Experiences with

Co-dydramol

Co-dydramol is a mixture of 2 different painkillers: paracetamol and dihydrocodeine. Dihydrocodeine belongs to a group of medicines called opiates.

It's used to treat aches and pains, including headaches, migraines, muscle and joint pain, period pain and toothache.

Paracetamol and dihydrocodeine work by blocking messengers in the nerves and brain that tell your body that you're in pain.

You'll usually take co-dydramol when everyday painkillers such as aspirin, ibuprofen and paracetamol have not worked on their own.

Co-dydramol comes in 4 different strengths. You can buy lower-strength tablets from pharmacies. Higher-strength tablets are only available on prescription.

Co-dydramol usually comes as tablets.

Who can take co-dydramol

Most adults and children aged 12 years old and over can take co-dydramol.

Who may not be able to take co-dydramol

Co-dydramol is not suitable for some people. To make sure it's safe for you, tell your doctor before starting to take this medicine if you:

• have ever had an allergic reaction to co-dydramol, paracetamol, dihydrocodeine or any other medicine
• have any problems with your digestion, such as IBS (irritable bowel syndrome) or Crohn's disease
• have lung problems, asthma or other breathing difficulties
• have a head injury
• have adrenal insufficiency
• have a condition that causes seizures or fits
• have an underactive thyroid
• regularly drink more than the maximum recommended amount of alcohol (14 units a week, spread across 3 days or more)
• have liver or kidney problems
• have myasthenia gravis, a rare condition that causes muscle weakness
• are trying to become pregnant, are already pregnant or are breastfeeding
• are under 18 years old and have had your tonsils or adenoids taken out because of obstructive sleep apnoea

Do not give co-dydramol to a child under 12 years old unless a doctor has prescribed it.

Dosage and strength

Co-dydramol comes in 4 different strengths. Each tablet contains 500mg of paracetamol, the same as in a standard paracetamol tablet or capsule. But each strength contains different amounts of dihydrocodeine.

Co-dydramol tablets contain 7.46mg, 10mg, 20mg or 30mg of dihydrocodeine.

The strength of each tablet is shown on the packet as 2 numbers. These show the amount of dihydrocodeine followed by the amount of paracetamol. So, if it says 10/500 on the packet, this means the tablets contain 10mg of dihydrocodeine and 500mg of paracetamol.

You can buy the lowest strength of co-dydramol (7.46/500) without a prescription from a pharmacy. The higher strengths (10/500, 20/500 and 30/500) are only available on prescription.

Adults and young people aged 16 years old and over an usually take1 to 2 co-dydramol tablets, of any strength, up to 4 times in 24 hours. Always leave at least 4 hours between doses.

For children aged 12 to 15 years old, the maximum daily dose depends on the strength of the co-dydramol, where it's from (a shop or prescribed), and how old they are.

Do not take more than the maximum dose of co-dydramol. The maximum dose for adults and young people aged 16 years old and over is 8 tablets over 24 hours. For children, if you’re unsure how much you should give them, ask your doctor or a pharmacist.

If this has been prescribed for you, follow your doctor's advice. If you bought this at a pharmacy, follow instructions provided.

You can take co-dydramol with or without food.

Swallow the tablets whole with a drink of water. Do not crush them.

Some tablets have a line down the middle to help you break them into 2 halves. If you have trouble swallowing medicines, break the tablet and then take each half separately.

It's important to leave a gap of at least 4 hours between doses of co-dydramol.

How long to take it for

If you buy co-dydramol from a pharmacy, do not take it for more than 3 days. If you still have pain, talk to your pharmacist or doctor.

If you've been prescribed co-dydramol, take it for as long as your doctor tells you to.

Depending on why you're taking it, you may need to take it for a few days or weeks at most, for example, if you're in pain after an injury or operation.

Talk to your doctor if you're not sure how long you need to take co-dydramol for.

If you've been taking prescribed co-dydramol for more than a few weeks and want to stop, speak to your doctor first.

If you take co-dydramol regularly and miss a dose, take it as soon as you remember, unless it's nearly time for your next dose. In this case skip the missed dose and take your next one at the usual time. Remember to leave at least 4 hours between doses.

Never take 2 doses of co-dydramol to make up for a missed dose.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

If you take too much

For adults, taking 1 or 2 extra tablets is unlikely to be harmful, as long as you do not take more than 8 tablets in 24 hours. A, child should not take more than their recommended dose in 24 hours.

It's important to leave a gap of at least 4 hours between doses of co-dydramol.

