Updated 16 January 2017

Low efficacy opioids

Low-efficacy opiods include codeine and porpoxyfene.

Codeine (codeine phosphate) and propoxyfene are low efficacy opiods.

They are effective against mild to moderate pain, but scientific studies have shown that paracetamol and NSAIDs in optimal doses are more effective. These drugs are, however, a good additive effect to these painkillers, so if paracetamol with or without a NSAID does not relieve your pain sufficiently, you will benefit by adding codeine or propoxyfene to your medication.

Many manufacturers combine these different painkillers in one commercial preparation and aim to block pain at two or three different receptor sites with one tablet (e.g. Myprodol® = paracetamol + ibuprofen + codeine; Doxyfene® = paracetamol + propoxyfene).

Like all the opioids, codeine and propoxyphene might cause sedation, so avoid taking them before activities that require concentration like a long car drive.

Codeine is also a good cough suppressant even at lower doses than used for pain relief.

Looking at the above two effects together, you now understand why some cough mixtures make you feel sleepy.

Another side effect is constipation, especially with codeine. This can be especially cumbersome in elderly people, and in certain situations like after a haemorrhoid operation.

Dependence and addiction are especially worrisome with propoxyfene. If used longer than a few days, it is strongly advisable to contact your physician, also because many of these preparations are combined with paracetamol, which carries the risk for liver toxicity.

It was mentioned that the “cocktail preparations” aim to block the different pain receptors with just one capsule or tablet. However, be careful.

Several of those cocktail preparations are irrational in the choice of their ingredients, and are therefore either poor pain killers or carry the risk of addiction, or both. E.g. some preparations, in addition to the actual pain killer contain a sedative to make you more relaxed, or some caffeine to perk you up, or even both of these! The “feel good” effect is what leads some people to swallow these capsules or tablets without actually having pain, and this is where the risk for addiction starts. Not only is the addiction itself undesirable, but paracetamol and NSAIDs can be harmful to your liver, kidneys and stomach, and even be fatal!

A word of advice: read the package insert!

Preferably only take “pure” painkillers (not the cocktail-type), which you can combine with each other. They also often work out cheaper. If you do take one of the cocktail pain killers, do not take them longer than two or three days without consulting a doctor.

Also, do not take different opioids or opioid-containing drugs together, because you will simply increase the risk for side effects without increasing the beneficial effect.

Examples of the most commonly used combination preparations and their ingredients:

  • Adco-dol®: paracetamol + codeine + caffeine + doxylamine (a sedative)

  • Betapyn®: paracetamol + codeine + caffeine + doxylamine

  • Codis®: aspirin + codeine

  • Distalgesic®: paracetamol + propoxyphene

  • Dolorol Forte®: paracetamol + codeine

  • Doloxene: aspirine + propoxyphene

  • Doxyfene: paracetamol + propoxyfene

  • Empacod®: paracetamol + codeine

  • Lentogesic®: paracetamol + dextropropoxyphene + L-Glutamine (a stimulant, which can make you feel agitated or “stoned”, and can cause confusion and delirium, especially in the elderly; the pure form has been taken off the market in many countries for the risk of liver failure)

  • Lotem®: paracetamol + ibuprofen

  • Mybulen®: paracetamol + ibuprofen + codeine

  • Mypaid®: paracetamol + ibuprofen

  • Myprodol: paracetamol + ibuprofen + codeine

  • Painamol®: paracetamol + codeine

  • Panado-co®: paracetamol + codeine

  • Stilpane®: paracetamol + codeine + caffeine + meprobamate (a sedative)

  • Stopayne®: paracetamol + codeine + caffeine + meprobamate

  • Suncodine®: paracetamol + codeine + caffeine + phenyltoloxamine (a sedative)

  • Synap Forte®: paracetamol + propoxyfene + caffeine + dephenhydramine (a sedative)

  • Syndol®: paracetamol + codeine + caffeine + doxylamine

  • Tenston®: paracetamol + aspirine + codeine + caffeine + meprobamate

  • Tenston SA®: like Tenston®, but without the aspirine

  • Veganin®: paracetamol + aspirine + codeine

Read more:
PAIN - A guide to therapy
Meds & You

Arthritis Foundation of South Africa
Multiple Sclerosis South Africa
The South African Society of Physiotherapy


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Professor Keertan Dheda has received several prestigious awards including the 2014 Oppenheimer Award, and has published over 160 peer-reviewed papers and holds 3 patents related to new TB diagnostic or infection control technologies. He serves on the editorial board of the journals PLoS One, the International Journal of Tuberculosis and Lung Disease, American Journal of Respiratory and Critical Medicine, Lancet Respiratory Diseases and Nature Scientific Reports, amongst others. Read his full biography at the University of Cape Town Lung Institute.

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