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
