Co-dydramol tablets for pain relief

About co-dydramol tablets

Co-dydramol contains two painkilling ingredients: paracetamol and dihydrocodeine. It is given to relieve short-lasting painful conditions where paracetamol alone is not sufficient. There are four different strengths of co-dydramol available, only one of which can be bought without a prescription at a pharmacy. The amount of paracetamol in the four different strengths is the same (500 mg), but the amount of dihydrocodeine differs and this determines the strength of the preparation.

The three main tablet strengths are: 10 mg/500 mg, 20 mg/500 mg, and 30 mg/500 mg, where the first number relates to how much dihydrocodeine is in the tablet, and the second is the amount of paracetamol present. Co-dydramol 7.46 mg/500 mg tablets can be bought from pharmacies as the brand Paramol®.

Combination painkillers like co-dydramol can be useful to reduce the total number of tablets that need to be taken in a day, but they may not always offer the best pain control. This is because it is difficult to adjust the dose to suit the level of your pain without increasing the risk of side-effects. Consequently, many doctors prefer not to prescribe combination painkillers.

Before taking co-dydramol tablets

Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking co-dydramol it is important that your doctor knows:

• If you are pregnant, trying for a baby, or breastfeeding.

• If you have a problem with the way your liver works, or a problem with the way your kidneys work.

• If you have prostate problems or any difficulties passing urine.

• If you have any breathing problems, such as asthma or chronic obstructive pulmonary disease (COPD).

• If you have been told you have low blood pressure or an abnormal heart rhythm.

• If you have any problems with your thyroid or adrenal glands.

• If you have epilepsy.

• If you have gallstones or a problem with your gallbladder or bile duct.

• If you have been constipated for more than a week or have an inflammatory bowel problem.

• If you have a condition causing muscle weakness, called myasthenia gravis.

• If you have recently had a severe head injury.

• If you have ever been dependent on drugs or alcohol.

• If you have ever had an allergic reaction to a medicine.

• If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.

How to take co-dydramol tablets

• Before you start this treatment, read the manufacturer's printed information leaflet from inside your pack. The manufacturer’s leaflet will give you more information about co-dydramol and a full list of side-effects which you may experience from taking it.

• The usual dose for adults is one or two tablets every 4-6 hours if needed. Remember to leave at least four hours between doses and do not take more than two tablets at any one time or more than eight tablets in any 24-hour period. This maximum recommended dose for all strengths of co-dydramol is due to the paracetamol content of the tablets.

• Swallow the tablets with a drink of water. You can take co-dydramol either before or after food, but taking your doses after food can help prevent feelings of sickness (nausea) which can occur with the first few doses.

• If you forget to take a dose, take it when you next need pain relief and then continue as before, taking your doses every four to six hours if needed. Do not take two doses together to make up for a forgotten dose.

Getting the most from your treatment

• You can take co-dydramol that you have bought without a prescription, for up to three days. Do not take it for longer than this. If you are still in pain after the three days, speak with your doctor or pharmacist for further advice. You should also speak with your pharmacist or doctor for further advice if the co-dydramol does not relieve your pain.

• Taking co-dydramol regularly to relieve a headache can actually make your headaches worse or more frequent. This is known as medication-overuse headache (also known as medication-induced headache). This can happen even when using co-dydramol at the recommended dose. General advice is that you should not take painkillers for a headache for more than two days at a time. Also you should not take them for more than two days in any week. Speak with a pharmacist or your doctor if you are worried about medication-overuse headache.

• It is important that you do not take any other medicines which contain paracetamol while you are taking co-dydramol. Always check the label of any preparation you buy or take, as many painkillers and cold and flu preparations which can be bought over the counter contain paracetamol. Alternatively, ask your pharmacist to advise you on which preparations are safe for you to take alongside co-dydramol.

• You should not drink alcohol while you are taking co-dydramol. This is because the dihydrocodeine it contains will increase the risk of side-effects from the alcohol.

• You will not be given co-dydramol for longer than is necessary. This is because when you take medicines containing dihydrocodeine repeatedly over a period of time and then stop, it can cause withdrawal symptoms. These symptoms include restlessness and feeling irritable. If you have already been taking it for some time and want to stop, your doctor will recommend that you reduce your dose slowly in order to avoid the risk of these effects.

• Medicines which contain dihydrocodeine are normally prescribed for short periods of time. If you take dihydrocodeine over a long period of time, your body can become used to it and it will not work as well. This is called tolerance.

• Never take more than the dose recommended on the label. If you suspect that you or someone else might have taken an overdose, go to the accident and emergency department of your local hospital straightaway, even if you/they feel well. This is because taking too much co-dydramol can cause serious damage to your liver and possibly death in severe cases. Take the container with you so that the doctor knows what has been taken.

• If you are having an operation or dental treatment, tell the person carrying out the treatment that you are taking a painkiller.

• If you buy any medicines, check with a pharmacist that they are safe to take with co-dydramol.

Can co-dydramol tablets cause problems?

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with co-dydramol. You will find a full list in the manufacturer's information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.

Important: people taking opioid medicines, and their family and friends, should be aware of the risk of accidental overdose and know when to seek medical help. The risk is higher if you also take other medicines that make you feel drowsy. Signs you have taken too much medicine include:

• Feeling very sleepy or dizzy.

• Feeling sick (nausea) or being sick (vomiting).

• Breathing difficulties.

• Loss of consciousness.

Overdose with co-dydramol has the extra complication of a paracetamol overdose, which can cause liver damage, kidney failure and death.

If you have taken more co-dydramol than you should or someone else accidentally swallows your medication, call for an ambulance and tell them the name of your medicine.

If you experience any other symptoms which you think may be due to this medicine, speak with your doctor or pharmacist.

How to store co-dydramol

• Keep all medicines out of the reach and sight of children.

• Store in a cool, dry place, away from direct heat and light.

Important information about all medicines