CO-CODAMOL 8/500 MG TABLETS - patient leaflet, side effects, dosage

5 how to store co-codamol tablets

Keep this medicine out of the sight and reach of children.

Store below 25°C in a dry place, protected from light.

Do not take this medicine after the expiry date which is stated on the label/carton/bot­tle.

The expiry date refers to the last day of that month.

Do not throw away any medicine via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer require. These measures will help protect the environment.

^Contents of the pack and other information

What Co-codamol tablets contain

• The active substances (the ingredients that makes the tablets work) are 8mg of codeine phosphate and 500mg paracetamol.
• The other ingredients are colloidal anhydrous silica, maize starch, stearic acid.

What Co-codamol tablets look like and contents of the pack

Co-codamol are white, circular, flat bevelled-edge uncoated tablets impressed ‘C’ and the identifying letters ‘CH’ on either side of a central division line on one face. Pack sizes are 100.

Marketing Authorisation Holder

Accord Healthcare Limited, Sage House, 319 Pinner Road, North Harrow, Middlesex, HA1 4HF, United Kingdom

Manufacturer

Accord, Barnstaple, EX32 8NS, UK.

This leaflet was last revised in June 2021

This medicine contains codeine phosphate which is an opioid, which can cause addiction. You can get withdrawal symptoms if you stop taking it suddenly.

Read all of this leaflet carefully before you start taking this medicine because it contains important information for you.

• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor or pharmacist.
• This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
• If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4.

What is in this leaflet

1 What Co-codamol tablets are and what they are used for

2|What you need to know before you take Co-codamol tablets

3. How to take Co-codamol tablets

± Possible side effects

5. How to store Co-codamol tablets

6 Contents of the pack and other information

1 What Co-codamol tablets are and what they are used for

This medicine has been prescribed for you for the short-term relief of moderate pain that is not relieved by other painkillers such as paracetamol or ibuprofen alone. This medicine can be used to reduce body temperature. Co-codamol can be used in adults and children over 12 years of age.

It contains the codeine which belongs to a class of medicines called opioids, which are ‘pain relievers’.

This medicine has been prescribed for you and should not be given to anyone else. Opioids can cause addiction and you may get withdrawal symptoms if you stop taking it suddenly. Your doctor or pharmacist should have explained how long you will be taking it for, when it is appropriate to stop and how to do this safely.

Continued top of next column

2|What you need to know before you take Co-codamol tablets

Do not take Co-codamol tablets:

• if you are allergic to paracetamol, codeine phosphate or other opioids, or any of the other ingredients of this medicine (listed in section 6)
• if you are a child under 12 years of age
• if you have diarrhoea caused by

poisoning or severe bloody diarrhoea (pseudomembranous colitis)

• if you have difficulty breathing or other chronic lung disease
• if you are having an asthma attack
• for pain relief in children and adolescents (0

• 18 years of age) after removal of their tonsils or adenoids due to obstructive sleep apnoea syndrome

• if you know that you metabolise codeine very rapidly into morphine
• if you are breast-feeding.

Warnings and precautions

Talk to your doctor before taking this medicine if you:

• are or have ever been addicted to opioids, alcohol, prescription medicines, or illegal drugs.
• have previously suffered from withdrawal symptoms such as agitation, anxiety, shaking or sweating, when you have stopped taking alcohol or drugs.
• feel you need to use more of Co-codamol tablets to get the same level of pain relief as this may mean you are becoming tolerant to the effects of this medicine or are becoming addicted to it. Speak to your doctor who will discuss your treatment and may change your dose or switch you to an alternative pain reliever.

Taking this medicine regularly, particularly for a long time, can lead to addiction. Your doctor should have explained how long you will be taking it for, when it is appropriate to stop and how to do this safely. Rarely, increasing the dose of this medicine can make you more sensitive to pain. If this happens, you need to speak to your doctor about your treatment. Addiction can cause withdrawal symptoms when you stop taking this medicine. Withdrawal symptoms can include restlessness, difficulty sleeping, irritability, agitation, anxiety, feeling your heartbeat (palpitations), increased blood pressure, feeling or being sick, diarrhoea, loss of appetite, shaking, shivering or sweating. Your doctor will discuss with you how to gradually

Continued over page reduce your dose before stopping the medicine. It is important that you do not stop taking the medicine suddenly as you will be more likely to experience withdrawal symptoms. Opioids should only be used by those they are prescribed for. Do not give your medicine to anyone else. Taking higher doses or more frequent doses of opioid, may increase the risk of addiction. Overuse and misuse can lead to overdose and/ or death.

