Paracetamol + Codeine - Oral

Paracetamol and Codeine are combined in this medicine.

Paracetamol + Codeine helps relieve mild to severe pain which can't be relieved by other pain medications such as paracetamol or ibuprofen alone.

Take Paracetamol + Codeine exactly as directed by your doctor or according to the instructions on the label. Do not take more or less than instructed by your doctor.

This medicine is available as a conventional tablet, effervescent tablet, capsule and oral solution.

If you are taking the conventional tablet or capsule, swallow it whole with a glass of water.

If you are taking the effervescent tablet, dissolve it in a glass of water then drink the solution immediately. Do not swallow the tablet whole.

If you are taking the oral solution, use the calibrated syringe or measuring cup provided to measure your dose.

Alert your doctor if Paracetamol + Codeine does not seem to help control your pain. Do not stop taking it suddenly as this may worsen your condition.

The dose of this medicine will be decided by your doctor. Your doctor will advise you on the treatment timeframe depending on the severity of your condition and your response to the medication.

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and return to your normal dosing schedule.

DO NOT double a dose under any circumstances.

Alert your doctor if you have the following conditions:

• severe respiratory depression (slow or ineffective breathing)
• asthma
• known or suspected paralytic ileus (bowel obstruction caused by slow movement or paralysis of the intestines)
• diarrhoea due to pseudomembranous colitis (inflammation of the lining of the large intestine due to an overgrowth of a certain bacteria)
• severe liver disease

as Paracetamol + Codeine may not be suitable for you.

Do not breastfeed while you are being treated with this medicine.

Generally, do not give Paracetamol + Codeine to children below 12 years old. Additionally, do not give this medicine to children below 18 years old who have undergone surgery or removal of tonsils and/or adenoid glands (glands that help protect the body from bacteria and viruses), unless instructed to do so by the doctor.

Some genetic traits can affect this medicine's level in the blood. Individuals who have increased CYP2D6 activity, also known as ultrarapid metabolisers of CYP2D6 may experience enhanced effects from Paracetamol + Codeine, which also increases the risk of causing serious side effects. Although not routinely done, your doctor may advise you to undergo genetic testing to check if this medicine is best suited for you. If you know you have this gene type, alert your doctor.

Do not take Paracetamol + Codeine if you are currently taking or have taken medicine that is used to treat depression known as a monoamine oxidase inhibitor (MAOI) such as isocarboxazid, phenelzine and tranylcypromine in the last 14 days.

Inform your doctor if you have the following conditions:

• allergies to other similar painkillers e.g. hydrocodone, oxycodone
• lung disease e.g. chronic obstructive pulmonary disease (a long-term lung disease that causes airflow obstruction making it hard to breathe)
• heart disease e.g. heart attack
• hypovolaemia (low volume of circulating fluids in the body)
• low blood pressure
• delirium tremens or alcohol withdrawal delirium (severe tremors, hallucination, and disorientation caused by withdrawal from alcohol)
• mental illness e.g. mood disorder, depression, anxiety disorders
• history of drug abuse or alcoholism
• history of epilepsy (fits or seizures)
• myasthenia gravis (muscle weakness disorder)
• sleep apnoea (sleep disorder that causes interrupted breathing during sleep)
• Addison's disease (a rare disorder where the adrenal glands produce insufficient amounts of certain hormones)
• thyroid problem e.g. hypothyroidism (underactive thyroid gland)
• stomach or bowel disorder
• prostate enlargement
• G6PD deficiency (an inherited blood disorder where the body lacks a certain enzyme necessary for the proper functioning of red blood cells)
• kidney disease
• mild to moderate liver disease

Let your doctor know if you are pregnant.

Be sure to check with your doctor or pharmacist before giving Paracetamol + Codeine to a child, the elderly, obese or debilitated individual (a person who is physically or mentally weak, usually due to illness or old age). They may be more sensitive to the side effects.

Individuals who are intermediate or poor metabolisers of CYP2D6 may respond poorer to this medicine. Although not routinely done, your doctor may advise you to undergo genetic testing to check if this medicine is best suited for you. If you know you have these gene types, inform your doctor.

Avoid long-term use of any painkillers.

If you are going to have certain laboratory tests (e.g. blood tests for certain enzymes called amylase or lipase), inform your doctor that you are taking Paracetamol + Codeine.

Why is it important to keep my appointments with the doctor?

Keep your appointments with your doctor. Your doctor needs to monitor your condition and check your response to the medication regularly.

• Routine tests (e.g. lung or bowel function) may be done while you are being treated with this medicine. Your doctor will advise you about how often you need to have these tests.
• Your blood pressure may fall to unsafe levels without you noticing it. Monitor your blood pressure regularly during treatment.
• Regular monitoring of pain relief, mental status, and signs and symptoms of substance abuse, misuse or addiction may also be needed.

Paracetamol + Codeine may cause dizziness, drowsiness or blurred vision. If affected, do not drive or take part in any activity in which you need to be alert or need to see clearly.

This medicine may cause your blood pressure to fall suddenly when you get up from a sitting or lying down position and you may feel giddy. To minimise this problem, stand up slowly.

Other side effects include any of the following: nausea, vomiting, headache, abdominal pain, indigestion, dry mouth, itching and sweating.

Some side effects may need immediate medical help. Alert your doctor quickly if you experience any of the following:

• signs and symptoms of lung problem e.g. slow, shallow or trouble breathing
• signs and symptoms of allergic reaction e.g. rashes, breathlessness, swelling of the face, eyes, or mouth
• rashes with peeling of the skin or blistering of the lips, mouth or eyes accompanied by fever
• severe stomach pain or constipation
• fits or seizures
• new or worsening pain
• yellowing of the skin or eyes, dark coloured urine, tiredness, swelling in the legs and ankles

Inform your doctor if any of these side effects do not go away or are severe, or if you experience other side effects.

Do not take Paracetamol + Codeine if you are currently taking or have taken medicine that is used to treat depression known as monoamine oxidase inhibitor (MAOI) such as isocarboxazid, phenelzine, and tranylcypromine in the last 14 days.

Inform your doctor and pharmacist if you are taking any of these medicines:

• other medicines that cause drowsiness or affect your concentration
• medicines for HIV infection e.g. ritonavir
• medicines to treat fungal infection e.g. ketoconazole
• medicines for epilepsy (fits or seizures) e.g. carbamazepine, phenytoin, phenobarbital
• medicines for irregular heartbeat e.g. amiodarone, quinidine
• medicines for nausea or vomiting e.g. metoclopramide
• certain antibiotics e.g. erythromycin, flucloxacillin
• blood-thinning medicines e.g. warfarin
• rifampicin (medicine to treat TB, an infection known as tuberculosis)

This list does not include all medicines that may interact with Paracetamol + Codeine.

Always notify your doctor and pharmacist if you are taking any other medicines, including herbal tonics such as traditional Chinese medicines, supplements, and medicines that you buy without a prescription.

Avoid alcohol. Alcohol intake may worsen the dizziness and drowsiness caused by Paracetamol + Codeine.

Store in a cool, dry place away from the reach of children.

Protect from light.

Medicines must not be used past the expiry date.