Co-codamol over the counter contains paracetamol and codeine
Drug reviews

Co-codamol Over the Counter – all facts you must know

Without a doubt, Co-codamol over the counter is one of the most popular products purchased from the pharmacy. Co-codamol tablets can be purchased from a pharmacy without a prescription. Certain supply restrictions apply when co-codamol is bought over the counter. 

Co-codamol over the counter: legal status

Co-codamol tablets available over the counter have the legal status of a pharmacy only medicine (P). P medicines can only be sold in a pharmacy which operates under the supervision of a pharmacist, this includes online pharmacies.  Over the counter codeine-containing products are restricted to 3-day use only (due to addictive properties); therefore, it is recommended that one pack of co-codamol can be sold per patient. Prolonged use of codeine-containing products or codeine requires the involvement of a GP and subsequent prescription(s) for the supply. Verbal recommendation from a GP to buy Co-codamol from a pharmacy on a regular basis is not sufficient for frequent requests to purchase this product.

Co-codamol over the counter: licensed use

Co-codamol over the counter is licensed for short-term management of acute pains which is not relieved by other painkillers such as paracetamol, ibuprofen or aspirin alone. This includes:

  • headaches
  • migraines
  • toothaches
  • backpain
  • muscle pain

Over the counter codeine-containing products are licensed for adults and children from 12 years of age. 

Co-codamol over the counter: active ingredients 

Co-codamol (8/500) which can be bought from a pharmacy contains two active ingredients: 

  • paracetamol (500mg per tablet)
  • codeine (8mg per tablet)

Most pharmacy chains including supermarket chains sell own versions of co-codamol. A packet of 32 Co-codamol tablets can be bought for as little as £2 (Tesco Pharmacy). A wide range of branded Co-codamol tablets can be purchased including:

  • Veganin (vegan Co-codamol), contains 8mg of codeine, 500mg of paracetamol and 30mg of caffeine per tablet.
  • Syndol Headache Relief Tablets, contains 8mg of codeine, 500mg of paracetamol and 30mg of caffeine per tablet.
  • Solpadeine Plus Tablets/Capsules, contains 8mg of codeine, 500mg of paracetamol and 30mg of caffeine per tablet.
  • Paracodol tablets: contain 8mg of codeine, 500mg of paracetamol per tablet.
  • Migraleve Yellow Tablets: contains, 8mg of codeine, 500mg of paracetamol per tablet.
  • Migraleve Tablets contain: 8mg of codeine, 500mg of paracetamol and 6.25mg buclizine hydrochloride (to stop migraine-related nausea)  of paracetamol and per tablet.

Branded versions of co-codamol products containing higher amounts of codeine combined with paracetamol are available over the counter. For example:

  • Solpadeine Max contains 12.8mg of codeine and 500mg of paracetamol per tablet.
  • Panadol Ultra contains 12.8mg of codeine and 500mg of paracetamol per tablet.
  • Syndol contains 10mg of codeine, 500mg of paracetamol, 30mg of caffeine and doxylamine succinate 5mg per tablet.

Co-codamol over the counter: formulations

Co-codamol over the counter is available in tablet, capsule, and effervescent formulation. Effervescent tablets dissolve when placed in the water. The effervescent formulation allows for quicker absorption, hence much faster relief of the symptoms.

Can you buy Co-Codamol 15/500 and 30/500 over the counter?

No. Higher strength of Co-codamol tablets and capsules (Co-codamol 15/500 and Co-codamol 30/500), are available as prescription medications and cannot be purchased over the counter. Prescription-only Co-codamol is one of the most commonly prescribed drugs in the UK

How does Co-codamol work?

The exact mechanism of action of paracetamol is not known. Paracetamol has both analgesic (helps with pain) and antipyretic properties (reduces temperature). Paracetamol does not have anti-inflammatory properties.

Codeine is classified as a weak opioid. Its analgesic actions are thought to be 1/10 of that induced by morphine (Mattia & Coluzzi, 2015). Once in the body, codeine is transformed (metabolised) into different active substances, including morphine, which is responsible for analgesics actions.

Generally, drugs work by binding to a receptor. Codeine acts on opioid receptors found in the body, including the brain and gastrointestinal system. Opioid receptors have a role in pain control and transmission. When codeine/morphine binds to target receptors, it stops pain signals from the brain to the affected parts of the body.

Codeine weakly binds to opioid receptors; however, its metabolite (part of codeine which is transformed in the body), morphine, has 200-fold better affinity for those receptors (Dean, 2016). Therefore, the analgesic effects of codeine depend on how much codeine is transformed into morphine in our body.


Codeine: variability in response 

The degree of codeine metabolism (transformation of co-codamol to its active form) varies largely between individuals, meaning that not everyone responds to Co-codamol treatment in the same way. 

Some people are poor metabolisers of codeine; hence they experience little pain relief from codeine. It is estimated that up to 7% of the Caucasian population are poor metabolisers of codeine (eMC, 2018). On the other hand, rapid codeine metabolisers have increased risk of experiencing side effects of opioid toxicity including confusion, nausea, vomiting, shallow breathing. Prevalence for rapid metabolisers of codeine is the highest amongst African/Ethiopian population, with an estimated 29% of the population affected (ibid).

Concomitant use of other drugs can affect codeine metabolism; for example, patients on fluoxetine (a popular antidepressant) can experience fewer benefits (including no benefit at all) in terms of pain management when both drugs are taken together.

Co-Codamol over the counter: possible side effects

Patients taking Co-codamol may experience the following side effects:

  • Drowsiness
  • Feeling sick
  • Constipation
  • Sweating

On prolonged use:

  • Addiction, dependence, and tolerance
  • Worsening of headaches

Why is Co-codamol over the counter addictive?

Over the counter co-codamol should not be used for more than three days at any given time. The UK licensing for all codeine-containing products requires prominent information on the packaging stating ‘Can cause addiction. For three days use only.’

When taken, co-codamol can cause a feeling of relaxation, drowsiness, and sometimes euphoria. All of these are caused by the release of dopamine within the brain’s reward system. Repeated use of drugs which have the potential for addiction cause changes to dopamine system within the brain contributing to addiction, physical dependence, and tolerance (more drug is needed to have the same effect).

Addiction becomes prominent with physical symptoms such as cravings for the drug. In case of codeine, some signs of addiction may include:

  • anxiety,
  • mood swings,
  • drowsiness,
  • nausea,
  • constipation,
  • dry mouth,
  • and more

Read more on symptoms of codeine addiction on TalktoFrank.

Co-codamol OTC: alternative options

Acute pain can be with different over the counter drugs. The choice may depend on the nature of the pain and any underlying health conditions one may have. Alternative options which should be considered before using co-codamol over the counter:

  • use of paracetamol alone
  • use of ibuprofen alone
  • use of both paracetamol and ibuprofen at the same time (concomitant use of paracetamol and ibuprofen may not be allowed in younger patients). Some evidence exists for superior pain relief properties of a combination product such as Nuromol (paracetamol & ibuprofen combined) over the use of individual drugs alone in acute pain management.
  • use of aspirin 300mg
  • use of OTC naproxen (Feminax Ultra) for the management of period pains
  • use of sumatriptan in the management of migraine headaches

Conclusion

Overall over the counter co-codamol may provide better pain relief than paracetamol or ibuprofen alone. However, patients need to be aware of side effects associated with codeine use and its addictive properties.

Sadly co-codamol became popular for all the wrong reasons. Co-codamol is too cheap and easily accessible despite of being classified as pharmacy only medicine. 

References:

I am a community pharmacist working in UK. I blog about drugs, health and pharmacy.

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