRA and specialist sources). Present in milk and mothers vary considerably in their capacity to metabolise codeine; risk of opioid toxicity in infant.

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Hepatic Impairment

Manufacturer advises caution in mild to moderate impairment; avoid in severe impairment. Dose adjustments Manufacturer advises consider dose reduction in mild to moderate impairment.

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Renal Impairment

Reduce dose or avoid codeine; increased and prolonged effect; increased cerebral sensitivity.

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Dose and formulations

Medicinal Forms

There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: oral suspension, oral solution Tablet CAUTIONARY AND ADVISORY LABELS 2(does not apply to the 8/500 tablet), 29, 30 ▶Co-codamol (Non-proprietary) Codeine phosphate 8 mg, Paracetamol 500 mg Co-codamol 8mg/500mg tablets | 100 tablet P £5.75 DT = £3.40 m | 500 tablet P £17.00 m | 1000 tablet P £34.00 m Codeine phosphate 15 mg, Paracetamol 500 mg Co-codamol 15mg/500mg tablets | 100 tablet P £15.00 DT = £3.68 m Codeine phosphate 30 mg, Paracetamol 500 mg Co-codamol 30mg/500mg caplets | 100 tablet P £4.60 DT = £4.47 m Co-codamol 30mg/500mg tablets | 30 tablet P £1.38 DT = £1.34 m | 100 tablet P £7.53 DT = £4.47 m ▶Codipar (Advanz Pharma) Codeine phosphate 15 mg, Paracetamol 500 mg Codipar 15mg/500mg tablets | 100 tablet P £8.25 DT = £3.68 m ▶Emcozin (M & A Pharmachem Ltd) Codeine phosphate 30 mg, Paracetamol 500 mg Emcozin 30mg/500mg tablets | 100 tablet P £2.94 DT = £4.47 m ▶Kapake (Galen Ltd) Codeine phosphate 30 mg, Paracetamol 500 mg Kapake 30mg/500mg tablets | 100 tablet P £7.10 DT = £4.47 m ▶Migraleve Yellow (McNeil Products Ltd) Codeine phosphate 8 mg, Paracetamol 500 mg Migraleve Yellow tablets | 16 tablet P s m ▶Panadol Ultra (GlaxoSmithKline Consumer Healthcare) Codeine phosphate 12.8 mg, Paracetamol 500 mg Panadol Ultra 12.8mg/500mg tablets | 20 tablet p £2.61 DT = £3.81 m ▶Solpadeine Max (Omega Pharma Ltd) Codeine phosphate 12.8 mg, Paracetamol 500 mg Solpadeine Max 12.8mg/500mg tablets | 20 tablet p £3.81 DT = £3.81 m | 30 tablet p £4.91 DT = £4.91 m ▶Solpadol (Sanofi) Codeine phosphate 30 mg, Paracetamol 500 mg Solpadol 30mg/500mg caplets | 30 tablet P £2.02 DT = £1.34 m | 100 tablet P £6.74 DT = £4.47 m ▶Zapain (Advanz Pharma) Codeine phosphate 30 mg, Paracetamol 500 mg Zapain 30mg/500mg tablets | 100 tablet P £3.11 DT = £4.47 m Effervescent tablet CAUTIONARY AND ADVISORY LABELS 2(does not apply to the 8/500 tablet), 13, 29, 30 EXCIPIENTS: May contain Aspartame ELECTROLYTES: May contain Sodium ▶Co-codamol (Non-proprietary) Codeine phosphate 8 mg, Paracetamol 500 mg Co-codamol 8mg/500mg effervescent tablets | 100 tablet P £8.75 DT = Nervous system £8.03 m Codeine phosphate 30 mg, Paracetamol 500 mg Co-codamol 30mg/500mg effervescent tablets | 32 tablet P £5.40 DT = £2.53 m | 100 tablet P £19.20 DT = £7.91 m ▶Codipar (Advanz Pharma) Codeine phosphate 15 mg, Paracetamol 500 mg Codipar 15mg/500mg effervescent tablets sugar-free | 100 tablet P £8.25 DT = £8.25 m ▶Solpadol (Sanofi) Codeine phosphate 30 mg, Paracetamol 500 mg Solpadol 30mg/500mg effervescent tablets | 32 tablet P £2.59 DT = £2.53 m | 100 tablet P £8.90 DT = £7.91 m Oral solution ▶Co-codamol (Non-proprietary) Codeine phosphate 6 mg per 1 ml, Paracetamol 100 mg per 1 ml Co-codamol 30mg/500mg/5ml oral solution sugar-free | 150 ml P £11.99 m Capsule CAUTIONARY AND ADVISORY LABELS 2(does not apply to the 8/500 capsule), 29, 30 EXCIPIENTS: May contain Sulfites ▶Co-codamol (Non-proprietary) Codeine phosphate 8 mg, Paracetamol 500 mg Co-codamol 8mg/500mg capsules | 32 capsule P s DT = £6.69 m | 100 capsule P £20.90 DT = £20.90 m Codeine phosphate 15 mg, Paracetamol 500 mg Co-codamol 15mg/500mg capsules | 100 capsule P £9.05 DT = £9.05 m Codeine phosphate 30 mg, Paracetamol 500 mg Co-codamol 30mg/500mg capsules | 100 capsule P £7.01 DT = £5.46 m ▶Codipar (Advanz Pharma) Codeine phosphate 15 mg, Paracetamol 500 mg Codipar 15mg/500mg capsules | 100 capsule P £7.25 DT = £9.05 m ▶Kapake (Galen Ltd) Codeine phosphate 30 mg, Paracetamol 500 mg Kapake 30mg/500mg capsules | 100 capsule P £7.10 DT = £5.46 m ▶Solpadol (Sanofi) Codeine phosphate 30 mg, Paracetamol 500 mg Solpadol 30mg/500mg capsules | 100 capsule P £6.74 DT = £5.46 m ▶Tylex (UCB Pharma Ltd) Codeine phosphate 30 mg, Paracetamol 500 mg Tylex 30mg/500mg capsules | 100 capsule P £7.93 DT = £5.46 m ▶Zapain (Advanz Pharma) Codeine phosphate 30 mg, Paracetamol 500 mg Zapain 30mg/500mg capsules | 100 capsule P £3.85 DT = £5.46 m eiiii F 467