Also talk to your doctor or pharmacist before taking Co-codamol tablets if you have:

• liver or kidney problems
• diseased adrenal glands (Addison’s disease) or high blood pressure caused by a tumour near a kidney (phaeochromocytoma)
• inflammatory bowel disease
• gall bladder disease or gall stones
• recently had surgery on your gastro-intestinal tract or urinary system
• an enlarged prostate gland and have difficulty urinating and are male
• epilepsy or suffered head injury or raised pressure in the skull (may cause painful eyes, changes in vision or headache behind the eyes)
• an underactive thyroid gland
• muscle weakness (myasthenia gravis)
• low blood pressure or are in shock

Do not take for longer than your doctor tells you to

• Taking codeine regularly for a long time can lead to addiction
• Taking a painkiller for headaches too often or for too long can make them worse
• Codeine is transformed to morphine in the liver by an enzyme. Morphine is the substance that produces pain relief. Some people have a variation of this enzyme and this can affect people in different ways. In some people, morphine is not produced or produced in very small quantities, and it will not provide enough pain relief. Other people are more likely to get serious side effects because a very high amount of morphine is produced. If you notice any of the following side effects, you must stop taking this medicine and seek immediate medical advice: slow or shallow breathing, confusion, sleepiness, small pupils, feeling or being sick, constipation, lack of appetite.

This medicine contains paracetamol. Do not take anything else containing paracetamol while taking this medicine.

Children and adolescents

Use in children and adolescents after surgery Co-codamol should not be used for pain relief in children and adolescents after removal of their tonsils or adenoids due to Obstructive Sleep Apnoea Syndrome.

Use in children with breathing problems Co-codamol is not recommended in children with breathing problems, since the symptoms of morphine toxicity may be worse in these children.

Other medicines and Co-codamol tablets Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines.

• ciprofloxacin (antibacterial medicine)
• Monoamine Oxidase Inhibitors (MAOIs, e.g. moclobemide)
• oral contraceptives (the “pill”)
• medicines to prevent blood clotting such as warfarin
• cyclizine, metoclopramide or domperidone (to prevent sickness)
• guanethidine or diuretics (“water tablets”) e.g. spironolactone, furosemide (to treat high blood pressure)
• mexiletine (to treat irregular heartbeats)
• loperamide or kaolin (to treat diarrhoea)
• selegiline (for Parkinson’s di­sease)
• phenytoin (to treat epilepsy)
• cimetidine (to treat stomach ulcers)
• atropine or hyoscine (anticholinergic medicines)
• cisapride (to treat gastro-oesophageal reflux disease)
• medicines which affect the nervous system such as sleeping tablets, diazepam, hydroxyzine and medicines to treat mental illness
• medicines to treat depression (e.g. tranylcypromine, amitriptyline)
• medicines which affect the liver (e.g. primidone and rifampicin)
• colestyramine (to treat high cholesterol levels)
• muscle relaxants
• barbiturates (e.g. phenobarbital)
• anaesthetics
• opioid antagonists (buprenorphine, naltrexone, naloxone)
• concomitant use of Co-codamol tablets and sedative medicines such as benzodiazepines or related drugs increases the risk of drowsiness, difficulties in breathing (respiratory depression), coma and may be life-threatening. Because of this, concomitant use should only be considered when other treatment options are not possible. However if your doctor does prescribe Co-codamol tablets together with sedative medicines the dose and duration of concomitant treatment should be limited by your doctor. Please tell your doctor about all sedative medicines you are taking, and follow your doctor’s dose recommendation closely. It could be helpful to inform friends or relatives to be aware of the signs and symptoms stated above. Contact your doctor when experiencing such symptoms.

Co-codamol with food and alcohol

If your diet is poor or you have a low protein intake, you may be at a higher risk of serious paracetamol poisoning when taking Co-codamol tablets.

Drinking alcohol whilst taking Co-codamol tablets may result in drowsiness, difficulties in breathing, coma and may be life-threatening. It is recommended not to take alcohol while you are taking Co-codamol tablets.

