Paracetamol + codeine

What is paracetamol + codeine?

Paracetamol + codeine is an analgesic (painkiller) used to treat different types of pain including headache and migraine. It is described as a combination analgesic because it contains 2 ingredients, paracetamol and codeine, that work to relieve pain by different actions. It is usually used for pain when paracetamol alone is not sufficient. Read more about pain relief medications.

In New Zealand paracetamol + codeine tablets are available in different strengths. The amount of paracetamol is the same (500 mg), but the amount of codeine differs and this determines the strength of the tablets:

• Paracetamol 500 mg + codeine 8 mg (Panadeine®) 
• Paracetamol 500 mg + codeine 15 mg (Panadeine Extra®, Panadeine Plus®).

Panadeine®, Panadeine Extra® and Panadeine Plus® tablets can be bought from a pharmacy without a prescription, after consultation with a pharmacist (pharmacist-only medicine). It is best to take the lowest effective dose, for the shortest possible time. Codeine may be addictive with long-term use.

Dose

• The usual dose of paracetamol + codeine is 1 or 2 tablets every 4 to 6 hours when needed for pain. Do not take more than 8 tablets in 24 hours. This may be less if you are frail or elderly, or have problems with your liver. Taking too much paracetamol can cause liver failure.
• The pharmacy label on your medicine will tell you how much to take, how often to take it and any special instructions. Talk to your doctor or pharmacist about the best dose for you if you are unsure.

Variations in response to codeine

Codeine is broken down in the liver to morphine, which is a strong pain reliever. People may respond differently to codeine depending on how their liver breaks down codeine.

• Some people are poor metabolisers, which means that they are unable to convert codeine to morphine, and don't get adequate pain relief.
• On the other hand, some people break down codeine very rapidly (ultra-rapid metabolisers) and are at increased risk of developing side effects, even at low doses.
• Estimates suggest that up to 10% of the European population may be poor or ultra-rapid metabolisers. The prevalence in Maori and Pacific people is not known.
• If you are taking codeine for pain relief, and it doesn’t seem to be working, let your doctor know. Alternatively, if you are taking codeine and you get side effects such as nausea, vomiting, constipation, lack of appetite, drowsiness, extreme sleepiness, difficulty waking, confusion or shallow breathing, let your doctor know. Other options may be better for you.

How to take paracetamol + codeine

• You can take paracetamol + codeine with or without food.
• Limit or avoid drinking alcohol while you are taking paracetamol + codeine. Taking it with alcohol can increase your chance of side effects such as feeling sleepy, drowsy or dizzy.
• If you forget to take a dose, take it when you next need pain relief and then continue as before, taking your doses every 4 to 6 hours if needed. Do not take 2 doses together to make up for a forgotten dose.

Precautions – before starting paracetamol + codeine

• Are you pregnant or breastfeeding?
• Do you have problems with your liver?
• Do you have difficulties passing urine or prostate problems?
• Do you have breathing problems, such as asthma or chronic obstructive pulmonary disease (COPD)?
• Do you have problems with your heart?
• Do you have thyroid problems?
• Do you have epilepsy?
• Do you have gallstones or a problem with your gallbladder or bile duct?
• Have been constipated for more than a week or have an inflammatory bowel problem?
• Do you have myasthenia gravis (causes weak muscles)?
• Have you recently had a severe head injury?
• Have you ever been dependent on drugs or alcohol?

If so, it’s important that you tell your doctor or pharmacist before you start paracetamol + codeine. Sometimes a medicine isn’t suitable for a person with certain conditions, or it can only be used with extra care.

Possible side effects

Like all medicines, paracetamol + codeine can cause side effects, although not everyone gets them. Often side effects improve as your body gets used to the new medicine.

Interactions

Paracetamol and codeine are contained in a wide variety of pain relief and cough and cold medicines. Do not take other medicines that also contain paracetamol or codeine without talking with your doctor or pharmacist. Paracetamol + codeine can interact with some medicines and herbal supplements so check with your doctor or pharmacist before starting paracetamol + codeine or before starting any new medicines.

Learn more

Medsafe Consumer Information Sheet: Panadeine Extra 
New Zealand Formulary Patient Information: paracetamol + codeine

References

1. Paracetamol + codeine phosphate New Zealand Formulary
2. Spotlight on codeine Medsafe, June 2018