Paracetamol with buclizine and codeine

How it works

Paracetamol provides central analgesic and antipyretic action, codeine is a weak opioid metabolised to morphine for additional analgesia, and buclizine is a sedating antihistamine that acts centrally to reduce migraine-associated nausea and vomiting.

Prescribing in practice

• The codeine component carries opioid risks—constipation, dependence and respiratory depression—and codeine is contraindicated in children and in known ultra-rapid metabolisers; it must not be used in those under eighteen after certain surgery or in breastfeeding.
• Beware paracetamol from multiple sources; the combined paracetamol content must be counted to avoid inadvertent overdose and hepatotoxicity.
• Buclizine adds sedative and antimuscarinic effects, increasing drowsiness especially with alcohol or other CNS depressants.

Monitoring

Monitor for adequate migraine relief, opioid-related effects and excessive sedation, and review frequency of use to avoid medication-overuse headache.

Counselling the patient

• This product contains paracetamol—do not take other paracetamol-containing medicines at the same time.
• It can cause drowsiness; avoid alcohol and do not drive if affected, and limit use to avoid rebound headaches and dependence.

Evidence & guidelines

Combination analgesics containing codeine carry MHRA restrictions on use in children and breastfeeding owing to variable codeine metabolism; use is guided by the SPC.