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Co-dydramol (dihydrocodeine and paracetamol) tablets


Oral formulations of paracetamol and dihydrocodeine.

Drugs List

  • co-dydramol (dihydrocodeine and paracetamol) 10mg+500mg tablets
  • co-dydramol (dihydrocodeine and paracetamol) 20mg+500mg tablets
  • co-dydramol (dihydrocodeine and paracetamol) 30mg+500mg tablets
  • co-dydramol (dihydrocodeine and paracetamol) 7.46mg+500mg tablets
  • PARAMOL 7.46mg+500mg tablets
  • REMEDEINE 20mg+500mg tablets
  • REMEDEINE FORTE 30mg+500mg tablets
  • Therapeutic Indications


    Pain - mild to moderate
    Pain - severe


    The duration of treatment should not exceed 3 days without medical review.


    One or two tablets every 4 to 6 hours when required.

    Maximum dose of 8 tablets in 24 hours.


    Dosage should be reduced in the elderly; some manufacturers recommend one tablet every 4 to 6 hours when required. Increase dose with caution, depending on tolerability, to two tablets every 4 to 6 hours when required.

    Maximum dose of 8 tablets in 24 hours.


    Children aged 16-18 years
    One or two tablets every 4 to 6 hours when required.
    Maximum dose of 8 tablets in 24 hours.

    Children aged 12-15 years
    One tablet every 4 to 6 hours when required.
    Maximum dose of 8 tablets in 24 hours.

    Children aged under 12 years
    Not recommended in this age group.

    Patients with Renal Impairment

    Consider dose reduction in renal impairment.

    Patients with Hepatic Impairment

    Consider dose reduction in mild to moderate hepatic impairment.

    Contraindicated in severe hepatic impairment.


    Acute alcohol intoxication
    Children under 12 years
    Risk of paralytic ileus
    Acute asthma
    Acute diarrhoea
    Acute respiratory depression
    Chronic obstructive pulmonary disease
    Head trauma
    Raised intracranial pressure
    Severe hepatic impairment

    Precautions and Warnings

    Allergic disposition
    Suicidal ideation
    Within 2 weeks of discontinuing MAOIs
    Addison's disease
    Benign prostatic hyperplasia
    Biliary tract disorder
    Cardiac failure secondary to pulmonary disorder
    Circulatory failure
    Drug addiction
    Drug misuse
    During or immediately prior to labour
    Gall bladder disorder
    Inflammatory bowel disease
    Mild hepatic impairment
    Myasthenia gravis
    Non-cirrhotic alcoholic liver disease
    Recent gastrointestinal surgery
    Recent surgery of the urinary tract
    Renal impairment
    Respiratory impairment
    Urethral stricture

    Reduce dose in hypothyroidism
    Advise patient ability to drive or operate machinery may be impaired
    Advise patient not to drive until they know how the medicine affects them
    Advise patient this medicine may be subject to driving restrictions
    Not all available strengths are licensed for all indications
    Can cause addiction
    Prolonged or excessive use may result in dependence
    Advise patient to report overdose immediately, even if patient feels well
    Excessive use may increase frequency of headache, may require withdrawal
    Overdosage causes liver damage
    Prolonged use and excessive doses may cause hepatic necrosis
    May affect results of some laboratory tests
    Avoid abrupt withdrawal
    Reduce dose in debilitated patients
    Reduce dose in elderly
    For three days use only
    Advise patient not to take paracetamol during treatment
    Advise patient that the effects of alcohol may be potentiated
    Advise patient to avoid alcohol during treatment
    Advise that alcohol increases the chances of liver damage with paracetamol
    Advise patient to consult a doctor if symptoms persist despite treatment
    Consult doctor if symptoms persist or treatment is required for > 3 days
    Patients should not exceed recommended dose

    Consider dose reduction in hypothyroidism and adrenocortical insufficiency (e.g Addison's disease).

    Patients should be advised not to exceed the recommended dose and not to take other paracetamol containing products concurrently. Immediate medical attention should be sought in the event of an overdose, even if the patient feels well, because of the risk of delayed, serious liver damage.

    Continued use should be assessed regularly by a medical professional, with consideration of the risks and benefits.

