Codeine/paracetamol

Codeine/paracetamol
Combination of
Codeine	Opioid analgesic
paracetamol	Anilide analgesic
Clinical data
Trade names	Tylenol with codeine, others
MedlinePlus	a601005
License data	US DailyMed: Acetaminophen codeine;
Routes of; administration	By mouth
ATC code	N02BE51 (WHO) ;
Legal status
Legal status	AU: S4 (Prescription only); CA: Schedule I; UK: POM (Prescription only) / P; US: Schedule III / Schedule V;
Identifiers
CAS Number	67889-72-9;
PubChem CID	11949633;
ChemSpider	10123946 ;
KEGG	D02146;
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Codeine/paracetamol, also called codeine/acetaminophen and co-codamol, is a compound analgesic, comprising codeine phosphate and paracetamol (acetaminophen). Codeine/paracetamol is used for the relief of mild to moderate pain when paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs; such as ibuprofen, aspirin, and naproxen) alone do not sufficiently relieve symptoms.^[2]^[3]

In 2022, it was the 166th most commonly prescribed medication in the United States, with more than 3 million prescriptions.^[7]^[8]

Side effects

The most common side effects include constipation, nausea and drowsiness.^[9] Others include coughing up blood from the lungs, skin rashes, dizziness, sedation, shortness of breath, hypersensitivity reaction, fainting (syncope or near syncope), confusion, loss of short-term memory, changes in blood, allergic reactions, euphoria, dysphoria, abdominal pain, itchiness, easy bruising, bleeding gums, vivid dreams, dry mouth and addiction.^[10]

Genetic differences between people cause differing rates of metabolism of codeine to morphine. In about 5% of people this may happen particularly fast, causing morphine to be passed through breast milk in amounts that may cause fatal respiratory depression in a breastfed baby.^[11]

Society and culture

Availability

Of the European Union member states, 11 allow over-the-counter sale of solid dosage forms of codeine, including codeine/paracetamol: Bulgaria, Cyprus, Denmark, France, Ireland, Latvia, Lithuania, Malta, Poland, Romania and Slovenia.^[12]

References

^ "Acetaminophen with Codeine Product information". Health Canada. 25 April 2012. Archived from the original on 13 September 2022. Retrieved 13 September 2022.
^ ^a ^b "Boots Paracetamol & Codeine 500mg/8mg Tablets - Patient Information Leaflet (PIL)". (emc). 30 November 2021. Archived from the original on 18 July 2022. Retrieved 17 July 2022.
^ ^a ^b "Co-Codamol 15/500 Tablets - Summary of Product Characteristics (SmPC)". (emc). 25 March 2021. Archived from the original on 5 August 2021. Retrieved 17 July 2022.
^ "Controlled Substances - Alphabetical Order" (PDF). Archived (PDF) from the original on 21 April 2021. Retrieved 29 June 2024.
^ "Acetaminophen and Codeine Phosphate tablet". DailyMed. 31 July 2020. Archived from the original on 18 March 2022. Retrieved 17 July 2022.
^ "Acetaminophen and Codeine Phosphate solution". DailyMed. 25 May 2022. Archived from the original on 11 May 2021. Retrieved 17 July 2022.
^ "The Top 300 of 2022". ClinCalc. Archived from the original on 30 August 2024. Retrieved 30 August 2024.
^ "Acetaminophen; Codeine Drug Usage Statistics, United States, 2013 - 2022". ClinCalc. Retrieved 30 August 2024.
^ "Co-codamol for adults: painkiller containing paracetamol and codeine". National Health Service. 19 December 2018. Archived from the original on 14 January 2022. Retrieved 16 April 2021.
^ Nielsen S, Van Hout MC (2017). "Over-the-Counter Codeine-from Therapeutic Use to Dependence, and the Grey Areas in Between". Current Topics in Behavioral Neurosciences. 34: 59–75. doi:10.1007/7854_2015_422. hdl:1959.4/unsworks_62273. ISBN 978-3-319-60014-7. PMID 26768736.
^ "Codeine Use While Breastfeeding May Be Dangerous". CTV News. 20 August 2008. Archived from the original on 1 September 2008. Retrieved 13 August 2020.
^ Foley M, Harris R, Rich E, Rapca A, Bergin M, Norman I, et al. (November 2015). "The availability of over-the-counter codeine medicines across the European Union". Public Health. 129 (11): 1465–1470. doi:10.1016/j.puhe.2015.06.014. PMID 26215740. Archived from the original on 25 March 2022. Retrieved 8 July 2020.

[1] "Acetaminophen with Codeine Product information". Health Canada. 25 April 2012. Archived from the original on 13 September 2022. Retrieved 13 September 2022.

[Boots_PIL-2] "Boots Paracetamol & Codeine 500mg/8mg Tablets - Patient Information Leaflet (PIL)". (emc). 30 November 2021. Archived from the original on 18 July 2022. Retrieved 17 July 2022.

[Co-Codamol_SmPC-3] "Co-Codamol 15/500 Tablets - Summary of Product Characteristics (SmPC)". (emc). 25 March 2021. Archived from the original on 5 August 2021. Retrieved 17 July 2022.

