Paracetamol with codeine
Co-codamol
A combination painkiller of paracetamol and codeine for pain not relieved by paracetamol alone.
What is Co-codamol?
Co-codamol is a combination painkiller that contains two ingredients: paracetamol and codeine (a low-strength opioid). It is used for short-term aches and pains when paracetamol on its own has not been enough. Because the codeine is an opioid, co-codamol can cause constipation and drowsiness, and using it regularly for more than a few days can lead to dependence — so it is best taken at the lowest effective amount for the shortest possible time. Crucially, you must not take it alongside any other paracetamol-containing medicine, as this can lead to a dangerous paracetamol overdose.
Education and reference only. This is a plain-language guide to Co-codamol — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Co-codamol is a painkiller that brings together paracetamol and codeine in a single tablet. Lower-strength versions can be bought from a pharmacy for short-term pain, while higher-strength versions are only available on prescription. It is typically used for pain that has not settled with paracetamol alone, such as headaches, muscular pain, period pain or pain after an injury or dental work. Because one of its ingredients (codeine) is an opioid, it is intended for short courses rather than ongoing daily use.
How it works
The two ingredients work in different ways that complement each other. Paracetamol is thought to act mainly within the brain and spinal cord to dampen pain signals and lower a raised temperature. Codeine is converted by the body into morphine, an opioid that attaches to opioid receptors in the nervous system to reduce the sensation of pain. Combining them can relieve pain that paracetamol alone does not fully control.
Company & origin
Originated / developed by: Various (widely available).
A long-established combination painkiller used across the UK, available in lower-strength forms from pharmacies and in higher-strength forms on prescription.
Practical use
How to take Co-codamol
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Take it exactly as directed on the label or by your prescriber, using the lowest amount that controls your pain for the shortest time needed.
- Always check the ingredients of any other painkiller, cold or flu remedy first — never take co-codamol with another product that also contains paracetamol.
- It can be taken with or without food; soluble tablets are dissolved in water before drinking.
- Avoid alcohol while taking it, as this adds to drowsiness and to the strain on your liver.
- Do not take it for longer than recommended without medical advice; if pain persists, go back to your pharmacist or doctor rather than continuing on your own.
Weighing it up
Advantages & disadvantages of Co-codamol
Advantages
- Combines two painkillers, so it can ease pain that paracetamol alone does not fully control.
- Lower-strength forms are available without a prescription for short-term use.
- Comes in several formats, including soluble tablets for people who find swallowing difficult.
Disadvantages
- Contains an opioid (codeine), so regular use can lead to tolerance and dependence.
- Commonly causes constipation and can cause drowsiness, limiting driving and other tasks.
- Because it contains paracetamol, it cannot be combined with other paracetamol products and carries overdose risk if doses are doubled up.
Practical use
Good to know
The single most important point is that co-codamol already contains paracetamol — so you must never take it together with other paracetamol products (including many cold and flu remedies), because doubling up risks a serious paracetamol overdose. Because the codeine is an opioid, expect constipation (drinking plenty of fluids and eating fibre helps) and possible drowsiness, and avoid alcohol. Take it at the lowest effective amount for the shortest time: using it regularly for more than a few days can lead to dependence and to headaches that come back as each dose wears off.
Who should not take it / use with caution
- Children under 12 should not take codeine-containing medicines, and it is avoided in teenagers under 18 after certain operations (such as tonsil or adenoid removal).
- People who are breastfeeding, because codeine passes into breast milk and the amount of morphine produced varies between individuals.
- People with breathing problems, certain bowel conditions, severe liver problems, or who are taking other medicines that cause drowsiness or other opioids — check with a pharmacist or doctor first.
Monitoring
- Reviewing how long you have been taking it, to avoid drifting into regular, dependence-forming use.
- Checking your pain is improving and that the cause does not need separate treatment.
- Watching for constipation, excess drowsiness or signs of dependence and reporting these.
Side effects
- Constipation is very common; drowsiness, dizziness and feeling sick can also occur.
- Taking it for more than a few days can lead to dependence, and to rebound headaches as each dose wears off.
- Rarely, codeine can cause slow or shallow breathing — this is more likely in people who convert codeine to morphine very quickly (ultra-rapid metabolisers); seek urgent help for severe drowsiness or breathing difficulty.
Key interactions
- Any other medicine containing paracetamol — combining them risks a dangerous paracetamol overdose.
- Other opioids, sleeping tablets, some antidepressants and sedating medicines add to drowsiness and breathing risk.
- Alcohol increases drowsiness and the strain on the liver, so it should be avoided.
Available as: Tablets, capsules and soluble tablets taken by mouth.
Answers
Co-codamol: frequently asked questions
What is co-codamol used for?
Co-codamol is used for short-term aches and pains — such as headaches, muscular pain, period pain or pain after an injury or dental work — when paracetamol on its own has not given enough relief.
Can I take co-codamol with paracetamol?
No. Co-codamol already contains paracetamol, so taking it alongside separate paracetamol tablets or any cold or flu remedy that contains paracetamol can cause a serious paracetamol overdose. Always check the ingredients of other medicines first.
Can co-codamol be addictive?
It can. Codeine is an opioid, so taking co-codamol regularly — especially for more than a few days — can lead to dependence. Using the lowest effective amount for the shortest time, and going back to your pharmacist or doctor if pain continues, helps reduce this risk.
Will co-codamol make me constipated?
Constipation is a very common effect of the codeine in co-codamol. Drinking plenty of fluids, eating fibre-rich foods and staying active can help; tell your pharmacist if it becomes troublesome.
Can children take co-codamol?
Codeine-containing medicines should not be given to children under 12, and they are avoided in under-18s after certain operations such as tonsil removal. Always seek medical advice for pain relief in children.
The wider class
About Opioid combination painkiller
Co-codamol belongs to the opioid combination painkiller class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF
- NICE CKS
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