No, you should not always take codeine with paracetamol. The combination is used for moderate pain not relieved by paracetamol alone, but it is not necessary for everyone and comes with specific risks and instructions.
It's safe to take codeine with paracetamol, ibuprofen or aspirin (aspirin is suitable for most people aged 16 and over). Some painkillers that you can buy without a prescription from pharmacies contain codeine. They include co-codamol, ibuprofen and codeine (such as Nurofen Plus) and Solpadeine.
Paracetamol plus codeine preparations produce a significant increase in analgesia compared with paracetamol alone. Thus, for occasional pain relief this combination therapy may be appropriate, though repeated use increases the occurrence of side-effects.
Codeine should only be taken as a 'top up' or 'rescue' painkiller if paracetamol is not sufficient to control your pain. Never take other medicines containing codeine or dihydrocodeine at the same time as the codeine tablets you have been instructed to take.
Skin rashes and hypersensitivity reactions occur occasionally. Overdosage with paracetamol if left untreated can result in severe, sometimes fatal liver damage and rarely, acute renal tubular necrosis. The most common adverse effects associated with codeine are nausea, vomiting, drowsiness, dizziness and constipation.
Mixing codeine with other drugs
Cautions with other medicines
Alternatives to Codeine
❌ NOT SAFE to combine:
If your kidney or liver function is impaired, your doctor may decide that codeine is not appropriate for you. There are other factors that may limit your use of codeine — for example, if you drink alcohol or take other medicines such as benzodiazepines that can cause drowsiness.
Codeine use can be harmful
Tolerance occurs when codeine becomes less effective and so the body needs higher and higher doses to feel the same relief from your symptoms. Severe withdrawal symptoms can result when the medicine is stopped; these include head and muscle aches, mood swings, insomnia, nausea and diarrhoea.
Side effects of codeine
Paracetamol/Codeine GH 500/30 may cause dizziness, light-headedness, drowsiness and problems with vision in some people, especially after the first dose. Children should not ride bikes if affected and should be supervised to avoid potential harm. Do not drink alcohol while taking Paracetamol/Codeine GH 500/30.
How long to take codeine for. If you buy codeine without a prescription, do not take this medicine for more than 3 days. Talk to your GP if your pain or cough does not improve after 3 days. If you are taking codeine on prescription, you may only take the medicine for a few days or weeks.
Codeine is addictive as it can produce a feeling of pleasure and a relaxing 'high', a rewarding stimulus which addicted individuals are compelled to replicate. Codeine is also physically addictive – long-term users often feel the need to take codeine to avoid withdrawal symptoms.
Co-codamol takes up to 1 hour to work. It keeps on working for about 5 hours. The most common side effects of co-codamol are constipation, feeling sick (nausea) or feeling sleepy.
It's safe to take paracetamol with other types of painkiller that do not contain paracetamol, such as ibuprofen, aspirin or codeine.
The seven most dangerous drug combinations include the following:
Who may not be able to take paracetamol
Drinking alcohol while you're on codeine may make you feel more sleepy, and can increase the risk of serious side effects. It's best to stop drinking alcohol during the first few days of treatment until you see how codeine affects you. If you feel sleepy with codeine, stop drinking alcohol while you're taking it.
Codeine is a painkiller that is part of a group of medicines called opiates. It's used to treat pain, for example, after an operation or an injury. It's also used for ongoing pain when painkillers such as paracetamol, ibuprofen and aspirin have not worked. Codeine is also used to treat diarrhoea.
Other studies, too, found that morphine, midazolam and haloperidol were the most prescribed drugs in the palliative setting [30–33]. These drugs are given to relieve symptoms such as pain, restlessness and agitation, which are frequently seen in advanced cancer [2].
The usual dose is 500mg (two tablets) twice a day. Opioids are stronger painkillers than paracetamol and may be given when paracetamol alone hasn't provided satisfactory pain relief. These include dihydrocodeine, tramadol and co-codamol. Like most medicines, opioids can have some unwanted effects.
Here are other basic tips to follow when taking paracetamol:
Adults can usually take 1 or 2 tablets (500mg) every 4 to 6 hours. They shouldn't take more than 4g (8x 500mg tablets) in the space of 24 hours. Always read the instructions that come with your medicine because dosage and strength of the tablet can vary. Paracetamol should start to work within an hour.