Use of OTC codeine and reassurance to customers
USE OF OTC CODEINE AND REASSURANCE
TO CUSTOMERS
When other analgesics are not suitable or have not been effective, opioid combination therapy is your customer's last line of defence. (Always refer the customer to a GP if pain persists and/or prescription medicine is required.)
It's important to reassure customers. Although there is a risk of addiction or dependence with long-term opioid use and a risk of withdrawal symptoms, it is unlikely they will become addicted if they take the medicine according to the instructions on the pack. OTC products containing opioids are not to be used for more than 3 consecutive days. Taking OTC pain relief for more than 3 days can make headaches worse and cause addiction.
Advise customers about possible side effects:
- Constipation
- Nausea
- Dry mouth
- Dizziness
- Sweating
- Itching
- Skin rash
- Difficulty passing urine
- Drowsiness may affect skilled tasks
- Risk of addiction with long-term use
Red flags requiring referral to a GP3
- Severe pain that is not relieved by OTC pain medication
- Pain increasing in severity with no apparent reason
- If pain lasts longer than reasonably expected
2.Non-prescription Medicines 4th Edition, Alan Nathan, Pharmaceutical Press
3.CPPE Responding to Minor Ailments Published 2008. NHS Education for Scotland
4.https://www.migrainetrust.org/living-with-migraine/treatments/acute-medicines/
5.Medicines, Ethics and Practice Edition 43 July 2019
6.N Iqbal et al. The effect of caffeine on the pharmacokinetics of acetaminophen in man. Biopharm Drug Dispos 1995 Aug; 16(6):481-7
7.https://bnf.nice.org.uk/treatment-summary/analgesics.html
8.https://www.britishpainsociety.org/static/uploads/resources/files/patient_pub_otc.pdf
9.https://cks.nice.org.uk/analgesia-mild-to-moderate-pain
10.https://www.nhs.uk/conditions/tension-headaches/
11.https://www.nhs.uk/conditions/migraine/symptoms/
12.https://www.nhs.uk/conditions/headaches
13.https://www.nhs.uk/conditions/sprains-and-strains
14.https://www.nhs.uk/conditions/dental-abscess/
15.https://www.nhs.uk/conditions/tooth-decay
Online references last accessed October 2019
Solpadeine Headache Soluble Tablets (GSL) contain paracetamol and caffeine. For the treatment of headache including migraine, backache, toothache, colds and influenza, sore throat, rheumatic pain and dysmenorrhea. Adults and children over 16 years: 2 tablets dissolved in water every 4-6 hours as needed. Max 8 tablets in 24 hours. Children 12-15 years: 1 tablet dissolved in water every 4-6 hours as needed. Max 4 tablets in 24 hours. Not recommended for children under 12 years. Do not take with other paracetamol-containing products. In case of overdose, seek immediate medical advice, even if the patient feels well. Contraindications: known hypersensitivity to ingredients. Caution: Renal or hepatic impairment, non-cirrhotic alcoholic liver disease, pregnancy/lactation, intolerance to some sugars. Interactions: warfarin and other coumarins. May affect absorption of metoclopramide, domperidone and cholestyramine. Avoid excessive caffeine intake. Side effects: thrombocytopenia, agranulocystosis, anaphylaxis, hypersensitivity reactions, hepatic dysfunction. PL 02855/0079. MAH: Omega Pharma Ltd, 32 Vauxhall Bridge Road, London SW1V 2SA, UK. RRP (ex. VAT): 16s £2.89 SPC: https://www.medicines.org.uk/emc/medicine/21536
Solpadeine Max Soluble Tablets (P) contain paracetamol, codeine phosphate hemihydrate and caffeine. For the treatment of acute moderate pain which is not relieved by paracetamol or ibuprofen alone, including headache, migraine, dental pain, period pain, strains & sprains, backache, arthritic & rheumatic pain and sciatica. Adults: 2 tablets dissolved in water every 4-6 hours as needed. Max 8 tablets in 24 hours. Children 16-18 years: 1-2 tablets dissolved in water every 6 hours as needed. Max 8 tablets in 24 hours. Children 12-15 years: 1 tablet dissolved in water every 6 hours as needed. Max 4 tablets in 24 hours. Do not give to children under 12 years. Do not take for more than 3 days without consulting a doctor. Do not take any other paracetamol