What is Co-Codamol?
Co-Codamol is a combination prescription analgesic containing two active ingredients: paracetamol and codeine phosphate. It provides stronger pain relief than paracetamol alone and is indicated for the short-term treatment of moderate pain in adults and adolescents aged 12 and over. Higher-strength formulations (30/500 mg) are prescription-only medicines across the European Union.
How does Co-Codamol work?
Co-Codamol achieves its analgesic effect through two complementary mechanisms:
- Paracetamol component: Paracetamol (also known as acetaminophen) works centrally in the brain to inhibit the synthesis of prostaglandins involved in pain signalling and temperature regulation. It does not significantly reduce inflammation at peripheral sites of injury.
- Codeine component: Codeine is a prodrug that is metabolised in the liver to morphine, a potent opioid analgesic. Morphine binds to mu-opioid receptors in the central and peripheral nervous system, inhibiting the transmission of pain signals and altering the perception of pain. Codeine also has antitussive (cough-suppressing) and antidiarrhoeal properties.
- Synergistic effect: The combination of a centrally acting analgesic (paracetamol) and an opioid (codeine) produces additive or synergistic pain relief at lower individual doses of each component than would be required if used separately.
The extent of codeine’s analgesic effect depends on individual genetic variation in the CYP2D6 enzyme. Poor metabolisers derive little benefit; ultra-rapid metabolisers may experience exaggerated opioid effects at standard doses.
Who is Co-Codamol for?
Co-Codamol is indicated for adults and adolescents (12 years and over) experiencing moderate pain that is not adequately controlled by non-opioid analgesics alone. Typical indications include:
- Musculoskeletal pain: Back pain, joint pain, and soft tissue injuries
- Dental pain: Toothache, post-extraction discomfort
- Headache and migraine: When standard analgesics have been insufficient
- Post-operative pain: Short-term management following minor surgical procedures
- Dysmenorrhoea: Moderate menstrual pain
Co-Codamol is not appropriate for children under 12 years, patients under 18 following certain surgical procedures (such as tonsillectomy), patients who are known ultra-rapid CYP2D6 metabolisers, or those with significant respiratory depression or severe hepatic impairment. It must not be used during breastfeeding. A full medical assessment is required before prescribing.
Dosage
Co-Codamol is available in several strengths, the most common being 8/500 mg and 30/500 mg (codeine/paracetamol). Prescription-strength formulations (30/500 mg) are the subject of this page.
| Patient Group | Dose | Maximum Daily Dose |
|---|---|---|
| Adults (18+) | 30/500 mg, 1–2 tablets every 4–6 hours | 8 tablets (240 mg codeine / 4,000 mg paracetamol) per 24 hours |
| Adolescents (12–17) | 30/500 mg, 1 tablet every 6 hours | 4 tablets (120 mg codeine / 2,000 mg paracetamol) per 24 hours |
Important: Co-Codamol is intended for short-term use only (maximum 3 days). If pain persists beyond three days, patients should seek medical review rather than continuing treatment independently. The maximum paracetamol dose across all products must not exceed 4,000 mg per day; patients must not take Co-Codamol alongside other paracetamol-containing products.
Side effects
As with all medicines, Co-Codamol may cause side effects. The codeine component in particular carries important risks that patients should be aware of.
Common side effects (may affect up to 1 in 10 people)
- Constipation (the most common opioid side effect)
- Nausea and vomiting
- Dizziness and lightheadedness
- Drowsiness
- Headache
- Dry mouth
Less common but serious side effects
- Dependence and withdrawal: Codeine is an opioid and can cause physical and psychological dependence even at therapeutic doses with prolonged use. Abrupt discontinuation after extended use may cause withdrawal symptoms.
- Respiratory depression: Codeine can suppress the respiratory drive, particularly at higher doses or in ultra-rapid metabolisers. This is a medical emergency.
- Hepatotoxicity: Paracetamol overdose — even inadvertent overdose from taking multiple paracetamol-containing products simultaneously — is a leading cause of acute liver failure. Never exceed the maximum paracetamol daily dose.
- Serotonin syndrome: Risk exists when codeine is used with other serotonergic drugs (SSRIs, MAOIs, triptans).
- Allergic reactions: Rare hypersensitivity reactions including skin rashes and anaphylaxis have been reported.
This is not a complete list of side effects. Refer to the EMA-approved product information for full prescribing details.
How to get Co-Codamol online in Europe
Higher-strength Co-Codamol (30/500 mg) is a prescription-only medicine (POM) throughout the European Union. It cannot be legally dispensed without a valid prescription from a licensed medical professional.
