Co-codamol contains paracetamol and codeine. Avoid alcohol while taking it: alcohol can intensify codeine’s sedative effects and increase the risk of slow or difficult breathing. Call emergency services if someone collapses, has trouble breathing or cannot be awakened after taking them together.
Some lower-strength codeine combinations are supplied by pharmacies without a prescription in the UK; higher strengths require a prescription. Rules differ by country. Pharmacy or prescription availability does not remove the risks of dependence, opioid overdose or paracetamol poisoning.
Co-codamol combines paracetamol (acetaminophen) with the opioid codeine to relieve pain when suitable simpler painkillers have not helped enough. Ingredients and strengths should be checked on the exact pack. Brand names include Kapake, Solpadol and Tylex in some countries, but availability and directions vary.
Co-Codamol Addiction UK and Side Effects of Abuse
Paracetamol reduces pain and fever. It is not an opioid and does not have the same anti-inflammatory effects as medicines such as ibuprofen. A pharmacist or prescriber can assess which pain treatment is suitable for your health conditions and other medicines.
Codeine is an opioid painkiller that is partly converted to morphine in the body. It can cause drowsiness, breathing suppression, tolerance, physical dependence and addiction. Conversion to morphine varies between people, affecting both pain relief and toxicity.
Dosing and Usage
Co-codamol is available as tablets, capsules and soluble tablets. Follow the instructions for the exact formulation; some are swallowed with water and others must be dissolved first.
Common UK strengths are labeled 8/500, 15/500 and 30/500.
In these examples, the second number means 500 mg of paracetamol per tablet or capsule.
The first number indicates the amount of codeine: 8 mg, 15 mg or 30 mg per unit. In the UK, 8/500 can be obtained from a pharmacy without a prescription; 15/500 and 30/500 require a prescription. Check the current leaflet and local supply rules.
Follow the exact leaflet or prescription for the amount, spacing and maximum daily use. Age-specific directions and lower limits may apply. Do not increase the amount or frequency yourself, double a missed dose, or take another medicine containing paracetamol or codeine. Seek immediate poison-service or medical advice after taking more than directed, even if you feel well.
In the UK, pharmacy-bought co-codamol should not be continued beyond three days without medical advice. This is a safety instruction, not a fixed threshold for addiction. Persistent pain needs reassessment. Follow the prescriber’s plan for prescribed treatment and discuss a reduction plan after sustained regular use.
Co-codamol can generally be taken with or without food; follow the product leaflet. Avoid alcohol and tell a pharmacist about all other medicines, including cough and cold products, sleep aids and herbal preparations. Some contain additional paracetamol, codeine or sedating ingredients.
The two ingredients relieve pain through different mechanisms. Their safety risks also differ: codeine can suppress breathing, while excess paracetamol can cause severe liver injury.
Paracetamol reduces pain and fever, but its precise mechanism is not fully established. It does not share codeine’s opioid action.
Related: Medication Guide
Paracetamol is mainly processed in the liver. Most is converted to harmless breakdown products, but a small amount forms a reactive metabolite. Excess intake can overwhelm protective processes and cause liver injury. Symptoms may be delayed, so suspected overdose requires immediate assessment even when the person feels well.
The CYP2D6 enzyme converts some codeine to morphine, which acts at opioid receptors to reduce pain signaling. Genetic and other differences affect conversion: some people get little relief, while others can develop serious opioid toxicity at recommended amounts. Repeated use can cause physical dependence, and some people develop addiction.
A medicine’s half-life describes how long its concentration takes to halve during elimination. It does not establish how long impairment lasts or when alcohol is safe. Clearance varies with the amount taken, repeated use, age, liver and kidney function, and other medicines.
Paracetamol and codeine are processed differently, and codeine’s active breakdown products also contribute to its effects. A single clearance estimate cannot establish safety for an individual, particularly after excess intake.
Drug effects and laboratory detectability are different questions. Do not use a predicted blood, urine, saliva or hair-test window to decide whether to drink alcohol. Ask a pharmacist or prescriber about your treatment; suspected overdose needs urgent advice rather than a wait for the medicine to clear.
Codeine and alcohol can both impair alertness and coordination. Together they can produce greater sedation and suppress breathing. Risk increases further with other sedating medicines.
Avoid alcohol while taking co-codamol. Severe drowsiness, slow or difficult breathing, collapse, coma and death are possible, particularly with larger amounts or additional sedating medicines. Harm can occur without deliberately taking an overdose.
Possible effects range from impaired alertness to life-threatening opioid toxicity; they are not equally common or inevitable. They can include:
- drowsiness
- lightheadedness
- difficulty concentrating
- Slow, shallow or difficult breathing
- fainting
- decreased heart rate
- low blood pressure
- Confusion and impaired judgment
- coma
- death
After combined use, do not drive or take more alcohol or sedating medicines. Seek prompt poison-service or medical advice if there is concern about the amount taken or symptoms. Call emergency services for slow or difficult breathing, collapse, a seizure or inability to awaken. Stay with the person while help is coming.
Severe breathing suppression can reduce oxygen reaching the brain and other organs and may cause lasting injury or death. Give naloxone if available for suspected opioid overdose and follow emergency-service instructions; naloxone does not treat paracetamol poisoning.
The liver risk is separate from codeine’s sedative effects. Excess paracetamol can generate more of a toxic breakdown product than the liver can safely neutralise. Risk depends on the amount and pattern of intake, liver health and individual circumstances.
