Opioid + paracetamol combination
Dihydrocodeine with paracetamol
Brand names: co-dydramol, Galake, Remedeine
Adult dose
Dose: 1–2 tablets QDS (typical 7.46mg dihydrocodeine / 500mg paracetamol or 10/500 / 20/500 / 30/500)
Route: Oral
Frequency: QDS PRN
Clinical pearls
- WHO pain ladder step 2
- NICE NG140 / NG193: avoid routine combination opioids for chronic pain
- FPM Opioids Aware
- Counsel against concurrent paracetamol products
Contraindications
- Respiratory depression
- Severe hepatic impairment (paracetamol)
- Concurrent paracetamol products (overdose risk)
- Standard opioid contraindications
Side effects
- Constipation
- Sedation
- Nausea
- Hepatotoxicity (paracetamol)
- Dependence
- Respiratory depression
Interactions
- CNS depressants
- MAOIs
- Warfarin (paracetamol potentiation at high doses)
Monitoring
- Pain score
- Respiratory rate
- Bowel function
- LFTs (long-term high dose)
Reference: BNF; NICE NG140; NICE NG193; FPM Opioids Aware; https://bnf.nice.org.uk/drugs/dihydrocodeine-with-paracetamol/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- Morphine Milligram Equivalents (MME) Calculator · Pain / Opioids
- Opioid Conversion / Equianalgesic Guide · Pain Management
- Rumack-Matthew Nomogram · Toxicology
- Numeric Rating Scale (NRS) Pain Assessment and Management · Pain Management
- King's College Criteria for Acute Liver Failure · Prognosis
- Kings College Criteria for Paracetamol Toxicity · Hepatology
Pathways
- Sepsis Screening and Sepsis Six · UK Sepsis Trust; NICE NG51; Surviving Sepsis Campaign 2021
- Unintentional Weight Loss Workup · NICE NG12; BSG
- Chronic Fatigue Workup · NICE NG206; BMJ Best Practice
- Lymphadenopathy Workup · NICE NG12; BMJ Best Practice
- Pre-op Medical Clearance · NICE NG45; ESC 2022
- Secondary Hypertension Workup · NICE NG136; ESH 2023