Prescrivia operates as a technology intermediary platform: we do not prescribe medicines, employ doctors, or sell medicines. Our platform connects patients with independent EU-registered doctors who can conduct confidential online health assessments.
The process works as follows:
- Complete a health assessment: Answer a structured set of health questions covering your medical history, pain history, current medications, and any prior use of opioid-containing medicines.
- Doctor review: An independent EU-registered doctor reviews your assessment. If Co-Codamol is clinically appropriate for your situation, they may issue a short-term prescription. If it is not appropriate, the doctor will advise on alternatives.
- Prescription and fulfilment: If a prescription is issued, it is forwarded to a licensed EU pharmacy partner, which dispenses and ships the medicine directly to you.
Important: Prescrivia does not guarantee that a prescription will be issued. All prescribing decisions are made independently by qualified medical professionals based on your individual clinical circumstances.
Important safety information
Do not use Co-Codamol if you:
- Are under 12 years of age
- Are under 18 and have had your tonsils or adenoids removed for sleep apnoea
- Are breastfeeding (codeine passes into breast milk and can cause serious harm to the infant)
- Are a known ultra-rapid CYP2D6 metaboliser
- Have severe respiratory disease, severe asthma, or conditions causing respiratory depression
- Are taking or have recently taken MAO inhibitors (within 14 days)
Tell your doctor before starting Co-Codamol if you have:
- Liver or kidney disease
- A history of opioid dependence or substance misuse
- Inflammatory bowel disease (Crohn’s disease, ulcerative colitis)
- Hypothyroidism or Addison’s disease
- A head injury or raised intracranial pressure
- A history of asthma or breathing disorders
Drug interactions: Co-Codamol interacts with alcohol (increased CNS depression), sedatives, benzodiazepines, antidepressants, antiepileptics, and other opioids. Alcohol must be avoided during treatment. Always disclose all current medications to your doctor during the assessment.
Co-Codamol is not appropriate for long-term pain management. Persistent or recurring pain should be assessed and managed with a comprehensive care plan by a qualified doctor.
Sources
Medical information on this page is based on the following sources:
- European Medicines Agency (EMA). Assessment report for codeine-containing products — Paediatric use restrictions. EMA/PRAC/221275/2013.
- World Health Organization (WHO). WHO Model List of Essential Medicines — Analgesics. who.int
- Derry S, et al. Single dose oral codeine, as a single agent, for acute postoperative pain in adults. Cochrane Database Syst Rev. 2010.
- European Medicines Agency (EMA). Questions and answers on the use of codeine for pain relief in children. Available at: ema.europa.eu
This content is reviewed periodically to reflect updated clinical guidance. It is provided for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for advice relevant to your individual health circumstances.
Frequently asked questions
- What is Co-Codamol used for?
- Co-Codamol is a combination analgesic containing paracetamol and codeine phosphate. It is used for the short-term treatment of moderate pain that has not responded adequately to paracetamol or ibuprofen alone, including headaches, dental pain, musculoskeletal pain, and post-operative pain.
- Is Co-Codamol stronger than paracetamol alone?
- Yes. The addition of codeine — a mild opioid analgesic — to paracetamol provides enhanced pain relief for moderate pain that does not respond sufficiently to paracetamol on its own. Clinical evidence supports the combination being more effective for moderate pain than either ingredient alone at standard doses.
- Can I get Co-Codamol online in Europe?
- Higher-strength Co-Codamol formulations (containing codeine 30 mg) are prescription-only medicines in the EU. Prescrivia is an intermediary platform connecting patients with independent EU-registered doctors who can assess whether Co-Codamol is clinically appropriate for your situation.
- What are the most common side effects of Co-Codamol?
- Common side effects include constipation, nausea, dizziness, drowsiness, and headache. The codeine component carries a risk of dependence with prolonged use, which is why it should only be used for short durations and under medical supervision.
- Can Co-Codamol be habit forming?
- Yes. Codeine is an opioid and carries a risk of psychological and physical dependence, particularly with prolonged use or higher doses. Co-Codamol is intended for short-term use only, and patients should not use it for longer than three days without medical guidance.
Behandlinger
Prescrivia er kun en formidlingsplattform. Vi leverer ikke medisinske tjenester, forskriver ikke behandlinger og utleverer ikke legemidler. Alle medisinske beslutninger tas av uavhengige EU-registrerte leger. Alle legemidler utleveres av lisensierte EU-apotek. Denne plattformen legger til rette for kontakt mellom pasienter og helsepersonell.