Paracetamol overdose can cause severe, sometimes fatal liver injury. Heavy drinking, malnutrition and liver disease can affect risk and suitable treatment limits. Seek immediate poison-service or medical advice after excess intake, even without symptoms; do not wait for jaundice or vomiting.
Serious liver injury may initially cause no obvious symptoms. Possible features later include the following; none can safely rule out poisoning:
- Liver injury or liver failure
- Upper-right abdominal pain
- Jaundice
- Lethargy
- Loss of appetite
- Fatigue
- Nausea
- Vomiting
Repeated codeine use can cause tolerance and physical dependence. Physical dependence means that reducing or stopping can cause withdrawal; addiction is a separate condition involving impaired control or continued use despite harm.
Dependence and addiction can occur during prescribed use, although they do not affect everyone. Higher amounts and longer use can increase risk. Regular review helps assess whether co-codamol remains useful; do not increase the dose yourself.
Using co-codamol to change mood or cope with distress, or mixing it with alcohol or other sedatives, warrants a confidential discussion with a pharmacist or prescriber. Support should address pain, mental health and medicine use without blame.
Other sedating medicines, including benzodiazepines, sleeping medicines, gabapentin and pregabalin, can increase opioid-related breathing risks. Check combinations with a pharmacist or prescriber rather than adding, increasing or abruptly stopping prescribed medicines yourself.
The MHRA’s opioid safety advice recommends discussing tolerance, dependence and addiction, monitoring treatment, and agreeing a plan for ending it. Regular review can help identify a problem and arrange support early.
Craving, unsuccessful attempts to control use, or continued use despite harm are reasons to seek assessment. Withdrawal alone does not prove addiction, and help is available through a GP, pharmacist or addiction service.
After sustained regular codeine use, discuss a gradual reduction plan with the prescriber rather than stopping abruptly on your own. Suspected overdose or a serious allergic reaction requires immediate medical help; do not treat it as routine withdrawal.
Some people must not use codeine-containing co-codamol; others need an individual assessment or adjusted treatment. The examples below are not a complete list of contraindications. Follow the exact current leaflet and ask a pharmacist or prescriber before use:
- Allergy to paracetamol, codeine or another ingredient: do not use the product
- Children under 12: do not give codeine-containing co-codamol
- Bowel obstruction or certain serious bowel conditions: seek product-specific medical advice
- People under 18 after tonsil or adenoid surgery for obstructive sleep apnea: do not use codeine
- Recent head injury or raised pressure in the brain: consult a prescriber; the medicine may be unsuitable
- Kidney disease: treatment may need different limits or spacing and requires medical advice
- Pregnancy or planning a pregnancy: consult the prescriber and follow the product’s pregnancy restrictions
- Breastfeeding: do not use codeine-containing co-codamol
- Liver disease: suitability and treatment limits require medical assessment
- Lung disease or sleep apnea: discuss the risk of breathing suppression before use
- Existing slow or difficult breathing: do not take another dose and seek urgent help; severe symptoms require emergency services
- Regular heavy drinking, alcohol dependence or recent heavy alcohol intake: discuss safety before taking co-codamol and avoid alcohol during treatment
Tell the clinician about all health conditions and medicines, including non-prescription products. If you may be alcohol-dependent, ask for a medically supported plan rather than abruptly stopping alcohol on your own; withdrawal can be dangerous.
Co-codamol can cause side effects, but not everyone experiences them and their severity varies. Ask a pharmacist or prescriber about persistent or concerning symptoms. Important examples include:
The following symptoms need different responses; breathing difficulty, collapse or inability to awaken requires emergency help:
- Constipation: Codeine can slow bowel movement. Fluids and dietary changes may help, but a pharmacist or prescriber can advise on treatment if constipation persists. Severe abdominal pain or a swollen abdomen needs medical assessment.
- Drowsiness: Codeine can make you sleepy even at recommended amounts. Avoid alcohol and do not drive or use machinery while impaired.
- Skin rash: Stop the medicine and seek urgent advice for a new rash, blistering or peeling. Call emergency services for face or throat swelling, breathing difficulty or collapse.
- Difficulty urinating: Codeine can cause urinary retention. Seek prompt medical advice; inability to pass urine, especially with pain, needs urgent assessment.
- Nausea and vomiting: These can occur at recommended amounts; food may reduce stomach upset but does not make an overdose safe. Excess intake needs immediate poison-service or medical advice even if there are no symptoms.
- Vision changes: Blurred or double vision needs medical advice. Do not drive or operate machinery while vision is affected.
- Dizziness: Avoid alcohol and driving while impaired and ask a pharmacist or prescriber to review treatment and other sedating medicines. Severe drowsiness, slow or difficult breathing, or inability to awaken requires emergency help.
- Headache: Frequent painkiller use can itself worsen headaches. Ask for a treatment review rather than taking more co-codamol or adding another paracetamol-containing medicine.
Avoid alcohol while taking co-codamol because it can intensify codeine’s effects on alertness and breathing. Paracetamol poisoning is a separate risk after excess intake. Follow the exact leaflet and ask a pharmacist or prescriber about your circumstances; feeling alert does not establish that a combination is safe.
Avoid alcohol while taking co-codamol. There is no universal waiting period after the last dose that guarantees the drug has cleared or that alcohol will be safe. Ask your pharmacist or prescriber for advice specific to your treatment and health.
Alcohol can intensify codeine’s sedative and breathing-suppressing effects. Waiting a fixed number of hours cannot reliably prevent this interaction.
