Aspirin, codeine (Codis 500)

How does it work?

Codis 500 soluble tablets contain two active ingredients, aspirin and codeine phosphate. This combination of medicines is sometimes known as co-codaprin. Co-codaprin tablets are also available without a brand name, ie as the generic medicine.

Aspirin belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs). It works by blocking the action of a substance in the body called cyclo-oxygenase. Cyclo-oxygenase is involved in the production of various chemicals in the body, some of which are known as prostaglandins. Prostaglandins are produced in response to injury or certain diseases and cause pain, swelling and inflammation. By blocking the action of cyclo-oxygenase, aspirin reduces the production of prostaglandins and can therefore be used to relieve pain and inflammation.

Codeine is a slightly stronger painkiller known as an opioid. Opioid painkillers work by mimicking the action of naturally occurring pain-reducing chemicals called endorphins. Endorphins are found in the brain and spinal cord and reduce pain by combining with opioid receptors.

Codeine mimicks the action of natural endorphins by combining with the opioid receptors in the brain and spinal cord. This blocks the transmission of pain signals sent by the nerves to the brain. Therefore, even though the cause of the pain may remain, less pain is actually felt.

Codis 500 soluble tablets contain 8mg of codeine, which in combination with the aspirin, is effective at relieving mild to moderate pain.

What is it used for?

  • Short-term (up to three days) relief of acute mild to moderate pain, including headaches, migraine, non-serious arthritic and rheumatic pain, soft tissue injuries such as sprains and strains, tendonitis, backache, nerve pain (neuralgia), toothache and period pain. Codis 500 should only be used if the pain has not been relieved by paracetamol, ibuprofen or aspirin alone.

How do I take it?

  • Codis 500 tablets should preferably be taken either with or after food. The tablets should be dissolved in a glass of water before taking.
  • Adults aged 18 years and over can take one or two Codis 500 tablets every four hours as needed to relieve pain. However, do not take more than eight tablets in 24 hours.
  • Adolescents aged 16 to 18 years can take one or two Codis 500 tablets every six hours as needed to relieve pain. Do not take more than eight tablets in 24 hours.
  • Do not take more than the recommended dose.
  • Do not take this medicine for longer than three days without consulting your doctor. Taking codeine regularly for more than three days can lead to addiction to the medicine and withdrawal symptoms when you stop taking it.
  • Consult your doctor if your symptoms persist despite taking this medicine.

Warning!

  • The information in this factsheet may differ from that found in the leaflet that is provided with the medicine. This is because this factsheet has been updated with the latest advice (released 28 June 2013) from the medicines watchdog, the MHRA, regarding the use of codeine in children. It follows a European safety review of the use of codeine in children. The product information leaflets for medicines affected by the advice will be updated in due course, but in the meantime if you are confused about any of our information, or want further advice, then you should talk to your pharmacist.
  • Codeine can cause drowsiness, although at the dose contained in this medicine this is very unlikely. However, if you do find this medicine makes you feel sleepy or dizzy you should not drive or operate machinery and avoid drinking alcohol.
  • Do not take this medicine for longer than three days without consulting your doctor. If this medicine is taken regularly for long periods of time, the body can become tolerant to it and it may become less effective at relieving pain. With prolonged use, the body may also become dependent on the codeine. As a result, when you then stop taking the medicine you may get withdrawal symptoms such as restlessness and irritability.
  • If you need to use this medicine for longer than three days you should consult your doctor or pharmacist for advice.
  • Taking a painkiller for headaches too often or for too long can actually make the headaches worse.
  • People can vary considerably in the way that their body metabolises codeine. For some people this may lead to an increased chance of getting side effects, such as reduced levels of consciousness; sleepiness; slow, shallow breathing; ‘pin-point’ pupils; lack of appetite; constipation; or nausea and vomiting. If you experience any of these you should stop using this medicine and get medical advice straight away. For other people it may mean that the codeine is less effective, so if you find this medicine doesn't relieve your symptoms well enough you should consult your doctor or pharmacist.
  • Children under 16 years of age should not take this medicine, unless on the advice of a doctor. This is because aspirin use in children has been associated with a rare condition called Reye's syndrome. This condition affects the brain and liver and though extremely rare, can be fatal. The causes of Reye's syndrome are not fully understood, but use of aspirin to treat fever in children with a virus has been implicated. There are many paracetamol and ibuprofen products not associated with Reye's syndrome available to treat pain and fever in this age group. For more advice talk to your pharmacist.

