Weak opioid analgesics (Formulary)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

MHRA alert: Opioids: risk of dependence and addiction.  New recommendations following a review of the risks of dependence and addiction associated with prolonged use of opioid medicines (opioids) for non-cancer pain. Before prescribing opioids, discuss with the patient the risks and features of tolerance, dependence, and addiction, and agree together a treatment strategy and plan for end of treatment (September 2020) (www.gov.uk).

MHRA alert: Benzodiazepines and opioids: reminder of risk of potentially fatal respiratory depression (March 2020) (www.gov.uk).

CODEINE

Therapy notes

  • The capacity to metabolise codeine can vary considerably and lead to either reduced therapeutic effect or marked increase in side-effects; refer to www.gov.uk/drug-safety-update.
  • Codeine should not be used by breast-feeding mothers because it can pass to the baby through breast milk and potentially cause harm.
  • Codeine should be avoided in paediatric care.

Formulation and dosage details

Formulation:

Tablets 15mg, 30mg

Dosage:

30 to 60mg every 4 hours when necessary.

Formulation and dosage details

Formulation:

Syrup 25mg/5mL

Dosage:

30 to 60mg every 4 hours when necessary.

DIHYDROCODEINE

Therapy notes

Formulation and dosage details

Formulation:

Tablets 30mg (CD schedule 3) 

Dosage:

30mg every 4 to 6 hours when necessary.
For advice on prescribing dihydrocodeine to drug misusers see Drugs used in substance dependence.

CO-CODAMOL

Therapy notes

Note: Compound analgesic preparations

  • Codeine and paracetamol prescribed concomitantly as separate drugs (instead of as co-codamol) provide greater dosing flexibility, especially for titration and cost-effectiveness.
  • Compound analgesic preparations with a therapeutic dose of an opioid analgesic, eg co-codamol 30/500 (codeine 30mg and paracetamol 500mg) are appropriate for use in chronic non-cancer pain and in palliative care. 
  • There are no substantiated advantages of compound analgesic preparations containing paracetamol with a low dose of an opioids analgesic, eg co-codamol 8/500 (codeine 8mg and paracetamol 500mg) or co-dydramol 10/500 (dihydrocodeine 10mg and paracetamol 500mg) tablets.

Formulation and dosage details

Formulation:

Tablets (codeine/paracetamol) 30/500 

Dosage:

1 to 2 tablets every 4 hours; maximum 8 tablets daily (see low-body weight dose reduction under paracetamol).
Note: The salt content of dispersible formulations of paracetamol and co-codamol may be unsuitable for some patients.

Formulation and dosage details

Formulation:

Effervescent tablets (codeine/paracetamol) 30/500

Dosage:

1 to 2 tablets every 4 hours; maximum 8 tablets daily (see low-body weight dose reduction under paracetamol).
Note: The salt content of dispersible formulations of paracetamol and co-codamol may be unsuitable for some patients.

Editorial Information

Document Id: F066