Paracetamol and codeine

Paracetamol + codeine is used for pain relief. Find out how to take it safely and possible side effects.

Type of medicine Also called
  • Analgesic (pain killer)
  • Combination analgesic 
  • Panadeine®
  • Panadeine Extra®
  • Panadeine Plus®
November 2020: Notification that codeine-containing medicines are now available on prescription only.
As of 5 November 2020, all codeine-containing medicines will be available on prescription only and can no longer be bought from your pharmacy without a prescription. Products that will be affected include:
  • Panadeine®
  • Panadeine Extra®
  • Panadeine Plus®
  • Nurofen Plus®
  • Panafen Plus®
  • Ibucode Plus®
  • Mersyndol®
Read more about codeine re-classification

What is paracetamol + codeine?

Paracetamol + codeine is an analgesic (pain relief medicine) used to treat different types of pain, including headache and migraine. It's 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 enough. Read more about pain relief medications.


  • The usual dose of paracetamol + codeine is 1 or 2 tablets every 4–6 hours when needed for pain. Do not take more than 8 tablets in 24 hours.
  • You may need to take less than this 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 your 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 enough pain relief.
  • Some other people break down codeine very quickly (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//Pākehā  population may be poor or ultra-rapid metabolisers. The prevalence in Māori and Pasifika people is not known.
  • If you are taking codeine for pain relief, and it doesn’t seem to be working, let your doctor know. 
  • If you are taking codeine and you get side effects such as nausea, vomiting, constipation, lack of appetite, drowsiness or extreme sleepiness, let your doctor know. Other options may be better for you.
  • If you have more severe side effects, such as difficulty waking, confusion or shallow breathing, let your doctor know straight away or call Healthline 0800 611 116.

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.

Precautions before starting paracetamol + codeine

  • Are you pregnant or breastfeeding?
  • Do you have problems with your liver?
  • Do you have difficulties passing urine (peeing) 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?
  • Do you have an inflammatory bowel problem?
  • Do you have myasthenia gravis (this 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.

What are the side effects of paracetamol + codeine?

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 or skin peeling, or mouth ulcers
  • Tell your doctor immediately or phone Healthline 0800 611 116.
  • Signs of liver damage, such as yellowing of skin or eyes, dark-coloured urine
  • Tell your doctor immediately or phone Healthline 0800 611 116.
  • Breathing difficulties, changes to your heartbeat, excessive sleepiness, difficulty waking, confusion and vomiting (being sick)
  • Tell your doctor immediately or phone Healthline 0800 611 116.
Did you know that you can report a side effect to a medicine to CARM (Centre for Adverse Reactions Monitoring)? Report a side effect to a product


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

Panadeine Extra Medsafe Consumer Information Sheet, NZ
Paracetamol + codeine NZ Formulary Patient Information


  1. Paracetamol + codeine phosphate NZ Formulary
  2. Spotlight on codeine Medsafe, NZ, 2018

Additional resources for healthcare professionals

WHO analgesic ladder – which opioid to use at step two? BPAC, NZ, 2008

Credits: Sandra Ponen, Pharmacist. Reviewed By: Angela Lambie, Pharmacist, Auckland Last reviewed: 04 Nov 2020