Use with caution in

  • Elderly people.
  • Decreased liver function.
  • Decreased kidney function.
  • Dehydration.
  • People with reduced lung function, eg due to asthma.
  • People with a history of allergies.
  • People who have a lack of an enzyme called G6PD in the blood (G6PD deficiency).
  • People with biliary tract disorders, eg gallstones or recent surgery on the biliary tract.
  • People with acute abdominal conditions such as appendicitis.
  • People who have recently had surgery on the stomach, intestines or urinary tract.
  • People with constipation or potential for blockage in the gut.
  • People with inflammatory bowel disorders such as Crohn's disease or ulcerative colitis.
  • People who have difficulty passing urine, for example men with an enlarged prostate gland (prostatic hypertrophy).
  • People with an underactive thyroid gland (hypothyroidism).
  • People with underactive adrenal glands, eg Addison's disease.
  • People with low blood pressure (hypotension) or shock.
  • A condition involving abnormal muscle weakness called myasthenia gravis.
  • People with a history of convulsions or fits, eg epilepsy.
  • People with an irregular heartbeat (arrhythmia).
  • People with a history of drug abuse or dependence.

Not to be used in

  • Children under 12 years of age.
  • Children aged 12 to 16 years of age, unless on the advice of a doctor (see warning above).
  • Relieving pain in children and adolescents under 18 years of age who have had surgery to remove their tonsils or adenoids (tonsillectomy or adenoidectomy or both) for obstructive sleep apnoea.
  • Codeine is not recommended for adolescents aged 12 to 18 years whose breathing might be compromised, including those with neuromuscular disorders; severe heart or lung conditions; upper airway or lung infections; multiple trauma; or who have had extensive surgical procedures.
  • People who are known to have a genetic variation of a liver enzyme called CYP2D6, which metabolises codeine into morphine (CYP2D6 ultra-rapid metabolisers). These people are more likely to experience side effects after taking codeine, because they convert more codeine into morphine than other people. See the warning section above.
  • People with very slow, shallow breathing (respiratory depression).
  • Chronic obstructive pulmonary disease (COPD).
  • People having an asthma attack.
  • People with raised pressure inside the skull (intracranial pressure).
  • People with a head injury.
  • People in whom aspirin or other NSAIDs, eg ibuprofen, cause allergic reactions such as asthma attacks, itchy rash (urticaria), nasal inflammation (rhinitis) or swelling of the lips, tongue and throat (angioedema).
  • Bleeding disorders such as haemophilia.
  • People with an active peptic ulcer or a history of this.
  • People with or at risk of paralysis or inactivity in the intestines that prevents material moving through the gut (paralytic ileus).
  • Severe heart failure.
  • Liver failure.
  • Severe kidney failure.
  • Treatment of gout.
  • Third trimester of pregnancy.
  • Breastfeeding.

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.

If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

  • This medicine should not be taken in the third trimester of pregnancy. If aspirin is used in the third trimester it may delay labour, increase the length of labour, increase the risk of bleeding in the mother and baby and cause complications in the newborn baby. If codeine is used regularly in the third trimester it may cause withdrawal symptoms in the baby after birth. If used during labour it may cause breathing difficulties in the baby after birth. Seek medical advice from your doctor before using this medicine during any stage of pregnancy.
  • Significant amounts of this medicine may pass into breast milk. It should not be used by breastfeeding mothers as it may be harmful to the nursing infant. Seek further medical advice from your doctor.

Label warnings

  • Take this medication with or after food.
  • Dissolve or mix with water before taking.
  • This medication contains aspirin.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.