or codeine containing products concurrently. Can cause addiction. Use for 3 days only. In case of overdose, seek immediate medical advice, even if the patient feels well. Contraindications: Known hypersensitivity to ingredients, lactation, known CYP2D6 ultra-rapid metabolisers, patients 0-18 years who undergo tonsillectomy and/or adenoidectomy for obstructive sleep apnoea syndrome. Caution: Severe renal or hepatic impairment, non-cirrhotic alcoholic liver disease, obstructive bowel disorders, previous cholecystectomy, acute abdominal conditions, pregnancy, salt restricted diet. Interactions: warfarin or other coumarins, domperidone, metoclopramide, colestyramine, monoamine-oxidase inhibitors. Side effects: Thrombocytopenia, agranulocystosis, anaphylaxis, cutaneous hypersensitivity reactions, hepatic dysfunction, GI disturbance, dependency or worsening of headache following prolonged use. PL 02855/0078. MAH: Omega Pharma Ltd, 32 Vauxhall Bridge Road, London, SW1V 2SA. RRP (excl. VAT): 32s £8.09 SPC: https://www.medicines.org.uk/emc/medicine/21649
Solpadeine Max Tablets (P) contain paracetamol and codeine phosphate hemihydrate. For the treatment of acute moderate pain which is not relieved by paracetamol or ibuprofen alone, including migraine, headache, dental pain, period pain, backache, arthritic & rheumatic pain, strains & sprains and sciatica. Adults: 2 tablets every 4-6 hours as needed. Max 8 tablets in 24 hours. Children 16-18 years: 1-2 tablets every 6 hours as needed. Max 8 tablets in 24 hours. Children 12-15 years: 1 tablet every 6 hours as needed. Max 4 tablets in 24 hours. Do not give to children under 12 years. Do not take for more than 3 days without consulting a doctor. Do not take any other paracetamol or codeine containing products concurrently. Can cause addiction. Use for 3 days only. In case of overdose, seek immediate medical advice, even if the patient feels well. Contraindications: Known hypersensitivity to ingredients, lactation, rare hereditary intolerance to some sugars, known CYP2D6 ultra-rapid metabolisers, patients 0-18 years who undergo tonsillectomy and/or adenoidectomy for obstructive sleep apnoea syndrome. Caution: Severe renal or hepatic impairment, non-cirrhotic alcoholic liver disease, obstructive bowel disorders, previous cholecystectomy, acute abdominal conditions, pregnancy. Interactions: warfarin or other coumarins, domperidone, metoclopramide, colestyramine, monoamine-oxidase inhibitors. Side effects: Thrombocytopenia, agranulocystosis, anaphylaxis, cutaneous hypersensitivity reactions, hepatic dysfunction, GI disturbance, dependency or worsening of headache following prolonged use. PL 02855/0074. MAH: Omega Pharma Ltd, 32 Vauxhall Bridge Road, London, SW1V 2SA. RRP (excl. VAT): 20s £5.89, 30s £7.59 SPC: https://www.medicines.org.uk/emc/medicine/16071
Solpadeine Plus Capsules (P) contain paracetamol, codeine phosphate hemihydrate and caffeine. For the treatment of acute moderate pain which is not relieved by paracetamol or ibuprofen alone, including migraine, headache, backache, rheumatic pain, period pain, dental pain, strains & sprains, sciatica. Adults: 2 capsules every 4-6 hours as needed. Max 8 capsules in 24 hours. Children 16-18 years: 1-2 capsules every 6 hours as needed. Max 8 capsules in 24 hours. Children 12-15 years: 1 capsule every 6 hours as needed. Max 4 capsules in 24 hours. Do not give to children under 12 years. Do not take for more than 3 days without consulting a doctor. Do not take any other paracetamol or codeine containing products concurrently. Can cause addiction. Use for 3 days only. In case of overdose, seek immediate medical advice, even if the patient feels well. Contraindications: Known hypersensitivity to ingredients, lactation, rare hereditary intolerance to some sugars, known CYP2D6 ultra-rapid metabolisers, patients 0-18 years who undergo tonsillectomy and/or adenoidectomy for obstructive sleep apnoea syndrome. Caution: Severe renal or hepatic impairment, non-cirrhotic alcoholic liver disease, obstructive bowel disorders, previous cholecystectomy, acute abdominal conditions, pregnancy. Interactions: warfarin or other coumarins, domperidone, metoclopramide, colestyramine, monoamine-oxidase inhibitors. Avoid excessive caffeine intake. Side effects: Thrombocytopenia, agranulocystosis, anaphylaxis, cutaneous hypersensitivity reactions, hepatic dysfunction, GI disturbance, dependency or worsening of headache following prolonged use. PL 02855/0077. MAH: Omega Pharma Ltd, 32 Vauxhall Bridge Road, London, SW1V 2SA. RRP (excl. VAT): 32s £6.79 SPC: https://www.medicines.org.uk/emc/medicine/21537
