Co-codamol is paracetamol with codeine added. It is genuinely useful for pain that paracetamol alone will not touch, and it is also the pharmacy medicine most likely to cause problems if it is taken for weeks rather than days — dependence and medication-overuse headache both creep up quietly.
Co-codamol is written as two numbers: the codeine dose then the paracetamol dose.
Every strength contains a full dose of paracetamol, so nothing else you take may contain paracetamol as well. That includes cold and flu remedies and plain paracetamol tablets.
The usual adult dose is one or two tablets every four to six hours, up to a maximum of eight tablets in 24 hours. Leave at least four hours between doses.
It is not suitable for anyone under 12. Between 12 and 18 it is only used where other painkillers have not worked, and never after tonsil or adenoid removal.
Constipation is close to universal with codeine and is worth planning for rather than reacting to — plenty of fluid, fibre and, if needed, an osmotic laxative such as macrogol. Bulk-forming laxatives do not work well against opioid constipation.
Other common effects: drowsiness, dizziness, feeling sick, and a dry mouth. Do not drive or operate machinery until you know how it affects you. Driving while impaired by codeine is an offence even when it has been prescribed.
Avoid alcohol, which increases drowsiness.
Codeine is an opioid, and taking it regularly for more than a couple of weeks can lead to dependence — needing it to feel normal, and feeling unwell without it. It is also one of the commonest causes of medication-overuse headache, where the painkiller itself starts producing the headaches you are treating.
If you have been taking co-codamol most days for more than a few weeks, do not simply stop — come and talk to us, or see your GP, about reducing it gradually and finding a better long-term approach.
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