  • Constipation.
  • Nausea and vomiting.
  • Indigestion or abdominal pain.
  • Dry mouth.
  • Dizziness.
  • Sweating.
  • Itching.
  • Skin rash.
  • Difficulty passing urine.
  • Codeine can cause drowsiness, although at the dose contained in this medicine this is very unlikely. However, if you do find this medicine makes you feel sleepy or dizzy you should not drive or operate machinery and avoid alcoholic drink.
  • Dependence on the medicine if used regularly or for long periods of time (see warning section above).
  • Allergic reactions such as skin rash, swelling of the lips, tongue and throat (angioedema) or narrowing of the airways (bronchospasm).
  • Increased time taken to stop bleeding.
  • Ulceration or bleeding in the stomach or intestines. If you experience any sign of bleeding from the stomach or bowels after taking this medicine, such as vomiting blood and/or passing black/tarry/bloodstained stools, you should stop taking this medicine and consult your doctor immediately.

The side effects listed above may not include all of the side effects reported by the medicine's manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you take this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to make sure that the combination is safe.

There is an increased risk of side effects if aspirin is taken with other non-steroidal anti-inflammatory drugs (NSAIDs), eg ibuprofen, diclofenac, naproxen. For this reason, aspirin should not be taken with any other NSAID.

People taking anticoagulant medicines used to prevent the blood clotting, eg warfarin, should not take aspirin to relieve pain or inflammation. This is because aspirin can irritate the stomach lining, as well as increasing the effects of warfarin, both of which increase the likelihood of bleeding.

There may also be an increased risk of bleeding if aspirin is taken with the following medicines:

  • 'blood-thinning' (antiplatelet) medicines such as clopidogrel or dipyridamole
  • heparin
  • iloprost
  • SSRI antidepressants such as fluoxetine, paroxetine, citalopram
  • venlafaxine.

There may be an increased risk of bleeding or ulceration in the stomach or intestines if aspirin is taken with corticosteroids, eg prednisolone, dexamethasone.

Aspirin reduces the rate at which the body can remove the medicine methotrexate. The two should not usually be used together.

Aspirin opposes the effect of sulfinpyrazone and probenecid.

There may be an increased risk of side effects if aspirin is taken with acetazolamide.

Codeine should not be used by people who are currently taking a monoamine oxidase inhibitor (MAOI) or who have taken one of these medicines in the last 14 days. MAOIs include the antidepressants phenelzine, tranylcypromine, isocarboxazid and moclobemide and the anti-Parkinson's medicine selegiline.

The dose of codeine in this medicine is unlikely to cause drowsiness, but this is more likely if the medicine is taken in combination with any of the following, which can also cause drowsiness:

  • alcohol
  • antipsychotics, eg haloperidol, chlorpromazine
  • benzodiazepines, eg temazepam, diazepam
  • sedating antihistamines, eg chlorphenamine, promethazine, triprolidine, hydroxyzine (some of these may be found in non-prescription cough and cold or hayfever remedies)
  • sleeping tablets, eg zopiclone
  • other strong opioid painkillers, eg dihydrocodeine, morphine, tramadol
  • tricyclic antidepressants, eg amitriptyline.

Codeine phosphate can reduce the muscular activity in the gut and so may oppose the effect of the following medicines on the gut:

  • domperidone
  • metoclopramide.

There may be an increased risk of side effects such as constipation, dry mouth and blurred vision if codeine is taken with antimuscarinic medicines that can cause these type of side effects, such as the following:

  • antimuscarinic medicines for Parkinson's symptoms, eg procyclidine, orphenadrine, trihexiphenidyl
  • antimuscarinic medicines for urinary incontinence, eg oxybutynin, flavoxate, tolterodine, propiverine, trospium
  • antispasmodics, eg atropine, hyoscine.

There is a risk of severe constipation if codeine is used with antimotility medicines for diarrhoea, such as loperamide.

Quinidine reduces the painkilling effect of codeine.

Rifampicin and ritonavir may also reduce the effects of codeine.

Other medicines containing the same active ingredients

  • Co-codaprin.