    Pregnancy and Lactation


    Use co-dydramol with caution during pregnancy.

    The risks and benefits should be considered before administering co-dydramol to a pregnant woman because opioid analgesics cross the placenta. Animal studies have shown opioids to cause delayed ossification in mice and increased resorption in rats.

    During labour, opioids enter the foetal circulation, posing a risk of opiate-typical withdrawal and respiratory depression in the neonate at birth. Gastric stasis and inhalation pneumonia in the mother during labour has also been reported. Administration of co-dydramol should be avoided during the late stages of labour and during delivery of a premature infant.

    The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( ) or if this is unavailable at the backup site ( ).


    At normal therapeutic doses, co-dydramol is likely to be present in breast milk at very low doses and is unlikely to adversely affect the nursing infant.

    However, other sources suggest neonates may be sensitive to even small doses of narcotic analgesics. Co-dydramol should therefore be avoided during breast-feeding unless the potential benefits outweigh the potential risks.

    Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
    Specialist advice is available from the UK Drugs in Lactation Advisory Service at

    Effects on Ability to Drive and Operate Machinery

    This class of medicine is in the list of drugs included in regulations under 5a of the Road Traffic Act 1988 (England and Wales).
    When prescribing this medicine: Advise patient the medicine can affect cognitive function and is likely to affect ability to drive. Advise patient not to drive until they know how the medicine affects them.

    Side Effects

    Abdominal pain
    Allergic reaction
    Anti-diuretic effect
    Biliary spasm
    Blood dyscrasias
    Blurred vision
    Breathing difficulties
    Decreased appetite
    Double vision
    Drug fever
    Dry mouth
    Erectile dysfunction
    Facial flushing
    Gastric irritation
    Haemolytic anaemia
    Hepatic impairment
    Hepatic necrosis
    Hypersensitivity reactions
    Increased sweating
    Mental status changes
    Micturition disorders
    Mood changes
    Mucosal lesions
    Muscle rigidity
    Papillary necrosis
    Paralytic ileus
    Raised intracranial pressure
    Reduced libido
    Respiratory depression
    Sexual dysfunction
    Sleep disturbances
    Thrombocytopenic purpura
    Toxic megacolon
    Ureteric spasm
    Urinary retention
    Visual disturbances

    Effects on Laboratory Tests

    Opioids may interfere with gastric emptying studies as they delay gastric emptying. Hepatobiliary imaging using technetium Tc 99m disofenin may also be affected as opioid treatment may cause constriction of the sphincter of Oddi and increase biliary tract pressure.


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: November 2017

    Reference Sources

    Summary of Product Characteristics: Co-dydramol tablets. Actavis UK Ltd. Revised May 2017

    Summary of Product Characteristics: Eroset 10mg/500mg Tablets. M & A Pharmachem Limited. Revised October 2017.

    Summary of Product Characteristics: Co-dydramol tablets. Wockhardt UK Ltd. Revised January 2017

    Summary of Product Characteristics: Co-dydramol tablets. Zentiva. Revised March 2017

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G. and Freeman, R., Wolters Kluwer Health, Philadelphia.

    NICE Evidence Services Available at: Last accessed: 06 November 2017

    US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed). Record 330 - Acetaminophen
    Available at:
    Last revised: 11 April 2017
    Last accessed: 07 November 2017

    US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed). Record 1123 - Dihydrocodeine
    Last revised: 04 September 2014
    Last accessed: 07 November 2017

    MHRA Drug Safety Update: Volume 3, Issue 2, September 2009. Over-the-counter painkillers containing codeine or dihydrocodeine.
    Last accessed: 07 November, 2017

    MHRA 2nd September 2009. Updated advice on non-prescription medicines containing codeine or dihydrocodeine (DHC).
    Last accessed: 07 November, 2017

    MHRA 19th September 2005
    Last accessed: 13 November 2017

    MHRA 10th September 2012
    Last accessed: 13 November 2017 Government departments. Department for Transport. Publications. Drug driving and medicine: advice for healthcare professionals. Drug driving: Guidance for healthcare professionals on drug driving. Available at: Last accessed: 07 November 2017 New drug driving offence implications for medicines packaging. Medicines Regulatory News. 10 December 2013. Available at: Last accessed: 07 November 2017

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