Solpadeine Plus Soluble Tablets (P) contain paracetamol, codeine phosphate hemihydrate and caffeine. For the treatment of acute moderate pain which is not relieved by paracetamol or ibuprofen alone, including migraine, headache, backache, rheumatic pain, period pain, dental pain, strains & sprains, sciatica. Adults: 2 tablets dissolved in water every 4-6 hours as needed. Max 8 tablets in 24 hours. Children 16-18 years: 1-2 tablets dissolved in water every 6 hours as needed. Max 8 tablets in 24 hours. Children 12-15 years: 1 tablet dissolved in water every 6 hours as needed. Max 4 tablets in 24 hours. Do not give to children under 12 years. Do not take for more than 3 days without consulting a doctor. Do not take any other paracetamol or codeine containing products concurrently. Can cause addiction. Use for 3 days only. In case of overdose, seek immediate medical advice, even if the patient feels well. Contraindications: Known hypersensitivity to ingredients, lactation, rare hereditary intolerance to some sugars, known CYP2D6 ultra-rapid metabolisers, patients 0-18 years who undergo tonsillectomy and/or adenoidectomy for obstructive sleep apnoea syndrome. Caution: Severe renal or hepatic impairment, non-cirrhotic alcoholic liver disease, obstructive bowel disorders, previous cholecystectomy, acute abdominal conditions, pregnancy. Interactions: warfarin or other coumarins, domperidone, metoclopramide, colestyramine, monoamine-oxidase inhibitors. Avoid excessive caffeine intake. Side effects: Thrombocytopenia, agranulocystosis, anaphylaxis, cutaneous hypersensitivity reactions, hepatic dysfunction, GI disturbance, dependency or worsening of headache following prolonged use. PL 02855/0080. MAH: Omega Pharma Ltd, 32 Vauxhall Bridge Road, London, SW1V 2SA. RRP (excl. VAT): 16s £3.89, 32s £7.09 SPC: https://www.medicines.org.uk/emc/medicine/21538
Solpadeine Plus Tablets (P) contain paracetamol, codeine phosphate hemihydrate and caffeine. For the treatment of acute moderate pain which is not relieved by paracetamol or ibuprofen alone, including migraine, headache, backache, rheumatic pain, period pain, dental pain. Adults: 2 tablets every 4-6 hours as needed. Max 8 tablets in 24 hours. Children 16-18 years: 1-2 tablets every 6 hours as needed. Max 8 tablets in 24 hours. Children 12-15 years: 1 tablet every 6 hours as needed. Max 4 tablets in 24 hours. Do not give to children under 12 years. Do not take for more than 3 days without consulting a doctor. Do not take any other paracetamol or codeine containing products concurrently. Can cause addiction. Use for 3 days only. In case of overdose, seek immediate medical advice, even if the patient feels well. Contraindications: known hypersensitivity to ingredients, lactation, rare hereditary intolerance to some sugars, known CYP2D6 ultra-rapid metabolisers, patients 0-18 years who undergo tonsillectomy and/or adenoidectomy for obstructive sleep apnoea syndrome. Caution: Severe renal or hepatic impairment, non-cirrhotic alcoholic liver disease, obstructive bowel disorders, previous cholecystectomy, acute abdominal conditions, pregnancy. Interactions: warfarin or other coumarins, domperidone, metoclopramide, colestyramine, monoamine-oxidase inhibitors. Avoid excessive caffeine intake. Side effects: Thrombocytopenia, agranulocystosis, anaphylaxis, cutaneous hypersensitivity reactions, hepatic dysfunction, GI disturbance, dependency or worsening of headache following prolonged use. PL 02855/0075. MAH: Omega Pharma Ltd, 32 Vauxhall Bridge Road, London, SW1V 2SA. RRP (excl. VAT): 32s £6.59 SPC: https://www.medicines.org.uk/emc/medicine/21539