Co-Codamol (Paracetamol/Codeïne)

Wat 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 receptplichtig geneesmiddels across the European Union.

Hoe werkt 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.

Voor wie 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.

Dosering

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.

Bijwerkingen

As with all medicines, Co-Codamol may cause side effects. The codeine component in particular carries important risks that patients should be aware of.

Veel voorkomende bijwerkingen (kunnen tot 1 op 10 personen treffen)

• Constipation (the most common opioid side effect)
• Nausea and vomiting
• Dizziness and lightheadedness
• Drowsiness
• Headache
• Dry mouth

Minder vaak voorkomende 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.

Hoe verkrijgt u Co-Codamol online in Europa krijgen

Higher-strength Co-Codamol (30/500 mg) is a receptplichtig geneesmiddel (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:

1. Vul een gezondheidsbeoordeling in: Answer a structured set of health questions covering your medical history, pain history, current medications, and any prior use of opioid-containing medicines.
2. Beoordeling door arts: 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 alternatieven.
3. Recept en levering: 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 garandeert niet that a prescription will be issued. All prescribing decisions are made independently by qualified medical professionals based on your individual clinical circumstances.

Belangrijke veiligheidsinformatie

Gebruik niet 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)

Informeer uw arts 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

Geneesmiddelinteracties: 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.

Bronnen

Medical information on this page is based on the following sources:

• Europees Geneesmiddelenbureau (EMA). Assessment report for codeine-containing products — Paediatric use restrictions. EMA/PRAC/221275/2013.
• Wereldgezondheidsorganisatie (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.
• Europees Geneesmiddelenbureau (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.