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Clinical resource

What is Co-codamol

Commonly used to treat toothache, migraines, and muscle pain, co-codamol is can be a highly effective medication to get instant relief

Medically reviewed byDr. Sarah Boss, MD
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Quick Summary

  • Co-codamol combines paracetamol and codeine for pain relief, but prolonged use or high doses can cause serious side effects and organ damage.
  • Regular use may lead to tolerance, dependence and addiction, while stopping abruptly can produce cravings, anxiety, sleep problems and physical withdrawal symptoms.
  • Excess co-codamol needs immediate poison-service or urgent medical advice even without symptoms because of paracetamol toxicity. Slow breathing, seizures, collapse or inability to wake require emergency services; naloxone does not treat paracetamol toxicity.

Painkillers are one of the most commonly prescribed medications in the world. These medications belong to different categories with varying intensities. While individuals suffering from mild to moderate level pain usually begin with everyday painkillers, like paracetamol and ibuprofen, those with higher pain intensities often resort to more potent medications like co-codamol. Co-codamol is an over-the-counter analgesic that combines paracetamol and codeine to rapidly kill pain signals.

Commonly used to treat toothache, migraines, and muscle pain, co-codamol is can be a highly effective medication to get instant relief. That said, it is imperative to know about its potential to damage health, especially if taken in high doses for a long time. A doctor should make everyone aware of these possible co-codamol side effects before prescribing it.

Using co-codamol, especially for more extended periods or persistently high doses can trigger certain side effects. How frequent or severe these side effects are may vary from one person to another. These side effects may also depend on whether or not an individual is simultaneously undergoing any other treatment. For example, it may be typically worse in people using other drugs or seeking radiotherapy while using co-codamol.

Some of the most common co-codamol dangers that may expect to occur in its long-term users are listed below. Keep in mind that it is unlikely for someone to have all these side effects, but they may develop some of them simultaneously.

Bleeding

Co-codamol may cause a drop in the total amount of platelets in the blood due to which a user may experience bleeding from the nose or gums. Gum bleeding is particularly prevalent after brushing teeth but usually stops on its own. Additionally, they may notice multiple tiny spots, similar to bruises, on their arms or legs.

Increased Risk of Infection

In addition to dropping platelets, co-codamol also decreases the number of white blood cells in the body. Because white blood cells are primarily responsible for keeping the body safe from infections, a decrease in their levels automatically puts the body at a high risk of acquiring an infection. Some common symptoms of an everyday infection may include a change in body temperature, feeling cold and shivery, headaches, aching muscles, and a general sense of unwellness. Individuals may develop other specific symptoms depending on what infection they have acquired.

Liver Damage

Codeine alone is not necessarily bad for the liver; however, using it in combination with other medications may put a higher strain on the organ. One such combination is with acetaminophen or paracetamol which is the primary formula of co-codamol. Paracetamol is one of the most commonly used medications in the world and is easily available over the counter under different labels. While it is among the safest drugs to take, its excessive consumption can cause serious problems, especially for the liver. The liver is chiefly responsible for processing paracetamol and if someone takes too much of it, it may cause liver damage.

Using paracetamol in higher amounts has also been linked to liver failure and deaths. Hence, it is critical for people using co-codamol to carefully stick to their prescribed dose.

Kidney Damage

Many pain relief medications that are presumably safe to use in prescribed doses can be particularly toxic to the kidneys in the long run. These medications use some everyday painkillers like aspirin and ibuprofen that have been linked to side effects as serious as renal failure.

While co-codamol may not hurt the kidneys badly, experts recommend using it with caution as it includes a combination of two different drugs that may increase the pressure on the kidneys for filtering it.

Allergic Reaction

A new rash or itching during co-codamol treatment needs prompt medical advice. Sudden swelling of the lips, mouth, tongue, or throat, trouble breathing or swallowing, or collapse may signal a severe allergic reaction. Call emergency services immediately for these symptoms.

Mood Changes

Mood changes refer to any abrupt elevation or depression of mood. Most people using co-codamol report developing depressive episodes; however, they usually resolve independently. However, if someone continues to suffer from these symptoms, it is essential to let a medical professional know so that they can commence necessary treatment before the condition worsens. In some people, co-codamol may also induce anxiety or confusion.

Drowsiness

Some people report feeling dizzy or drowsy while using co-codamol. Hence, experts advise against driving or operating machinery while taking this medication.

Headaches

Rarely, co-codamol may induce headaches in certain users. However, most of them are self-limiting and do not require any treatment.

Hearing Changes

Co-codamol has also been associated with a certain degree of hearing loss, especially when it comes to high-pitched sounds. Always inform a nurse or doctor if you notice any of these changes.

Difficulty Breathing

Breathing difficulty, short or shallow breaths, severe wheezing, inability to wake, or collapse after co-codamol can be an emergency. Call emergency services immediately; do not wait to see whether breathing problems persist.

Feeling Sick

Using co-codamol may make users feel generally unwell and nauseous. This side effect is common during the initial days but subsides on its own soon. To cope with it, experts recommend avoiding fried or fatty food, drinking plenty of water, eating smaller meals, and practicing relaxation techniques.

Constipation

Constipation is one of the most common co-codamol side effects triggered by codeine. However, this side effect with manageable by drinking plenty of fluids and eating fruit and vegetables to increase the fiber intake. If this side effect continues for more than three days, contact a doctor to get a laxative.

Pancreatic Inflammation

Sudden severe abdominal pain can indicate pancreatitis or another urgent problem. Seek urgent medical assessment rather than assuming it is an expected long-term side effect.

Skin Problems

In some people, co-codamol may induce skin issues, like itching, dryness, and rashes. Report a new rash or itching promptly; sudden swelling, breathing or swallowing difficulty, or collapse requires emergency services.

