Co-codamol 30/500

How it works

Codeine is a weak opioid that is metabolised to morphine to act on mu-opioid receptors, while paracetamol provides central analgesic and antipyretic action through poorly understood central mechanisms; together they give additive analgesia.

Prescribing in practice

• Because the tablet contains paracetamol, warn against taking any additional paracetamol-containing products to avoid inadvertent overdose and hepatotoxicity, and never exceed the stated maximum tablets in 24 hours.
• Codeine is converted to morphine by CYP2D6 and effect varies with metaboliser status — ultra-rapid metabolisers risk opioid toxicity, so it is contraindicated in breastfeeding and avoided in children, while interacting CYP2D6 inhibitors and other CNS depressants increase risk.
• Use for the shortest effective period, anticipate constipation and the potential for dependence, and reduce dose or avoid in significant renal or hepatic impairment per the SPC.

Monitoring

Monitor pain control, bowel function, and signs of opioid sedation or excessive use, and reassess the need to continue at each review.

Counselling the patient

• Do not take any other medicine containing paracetamol at the same time.
• Expect possible constipation and drowsiness; do not drive if affected, and do not drink alcohol.
• Take it only as needed for short-term pain and seek advice before stopping a regular course to avoid withdrawal.

Evidence & guidelines

NICE guidance supports short-term, lowest-effective-dose opioid-containing analgesia for acute pain and cautions against routine long-term use.