Co-codamol

What Does Co-codamol Do?

Co-codamol is a painkiller, primarily used for managing moderate to severe pain. It is a common prescription for ailments like migraines, muscular pain, nerve pain, and surgical or dental pain. Additionally, this drug has antipyretic properties that can reduce fever. 

How Does Co-codamol Work?

Co-codamol works as a pain reliever through the dual action of its active ingredients: paracetamol and codeine. Paracetamol inhibits prostaglandin synthesis, subduing pain transmission and fever. Meanwhile, codeine, an opioid, binds to mu-opioid receptors in the brain and spinal cord. This binding adjusts pain perception and lessens the emotional reaction to pain. Additionally, codeine suppresses the cough reflex.

Drug Type and Category of Co-codamol

Co-codamol, a potent painkiller, belongs to the combination analgesics category of drugs. 

What dosage of Co-codamol should you be taking?

NICE Guidelines ¹

Adults:

• Take 1 or 2 tablets (of any strength) up to 4 times in 24 hours
• Leave a gap of at least 4 to 6 hours between doses
• The maximum dose is 8 co-codamol tablets in 24 hours

Children aged 16 to 18 years:

• Take 1 to 2 tablets every 6 hours, up to a maximum of 8 tablets in 24 hours

Children aged 12 to 15 years:

• Take 1 tablet every 6 hours, up to a maximum of 4 tablets in 24 hours

The NICE guidelines state that Co-codamol should not be used in children under 12 years of age due to the risk of opioid toxicity.

Additionally, Co-codamol can be addictive, so it's important to take it only as directed by your doctor and not to increase the dose or take more than the recommended amount.

What are the side-effects of Co-codamol?

Common side effects:

• Constipation - this is by far the most common side effect and some patients including the elderly may require a laxative. 
• Nausea or vomiting 
• Dizziness 
• Drowsiness 
• Headaches 

Serious side effects (rare):

• Skin rash 
• Difficulty urinating 
• Changes in vision 
• Muscle stiffness 
• Symptoms of low blood pressure (e.g. feeling faint) 

Long-term side effects:

• Tolerance, meaning higher doses are needed over time to control pain 
• Increased sensitivity to pain (hyperalgesia) 
• Potential for addiction to the codeine component 

Co-codamol can cause life-threatening breathing problems, especially when first starting the medication, after a dosage increase, in older adults, or in those with existing lung problems . Patients should be monitored closely for these serious side effects.

Drug Interactions

• Alcohol: Avoid alcohol while taking co-codamol as it can increase the risk of side effects like drowsiness, dizziness, and breathing problems.
• Benzodiazepines (e.g. diazepam, alprazolam): Combining co-codamol with benzodiazepines can cause profound sedation, respiratory depression, coma and even death. Avoid concomitant use if possible, and limit dosages and durations if used together.
• Antidepressants (e.g. fluoxetine, paroxetine): Some antidepressants can inhibit the metabolism of codeine, potentially increasing its effects. Monitor for increased side effects if used together.
• Antifungals (e.g. ketoconazole): Certain antifungals may decrease the metabolism of codeine, leading to higher levels and increased risk of side effects. Avoid concomitant use if possible.
• Anticonvulsants (e.g. carbamazepine, phenytoin): These drugs can increase the metabolism of codeine, potentially reducing its effectiveness. Monitor for decreased pain relief if used together.
• Opioid analgesics (e.g. fentanyl, oxycodone): Combining multiple opioids can increase the risk of respiratory depression, sedation, and overdose. Avoid concomitant use if possible.

Natural Alternatives to Co-codamol

Herbal and dietary supplements ² such as Boswellia (frankincense) have anti-inflammatory properties that may help reduce pain. Turmeric contains curcumin, which has been shown to have analgesic and anti-inflammatory effects. Cloves contain eugenol, a natural pain reliever that can be used topically for toothaches or other localised pain. Fish oil supplements rich in omega-3 fatty acids may help reduce inflammation and pain.

Acupuncture is an ancient Chinese practice that involves inserting thin needles into specific points on the body. It may help relieve various types of pain, including headaches, back pain, and arthritis pain. ²

Physiotherapy, osteopathy and other manual therapies can help significantly with joint and muscle pain without the need for opioids. 

Applying heat or cold directly to the site of pain can help reduce inflammation and provide relief. Heat is often better for chronic pain, while ice is more effective for acute injuries. ²

Interesting facts about Co-codamol

In many countries, co-codamol is only available by prescription from a doctor. Over-the-counter sales of co-codamol have been restricted in some countries due to concerns about misuse and abuse.

Some individuals metabolise codeine differently due to genetic variations, which can affect the drug's effectiveness and the risk of side effects. This means that for some people, co-codamol may not provide adequate pain relief, while for others, it may be too strong.

Disclaimer

This article is generated for informational purposes only. It was created in July 2024. Medications and medical guidance can change over time. Therefore, it is essential to consult with your general practitioner or healthcare provider before making any decisions regarding medications or treatment plans. Your GP can provide personalised advice based on your specific health needs and conditions.

References

1. https://bnf.nice.org.uk/drugs/co-codamol/
2. https://www.healthline.com/health/pain-relief/surprising-natural-pain-killers