Pregnancy and breast-feeding Pregnancy

Do not take Co-codamol tablets if you are pregnant or think you might be pregnant unless you have discussed this with your doctor and the benefits of treatment are considered to outweigh the potential harm to the baby. If you take Co-codamol tablets during pregnancy, your baby may become dependent and experience withdrawal symptoms after the birth which may need to be treated.

Breast-feeding

Do not take Co-codamol tablets while you are breast-feeding as codeine and morphine pass into breast milk and will affect your baby.

Driving and using machines

Co-codamol tablets may cause dizziness, blurred vision or the inability to think clearly.

Make sure you are not affected before you drive or operate machinery. The medicine can affect your ability to drive as it may make you sleepy or dizzy.

• Do not drive while taking this medicine until you know how it affects you.
• It is an offence to drive if this medicine affects your ability to drive.
• However, you would not be committing an offence if:

• – The medicine has been prescribed to treat a medical or dental problem and

• – You have taken it according to the instructions given by the prescriber or in the information provided with the medicine and

• – It was not affecting your ability to drive safely Talk to your doctor or pharmacist if you are not sure whether it is safe for you to drive while taking this medicine.

3 how to take co-codamol tablets always take this medicine exactly as your doctor has told you. check with your doctor or pharmacist if you are not sure. your doctor should have discussed with you how long the course of tablets will last. they will arrange a plan for stopping treatment. this will outline how to gradually reduce the dose and stop taking the medicine.

Swallow the tablets with water.

Take this medicine for as long as your doctor tells you to, as it may be dangerous to stop without their advice.

The recommended dose is

• Adults and children 16 to 18 years: 1 to 2 tablets every 6 hours, as needed. Do not take more than 8 tablets in 24 hours
• Children 12 to 15 years: 1 tablet every 6 hours as needed. Do not give your child more than 4 tablets in 24 hours
• Children under 12 years: should not be taken due to the risk of severe breathing problems
• Elderly: Dosage is usually reduced in the elderly with liver damage.

If you take more Co-codamol tablets than you should

Talk to your doctor at once if you take too much of this medicine, even if you feel well. This is because too much paracetamol can cause delayed, serious liver damage.

If you (or someone else) swallow a lot of tablets at the same time, or you think a child may have swallowed any, contact your nearest hospital casualty department or tell your doctor immediately. Symptoms of an overdose include feeling or being sick, loss of appetite, stomach pain or liver damage, coma, pale or clammy skin, fits, confusion, drowsiness, tiredness, low blood pressure, pinpoint pupils, slow heartbeat or breathing rate.

If you forget to take Co-codamol tablets

Do not take a double dose to make up for a forgotten dose. If you forget to take a dose, take it as soon as you remember it and then take the next dose at the right time.

If you stop taking Co-codamol tablets

Do not suddenly stop taking this medicine. If you want to stop taking this medicine, discuss this with your doctor first. They will tell you how to do this, usually by reducing the dose gradually so that any unpleasant withdrawal effects are kept to a minimum. Withdrawal symptoms such as restlessness, difficulty sleeping, irritability, agitation, anxiety, feeling your heartbeat (palpitations), increased blood pressure, feeling or being sick, diarrhoea, shaking, shivering or sweating may occur if you suddenly stop taking this medicine.

Contact your doctor for advice on how to stop taking Co-Codamol tablets gradually to avoid withdrawal symptoms.

If you have any further questions on the use of this medicine, ask your doctor or pharmacist.

4 possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

• Stop taking co-codamol and see a doctor or go to a hospital straight away if you have: Very rare (may affect up to 1 in 10,000 people): a severe skin reaction, such as reddening of the skin with blisters or peeling and may be associated with a high fever and joint pain. There may also be severe blisters and bleeding in the lips, eyes, mouth, nose and genitals (Stevens-Johnson syndrome or toxic epidermal necrolysis), or if you experience a red, scaly rash with bumps under the skin and blisters (acute generalised exanthematous pustulosis or fixed drug eruption).

Not known (frequency cannot be estimated from the available data):

• swelling of the hands, feet, ankles, face, lips or throat which may cause difficulty in swallowing or breathing, increased sweating, redness or flushed face, mucosal lesions (such as mouth ulcers), drug fever. You could also notice an itchy, lumpy rash (hives) or nettle rash (urticaria). This may mean you are having an allergic reaction to co-codamol.