Paracetamol + codeine

Easy-to-read medicine information about paracetamol + codeine – what it is, how to take paracetamol + codeine safely and possible side effects.

Type of medicine Also called
  • Analgesic (pain killer)
  • Combination analgesic 
  • Panadeine®
  • Panadeine Extra®
  • Panadeine Plus®

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.

Be careful when taking some pain relief and cough and cold medicines
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.

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.

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.

Side effects What should I do?
  • Feeling sleepy, dizzy or tired
  • Be careful when driving or using tools until you know how this medicine affects you.
  • Do not drink alcohol.
  • Feeling sick or vomiting
  • Try taking paracetamol + codeine with food.
  • Tell your doctor if troublesome.
  • Constipation
  • Headache
  • Dry mouth
  • These are quite common when you first start taking paracetamol + codeine, and usually go away with time.
  • Tell your doctor if troublesome.
  • Changes in your vision
  • Skin rash and itching
  • Contact your doctor for advice.
  • Serious skin reaction with severe rash, skin peeling, or mouth ulcers
  • Tell your doctor immediately or ring HealthLine 0800 611 116.
  • Signs of liver damage, such as yellowing of skin or eyes, dark-coloured urine
  • Tell your doctor immediately or ring HealthLine 0800 611 116.
  • Breathing difficulties, changes to your heartbeat, excessive sleepiness, difficulty waking, confusion and vomiting
  • Tell your doctor immediately or ring HealthLine 0800 611 116.

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
Credits: Sandra Ponen, Pharmacist. Reviewed By: Angela Lambie, Pharmacist, Auckland Last reviewed: 21 Mar 2019