Addiction

Prolonged use of co-codamol can trigger dependence in many individuals. This co-codamol abuse forces the users to increase their daily dosage to feel the same effects, ultimately paving the way for addiction. Once an addiction develops, it becomes difficult for a person to stop using this pain medication. Most people develop uncomfortable withdrawal symptoms if they try to quit using co-codamol on their own. These symptoms include:

  • Sleeping difficulties
  • Cravings for co-codamol
  • Anxiety or agitation
  • Runny nose and watery eyes
  • Excessive yawning
  • Sweating
  • Muscle aches
  • Stomach cramps
  • Diarrhea
  • Nausea and vomiting
  • Dilated pupils

Overdose

When a person dependent on co-codamol continues to take this medication in progressively higher doses, they put themselves at risk of an overdose. Some common symptoms of a potential co-codamol overdose include the following:

  • Blue tint to the skin, lips, or under the fingernails
  • Chest pain
  • Changes in consciousness
  • Slowed, irregular breathing
  • Slowed heart rate
  • Low blood pressure
  • Loss of pulse
  • Hallucinations
  • Seizures
  • Coma

If more co-codamol than recommended has been taken, contact a poison service or urgent medical service immediately, even if the person feels well: paracetamol can cause delayed liver injury. Review all medicines containing paracetamol. Call emergency services for slow breathing, seizures, collapse, or inability to wake. Naloxone may reverse codeine-related breathing suppression but does not treat paracetamol toxicity; urgent medical assessment remains essential even after naloxone.

Before initiating co-codamol to manage pain, it is important to educate yourself regarding its safety in special circumstances.

Combining with other foods, drinks, and medicines

The components of co-codamol may interact with certain other medicines and herbal supplements. So before taking it, always tell your healthcare provider about any medications that you are currently taking, including herbal supplements, vitamins, and other over-the-counter remedies.

Contraception and Pregnancy

If you are pregnant or planning pregnancy, discuss pain treatment with your prescriber. Co-codamol may sometimes be appropriate after weighing benefits, risks, and alternatives. Long-term use is generally not recommended, and codeine near delivery can cause newborn drowsiness or withdrawal. Do not abruptly stop regular treatment without advice.

Breastfeeding

Most experts advise against breastfeeding during co-codamol treatment as the drug may pass onto the breast milk and enter the baby’s body.

Simultaneous Treatments

If you are having any other treatments for an active medical health condition, such as radiotherapy, chemotherapy, or even dental problems, make sure the healthcare physician prescribing co-codamol knows about it.

Questions

Frequently Asked Questions

What does co-codamol contain?

Co-codamol is a mixture of two pharmaceutical chemicals: paracetamol and codeine. Paracetamol is one of the most commonly used medications for pain relief that interferes with the substances a body secretes in response to injury called prostaglandins. These prostaglandins make the nerves highly sensitive and induce feelings of pain. By reducing their synthesis and secretion, paracetamol kills the effects of pain in the body. Codeine, on the other hand, is a type of opioid that works like the body’s natural painkillers called endorphins. This chemical manages pain by blocking the transference of pain signals to the brain.

How much co-codamol can I take without side effects?

The safe dose of co-codamol typically varies according to the age group of the users. For adults, experts advise taking two tablets every four to six hours as required, with a maximum dose of eight tablets per day. Children between 16 to 18 years can take one to two tablets every six hours, with a maximum of eight tablets in 24 hours. For children between the ages of 12 and 15 years, one tablet of co-codamol every six hours is recommended, with a total limit of four tablets daily. Remember that you must not take co-codamol for more than three consecutive days. If the medication fails to improve pain even after this time limit, contact a doctor for further advice.

Can you take co-codamol with antibiotics?

So far, research believes that it is safe to combine co-codamol with most antibiotics. However, it is still better to discuss your circumstances with a doctor before combining the two drug classes to minimize the risks.

Can I take co-codamol with alcohol?

No, experts warn against mixing co-codamol with alcohol. The use of alcohol with this medication can potentially worsen its side effects and cause troubles like poor concentration, dizziness, sleeping issues, unusual dreams, and drowsiness.

How long after taking co-codamol can I drink?

Avoid alcohol while taking co-codamol because its codeine component can increase sedation and suppress breathing. There is no universal waiting interval after the last dose that guarantees safety. Ask your pharmacist or prescriber for advice based on your dose, other medicines, and health.

Editorial evidence

Evidence & sources

Selected clinical guidelines, peer-reviewed research, and public-health sources used in this article.

01Substance Abuse and Mental Health Services Administration. (2024). National helpline.View source
02National Health Service. (2022). Paracetamol: Side effects.
03National Center for Biotechnology Information. (2023). Acetaminophen toxicity.
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04National Health Service. (2023). Codeine: About codeine.
05Centers for Disease Control and Prevention. (2024). About prescription opioids.
06National Institute on Drug Abuse. (2024). Misuse of prescription drugs.View source
07National Health Service. (2024). Co-codamol for adults.View source
08National Institute on Drug Abuse. (2024). Prescription opioids (drug facts). National Institutes of Health.View source
09National Institute for Health and Care Excellence. (2021). Chronic pain (primary and secondary) in over 16s: Assessment of all chronic pain and management of chronic primary pain (NICE guideline NG193).View source
10World Health Organization. (2023). Opioid overdose.View source
11Derry, S., Karlin, S. M., Moore, R. A., & McQuay, H. J. (2015). Single dose oral ibuprofen plus paracetamol (acetaminophen) for acute postoperative pain in adults. Cochrane Database of Systematic Reviews.View source
12U.S. Food and Drug Administration. (2023). Acetaminophen information.
13MedlinePlus. (2024). Codeine. U.S. National Library of Medicine.View source
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