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Dose text by age group

Adult

8/500–16/1000 mg every 4–6 hours as required;

First-line fragment. Read the complete Indications and Dose section above.

PDF page 496

Adult

15/500–30/1000 mg every 4–6 hours as required;

First-line fragment. Read the complete Indications and Dose section above.

PDF page 496

Adult

30/500–60/1000 mg every 4–6 hours as required;

First-line fragment. Read the complete Indications and Dose section above.

PDF page 496

Adult

2 tablets every 4–6 hours as required; maximum

First-line fragment. Read the complete Indications and Dose section above.

PDF page 496

Adult

2 tablets every 4–6 hours as required; maximum

First-line fragment. Read the complete Indications and Dose section above.

PDF page 496

Adult

2 capsules every 4–6 hours as required;

First-line fragment. Read the complete Indications and Dose section above.

PDF page 496

Adult

2 tablets every 4–6 hours as required, tablets to

First-line fragment. Read the complete Indications and Dose section above.

PDF page 496

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.

Drug reference

Co-codamol

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 496, 497

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

PDF page 496

Contra Indications

PDF page 496

Cautions

PDF page 496

Prescribing And Dispensing Information

PDF page 497

Exceptions To Legal Category

Co-codamol 8/500 can be sold to the public in certain circumstances; for exemptions see Medicines, Ethics and Practice, London, Pharmaceutical Press (always consult latest edition).

PDF page 497

Safety

Interactions

→Appendix 1: opioids. paracetamol

PDF page 496

Side Effects

PDF page 496

Breast Feeding

PDF pages 496, 497

Hepatic Impairment

Manufacturer advises caution in mild to moderate impairment; avoid in severe impairment. Dose adjustments Manufacturer advises consider dose reduction in mild to moderate impairment.

PDF page 497

Renal Impairment

Reduce dose or avoid codeine; increased and prolonged effect; increased cerebral sensitivity.

PDF page 497

Dose and formulations

Medicinal Forms

PDF page 497

Dose text by age group

Adult

8/500–16/1000 mg every 4–6 hours as required;

First-line fragment. Read the complete Indications and Dose section above.

PDF page 496

Adult

15/500–30/1000 mg every 4–6 hours as required;

First-line fragment. Read the complete Indications and Dose section above.

PDF page 496

Adult

30/500–60/1000 mg every 4–6 hours as required;

First-line fragment. Read the complete Indications and Dose section above.

PDF page 496

Adult

2 tablets every 4–6 hours as required; maximum

First-line fragment. Read the complete Indications and Dose section above.

PDF page 496

Adult

2 tablets every 4–6 hours as required; maximum

First-line fragment. Read the complete Indications and Dose section above.

PDF page 496

Adult

2 capsules every 4–6 hours as required;

First-line fragment. Read the complete Indications and Dose section above.

PDF page 496

Adult

2 tablets every 4–6 hours as required, tablets to

First-line fragment. Read the complete Indications and Dose section above.

PDF page 496

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.