[4] "Controlled Substances - Alphabetical Order" (PDF). Archived (PDF) from the original on 21 April 2021. Retrieved 29 June 2024.

[5] "Acetaminophen and Codeine Phosphate tablet". DailyMed. 31 July 2020. Archived from the original on 18 March 2022. Retrieved 17 July 2022.

[6] "Acetaminophen and Codeine Phosphate solution". DailyMed. 25 May 2022. Archived from the original on 11 May 2021. Retrieved 17 July 2022.

[7] "The Top 300 of 2022". ClinCalc. Archived from the original on 30 August 2024. Retrieved 30 August 2024.

[8] "Acetaminophen; Codeine Drug Usage Statistics, United States, 2013 - 2022". ClinCalc. Retrieved 30 August 2024.

[NHS-9] "Co-codamol for adults: painkiller containing paracetamol and codeine". National Health Service. 19 December 2018. Archived from the original on 14 January 2022. Retrieved 16 April 2021.

[10] Nielsen S, Van Hout MC (2017). "Over-the-Counter Codeine-from Therapeutic Use to Dependence, and the Grey Areas in Between". Current Topics in Behavioral Neurosciences. 34: 59–75. doi:10.1007/7854_2015_422. hdl:1959.4/unsworks_62273. ISBN 978-3-319-60014-7. PMID 26768736.

[11] "Codeine Use While Breastfeeding May Be Dangerous". CTV News. 20 August 2008. Archived from the original on 1 September 2008. Retrieved 13 August 2020.

[12] Foley M, Harris R, Rich E, Rapca A, Bergin M, Norman I, et al. (November 2015). "The availability of over-the-counter codeine medicines across the European Union". Public Health. 129 (11): 1465–1470. doi:10.1016/j.puhe.2015.06.014. PMID 26215740. Archived from the original on 25 March 2022. Retrieved 8 July 2020.

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v t e Non-steroidal anti-inflammatory drugs (NSAIDs) (primarily M01A and M02A, also N02BA)
pyrazolones / pyrazolidines	Aminophenazone Ampyrone Azapropazone Clofezone Difenamizole Famprofazone Feprazone Kebuzone Metamizole Mofebutazone Morazone Nifenazone Oxyphenbutazone Phenazone Phenylbutazone Propyphenazone Sulfinpyrazone Suxibuzone^‡
salicylates	Aspirin (acetylsalicylic acid)^# Aloxiprin Benorylate Carbasalate calcium Diflunisal Dipyrocetyl Ethenzamide Guacetisal Magnesium salicylate Methyl salicylate Salsalate Salicin Salicylamide Salicylic acid (salicylate) Sodium salicylate
acetic acid derivatives and related substances	Aceclofenac Acemetacin Alclofenac Amfenac Bendazac Bromfenac Bufexamac Bumadizone Diclofenac Difenpiramide Etodolac Felbinac Fenclozic acid Fentiazac Indometacin Indometacin farnesil Isoxepac Ketorolac Lonazolac Mofezolac Oxametacin Prodolic acid Proglumetacin Sulindac Tiopinac Tolmetin Zomepirac^†
oxicams	Ampiroxicam Droxicam Isoxicam Lornoxicam Meloxicam Piroxicam Pivoxicam Tenoxicam
propionic acid derivatives (profens)	Alminoprofen Benoxaprofen^† Carprofen^‡ Dexibuprofen Dexketoprofen Fenbufen Fenoprofen Flunoxaprofen Flurbiprofen Ibuprofen^# Ibuproxam Indoprofen^† Ketoprofen Loxoprofen Miroprofen Naproxen Oxaprozin Pelubiprofen Piketoprofen Pirprofen Suprofen Tarenflurbil Tepoxalin^‡ Tiaprofenic acid Vedaprofen^‡ Zaltoprofen COX-inhibiting nitric oxide donator: Naproxcinod
n-arylanthranilic acids (fenamates)	Azapropazone Clonixin Etofenamate Floctafenine Flufenamic acid Flunixin Flutiazin Glafenine^† Meclofenamic acid Mefenamic acid Morniflumate Niflumic acid Tolfenamic acid
COX-2 inhibitors (coxibs)	Apricoxib Celecoxib (+tramadol) Cimicoxib^‡ Deracoxib^‡ Etoricoxib Firocoxib^‡ Lumiracoxib^† Mavacoxib^‡ Parecoxib Robenacoxib^‡ Rofecoxib^† Valdecoxib^†
other	Aminopropionitrile Benzydamine Chondroitin sulfate Diacerein Fluproquazone Glucosamine Glycosaminoglycan Hyperforin Nabumetone Nimesulide Oxaceprol Proquazone Superoxide dismutase / orgotein Tenidap
NSAID combinations	Ibuprofen/famotidine Ibuprofen/hydrocodone Ibuprofen/oxycodone Ibuprofen/paracetamol Meloxicam/bupivacaine Naproxen/diphenhydramine Naproxen/esomeprazole
Key: underline indicates initially developed first-in-class compound of specific group; ^#WHO-Essential Medicines; ^†withdrawn drugs; ^‡veterinary use.
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