Meds and you

Updated 11 February 2013

Paracetamol + codeine

The combination of paracetamol and codeine relieves pain and reduces fever.


Paracetamol and codeine are the active ingredient of Co-Codamol, Dolorol Forte, Nitrocod, Painamol Plus, Paincodein, Panado-Co, Kodapon, Napacod and Infapain.

General information

The combination of paracetamol and codeine relieves pain and reduces fever.

It is indicated for the relief of mild to moderate pain and fever, such as headaches, toothache and pain associated with colds and flu.

Paracetamol is the analgesic of choice for mild to moderate pain and to reduce fever. It is suited for both adults and children and, as it does not cause stomach irritation, it is safe for those who suffer from peptic ulcers and those who cannot take aspirin.

When taken by mouth it is rapidly absorbed into the body, and will be effective within 30 minutes. Paracetamol is safe for occasional use by those being treated with anticoagulants.

Codeine is most often prescribed to treat mild to severe pain, but is also effective in treating irritating, dry coughs, and diarrhoea. It should be used with caution by patients with a history of alcohol or drug abuse as risk of dependency does exist.

Neither paracetamol nor codeine cures the underlying condition responsible for pain, fever or inflammation, but keeps the symptoms under control.

How does the combination work?

Paracetamol blocks the production of chemicals responsible for pain, fever, swelling and inflammation.

Codeine exerts its effect by acting on parts of the central nervous system which process pain signals or the cough reflex.

Fast facts

Drug schedule: Schedule 2

Available as: Tablets and syrup

What does it do? The paracetamol-codeine combination relieves pain and fever.

Overdose risk: High

Dependence risk: Medium

Available as a generic? Yes

Available on prescription only ? No

User information

Onset of effect: Within 30 minutes

Duration of action: Up to 6 hours

Dietary advice: Alcohol in combination with paracetamol may substantially increase the risk of liver damage and sedation

Stopping: It can be safely stopped when no longer needed

Prolonged use: The likelihood of adverse effects increases with prolonged use. Dependence is a possible risk of long-term use. Your doctor may perform periodic liver and kidney function tests, while also examining you for possible gastrointestinal damage.

Special precautions

Consult your doctor before using this drug if:

  • You have asthma,
  • you have kidney or liver disease,
  • you have a bleeding disorder or if you are taking blood thinning medication,
  • you have a head injury,
  • you have a thyroid disorder,
  • you have epilepsy,
  • you have difficulty urinating, or
  • You are taking other medication.

Pregnancy: Avoid. Potential risk to the foetus has been reported. Consult your doctor before use, or if you are planning to fall pregnant.

Breastfeeding: Avoid. This medication is passed through breast milk and may affect your baby adversely. Consult your doctor before use.

Porphyria: This medication is safe to use.

Infants and children: This medication is safe for use in children at the recommended dose.

Elderly: Caution is advised in the elderly as side effects may be more likely. The dose may need to be adjusted.

Driving and hazardous work: Caution is advised as use of this medication may lead to dizziness, sedation and light-headedness. Avoid until you know how it affects you.

Alcohol: Avoid concomitant use of alcohol with this medication as it may worsen stomach irritation and sedative effects.

Possible side effects


Side effect


Consult your doctor



Only if severe

In all cases




Nausea/ vomiting



Drowsiness/ dizziness/ light-headedness









Change in mood



Rash/ itchy skin



Slurred speech



Difficulty breathing






Yellow-tinged skin and eyes




Drug interactions:

Blood pressure medication

Reduced pressure lowering effect


Increased risk of liver damage


Risk of bleeding

Atropine and related drugs

Increased risk of constipation, urinary retention, etc.


Increased risk of carbamazepine toxicity


Reduced effect of paracetamol

Drugs that may cause sedation

Increased risk of sedation

Drugs for treating diarrhoea

Risk of severe constipation

Monoamine oxidase inhibitors

Increase risk of low blood pressure


Increase painkilling effect


Risk of paracetamol toxicity; Therapeutic doses may not be safe

Metoclopramide, Domperidone

Risk of paracetamol toxicity

Oral contraceptives

Reduced paracetamol effect

Disease interactions

Consult your doctor before using this drug if y ou have asthma, kidney or liver disease, a bleeding disorder, a head injury, a thyroid disorder, epilepsy or if you have difficulty urinating.

Overdose action

A small overdose is no cause for concern. In case of intentional large overdose seek emergency medical attention.

Recommended dosage

Dosage should not exceed that recommended for each individual agent

This material is not intended to substitute medical advice, but is for informational purposes only. Please consult a physician for specific treatment and recommendations.


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