Co-dydramol

1. About co-dydramol

Co-dydramol is a mixture of 2 different painkillers: paracetamol and dihydrocodeine.

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

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

Co-dydramol usually comes as tablets.

You can buy lower-strength tablets from pharmacies. Higher-strength tablets are only available on prescription.

2. Key facts

• Co-dydramol comes in 4 different strengths. You can buy the lowest-strength tablets from pharmacies. Higher strengths are only available on prescription.
• The most common side effects of co-dydramol are constipation and feeling sick or sleepy.
• If you've bought co-dydramol from a pharmacy, do not use it for more than 3 days without talking to your doctor.
• It's possible to become addicted to the dihydrocodeine in co-dydramol, but your doctor will explain how to reduce the risks of becoming addicted.
• If you need to take co-dydramol for more than a few weeks, your treatment plan may include details of how and when to stop taking this medicine.

3. Who can and cannot take co-dydramol

Adults and children aged 12 years and over can take co-dydramol.

Co-dydramol is not suitable for some people. Tell your doctor before starting 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 irritable bowel syndrome or Crohn's disease
• have lung problems, asthma or other breathing difficulties
• have a head injury
• have adrenal gland problems
• 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)
• have liver or kidney problems
• have myasthenia gravis, a rare illness that causes muscle weakness
• are trying to become pregnant, are already pregnant or are breastfeeding
• are under 18 years and have had your tonsils or adenoids taken out because of obstructive sleep apnoea

4. How and when to take co-dydramol

It's important to take co-dydramol as your doctor has asked you to. This is particularly important because it can be addictive.

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. Taking too much can be very dangerous because the paracetamol in it can cause liver damage.

Different strengths of co-dydramol

Co-dydramol comes in 4 different strengths. The tablets contain either 7.46mg, 10mg, 20mg or 30mg of dihydrocodeine.

All co-dydramol tablets also contain 500mg of paracetamol – the same as in a standard paracetamol tablet or capsule.

The strength is shown as 2 numbers on the packet. These give the amount of dihydrocodeine followed by the amount of paracetamol. So if it says 10/500 on the packet, this means the tablets contains 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.

Dosage

Adults (16 years and older) – 1 to 2 co-dydramol tablets (of any strength) up to 4 times in 24 hours. Always leave at least 4 hours between doses.

Children (12 to 15 years) – 1 tablet up to 4 times in 24 hours. If your child has been prescribed co-dydramol, follow the doctor's instructions. Always leave at least 4 hours between doses.

If you've bought 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 your doctor prescribed co-dydramol for you, take it for as long as they tell you to.

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.

Never take double doses of co-dydramol, and never take extra doses to catch up.

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.

What if I take too much?

If you need to go to A&E, do not drive yourself. Get someone else to drive you or call for an ambulance.

Take the co-dydramol box, or the leaflet inside the packet, plus any remaining medicine with you.

5. Taking co-dydramol with other painkillers

It's safe to take co-dydramol with ibuprofen or aspirin. However, do not give aspirin to children under the age of 16 (unless their doctor prescribes it).

Do not take co-dydramol with paracetamol or other medicines that contain paracetamol. These include painkillers such as Tramacet (paracetamol combined with tramadol) and co-codamol, migraine remedies, and some cough and cold remedies such as Lemsip and Night Nurse.

Co-dydramol already contains paracetamol, so you could be at risk of a paracetamol overdose.

6. Side effects

Like all medicines, co-dydramol can cause side effects, although not everyone gets them. Many people have no side effects or only minor ones. You are more likely to have side effects if you take the higher strengths of co-dydramol.

Common side effects

Common side effects happen in more than 1 in 100 people. Tell your doctor if the side effects bother you or do not go away. Common side effects include:

• constipation
• feeling or being sick (nausea or vomiting)
• feeling sleepy
• headaches

Serious side effects

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

Tell a doctor straight away if you have:

• a skin rash
• difficulty peeing
• changes in your eyesight
• dizziness

Serious allergic reaction

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

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

7.

8. How to cope with side effects of co-dydramol

What to do about:

• constipation – eat more high-fibre foods, such as fresh fruit and vegetables, and cereals. Try to drink several glasses of water or another non-alcoholic liquid each day. If you can, try to exercise more regularly – for example, by going for a daily walk or run.
• feeling or being sick – try taking co-dydramol with or just after a meal or snack. Stick to simple meals and do not eat rich or spicy food. If you're being sick, try small frequent sips of water to avoid dehydration. Feelings of sickness should normally wear off after a few days. Talk to your doctor about taking an anti-sickness medicine if it carries on for longer.
• feeling sleepy – this side effect should go away within a few days as your body gets used to the dihydrocodeine. Do not drive, cycle or use tools or machinery if you're feeling this way. Do not drink any alcohol, as this will make you feel more tired. Speak to your doctor if it carries on for longer.
• headaches – make sure you rest and drink plenty of fluids. Do not drink too much alcohol. Ask your pharmacist to recommend a painkiller. Talk to your doctor if the headaches last longer than a week or are severe.

9. Pregnancy and breastfeeding

While co-dydramol can be taken in pregnancy, other painkillers may be more suitable.

Co-dydramol contains paracetamol and dihydrocodeine. Paracetamol is safe to take in pregnancy, however dihydrocodeine can affect your baby, particularly towards the end of pregnancy.

Your baby may get used to having dihydrocodeine and may have withdrawal symptoms when they're born. There is a slightly higher risk of your baby having breathing problems. These are usually temporary, but your baby may need extra monitoring.

For these reasons, co-dydramol is not generally recommended. However, if you have pain that requires stronger pain relief than paracetamol, talk to your doctor. They might prescribe co-dydramol if they think this is the best option for you.

Co-dydramol and breastfeeding

Only take co-dydramol while breastfeeding if your doctor advises you to.

It is not known how much dihydrocodeine gets into breast milk, but it is likely to be a small amount. Paracetamol alone is OK to take while you are breastfeeding.

If your doctor says it is OK for you to keep taking co-dydramol, then monitor your baby for any possible side effects, such as increased sleepiness, not feeding as well, or problems breathing. However, it is 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.

10. Cautions with other medicines

Some medicines can affect the way co-dydramol works.

Tell your doctor if you're taking these medicines before you start taking co-dydramol:

• sleeping pills or tranquillisers
• antidepressants
• medicines to stop you feeling sick or vomiting, such as domperidone or metoclopramide
• blood-thinning medicines, 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 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.

11. Common questions about co-dydramol