Taking too much can be very dangerous and you may need treatment because the paracetamol in it can cause liver damage.

• you take more than 2 extra tablets of co-dydramol
• you take more than 8 tablets of co-dydramol in 24 hours
• a child has had more than their recommended dose in 24 hours

• you take too much co-dydramol and are finding it difficult to breathe

If you need to go to A&E, do not drive. Ask someone to drive you or call 999 and ask for an ambulance.

Bring the co-dydramol packet or leaflet inside it, any remaining medicine, and any other medicines you take.

Common side effects

These common side effects of co-dydramol happen to more than 1 in 100 people. There are things you can do to help cope with them:

Speak to a doctor or pharmacist if the advice on how to cope does not help and a side effect is still bothering you or does not go away.

Serious side effects

Serious side effects are rare and happen in less than 1 in 100 people.

Tell a doctor or call 111 straight away if you:

• get a skin rash
• have difficulty peeing
• have changes in your eyesight

Serious allergic reaction

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to co-dydramol.

If you buy co-dydramol from a pharmacy, do not use it for more than 3 days. If your pain has not gone away, talk to a pharmacist or doctor.

If you need to take co-dydramol for a long time, your body can become used to (known as tolerance) the dihydrocodeine in it. That means you need higher doses to control your pain over time.

Some people can become more sensitive to pain (hyperalgesia). If this happens, your doctor will reduce your dose gradually to help these symptoms.

It's possible to become addicted to the dihydrocodeine in co-dydramol. For this reason, your dose will be reviewed to make sure you’re only taking the amount you need to control your pain.

Your treatment plan may include details of how and when you'll stop taking co-dydramol.

If you're having treatment for cancer pain or other severe pain, your pain control will be carefully monitored. Speak to your doctor if you're worried about tolerance, hyperalgesia or becoming addicted.

Other side effects

These are not all the side effects of co-dydramol. For a full list, see the leaflet inside your medicine packet.

Co-dydramol and pregnancy

You can take co-dydramol in pregnancy if you need to.

Co-dydramol contains paracetamol and dihydrocodeine. Although paracetamol is safe to take at any time in pregnancy, taking dihydrocodeine towards the end of pregnancy may cause your baby to have withdrawal symptoms, such as drowsiness, after they're born. Your baby may need extra time in hospital for observation.

It's important to treat pain in pregnancy. Co-dydramol might sometimes be the best option for pain during pregnancy, but speak to your doctor. They can help you decide what's right for you and your baby.

Co-dydramol and breastfeeding

If your doctor or midwife says your baby is healthy, it's usually OK to take co-dydramol while breastfeeding. However, only take it if your doctor advises you to. Try to take it in low doses and only use it for a short time.

It's usually better to take paracetamol on its own while breastfeeding.

Co-dydramol contains paracetamol and dihydrocodeine. Paracetamol gets into breast milk in small amounts. It's not known how much dihydrocodeine gets into breast milk, but it's also thought to be a small amount. It's unlikely that co-dydramol will cause any side effects in your baby.

Talk to your doctor, pharmacist, midwife, or health visitor if you have any concerns about your baby while you are breastfeeding. This includes if your baby:

• is not feeding as well as usual
• has constipation

• your baby is unusually sleepy
• your baby has breathing problems

However, these effects are very rare, and unlikely to happen, especially with low strength co-dydramol taken for a short time.

Co-dydramol and fertility

Taking co-dydramol that contains higher levels of dihydrocodeine, for a long time, can make it more difficult for you to get pregnant or to make someone pregnant. This is because dihydrocodeine can cause hypogonadism (where the body stops making enough sex hormones).

When you stop taking co-dydramol, your sex hormones should go back to normal.

If you're worried about co-dydramol and your fertility, talk to your doctor.

Cautions with other medicines

Some medicines can affect the way co-dydramol works.

Tell your doctor or speak to a pharmacist before starting to take co-dydramol if you take:

• sleeping pills or tranquillisers
• antidepressants
• medicines to stop you feeling sick or vomiting, such as domperidone or metoclopramide
• medicines to help prevent blood clots, such as warfarin
• antihistamines
• epilepsy medicines
• antipsychotics
• medicines to treat tuberculosis (TB)
• medicines to treat anxiety

Mixing co-dydramol with herbal remedies and supplements

There's not enough information to say that complementary medicines, and herbal remedies and supplements are safe to take with co-dydramol. They're not tested in the same way as pharmacy and prescription medicines. They're generally not tested for the effect they have on other medicines.

Related links

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