Paracetamol with dihydrocodeine
Co-dydramol
A combination painkiller of paracetamol and dihydrocodeine for pain not relieved by paracetamol alone.
What is Co-dydramol?
Co-dydramol is a combination painkiller that contains paracetamol and dihydrocodeine (a low-strength opioid). It is used for short-term aches and pains when paracetamol alone has not been enough. Because the dihydrocodeine is an opioid, co-dydramol can cause constipation and drowsiness, and regular use over more than a few days can lead to dependence — so it is best used at the lowest effective amount for the shortest time. As with all paracetamol combinations, you must not take it with any other paracetamol-containing medicine because of the risk of overdose.
Education and reference only. This is a plain-language guide to Co-dydramol — 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-dydramol is a painkiller that combines paracetamol with dihydrocodeine in one tablet. It is closely related to co-codamol, the difference being that the opioid ingredient is dihydrocodeine rather than codeine. It is used for pain that has not settled with paracetamol alone, such as muscular pain, period pain, headaches or pain after an injury. Because it contains an opioid, it is meant for short courses rather than long-term daily use.
How it works
Its two ingredients act in different but complementary ways. Paracetamol works mainly within the brain and spinal cord to reduce pain signals and lower a raised temperature. Dihydrocodeine is an opioid that attaches to opioid receptors in the nervous system, dampening the perception of pain. Together they can relieve pain that paracetamol on its own does not fully control.
Company & origin
Originated / developed by: Various (widely available).
A combination painkiller used in the UK, available on prescription and, in lower-strength form, from pharmacies.
Practical use
How to take Co-dydramol
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Take it exactly as directed, 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-dydramol with another product that contains paracetamol.
- It can be taken with or without food, swallowed with a drink of water.
- Avoid alcohol while taking it, as this adds to drowsiness and the strain on your liver.
- Do not continue it for longer than recommended without medical advice; if pain persists, return to your pharmacist or doctor.
Weighing it up
Advantages & disadvantages of Co-dydramol
Advantages
- Combines two painkillers, so it can ease pain that paracetamol alone does not fully relieve.
- Offers an alternative opioid (dihydrocodeine) for people who need stronger relief than paracetamol.
- Widely available and familiar to UK prescribers and pharmacists.
Disadvantages
- Contains an opioid (dihydrocodeine), so regular use can lead to tolerance and dependence.
- Commonly causes constipation and can cause drowsiness, affecting driving and daily tasks.
- Because it contains paracetamol, it cannot be combined with other paracetamol products and risks overdose if doses are doubled up.
Practical use
Good to know
As with co-codamol, the key safety point is that co-dydramol already contains paracetamol — so you must never take it alongside other paracetamol products, because doubling up risks a serious paracetamol overdose. The dihydrocodeine is an opioid, so expect constipation and possible drowsiness, and avoid alcohol. Use the lowest effective amount for the shortest time: regular use for more than a few days can cause dependence and rebound headaches as each dose wears off.
Who should not take it / use with caution
- People with breathing problems or certain bowel conditions, in whom opioids can be unsafe.
- People with severe liver problems, or who are taking other opioids or sedating medicines that add to drowsiness.
- People who are pregnant or breastfeeding should seek advice first, as opioids can affect the baby.
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 underlying 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, slow or shallow breathing can occur — seek urgent help for severe drowsiness or difficulty breathing.
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 taken by mouth.
Answers
Co-dydramol: frequently asked questions
What is co-dydramol used for?
Co-dydramol is used for short-term aches and pains — such as muscular pain, period pain, headaches or pain after an injury — when paracetamol on its own has not given enough relief.
How is co-dydramol different from co-codamol?
Both combine paracetamol with a low-strength opioid for short-term pain. The difference is the opioid: co-dydramol contains dihydrocodeine, while co-codamol contains codeine. Both carry similar cautions around constipation, drowsiness and dependence.
Can I take co-dydramol with paracetamol?
No. Co-dydramol already contains paracetamol, so taking it with separate paracetamol tablets or a cold or flu remedy that contains paracetamol can cause a serious paracetamol overdose. Always check the ingredients of other medicines first.
Can co-dydramol be addictive?
It can. Dihydrocodeine is an opioid, so taking co-dydramol regularly — especially for more than a few days — can lead to dependence. Using the lowest effective amount for the shortest time, and seeking advice if pain continues, helps reduce this risk.
Will co-dydramol make me drowsy or constipated?
Both are common with the dihydrocodeine in co-dydramol. Avoid driving if you feel drowsy, and help prevent constipation by drinking plenty of fluids and eating fibre-rich foods. Tell your pharmacist if either becomes troublesome.
The wider class
About Opioid combination painkiller
Co-dydramol 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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