4.7.1.1 Non-opioid and compound analgesics

ChoiceDrugDosage
1st choiceParacetamol tablets 500mgDose:
0.5-1g every 4-6 hours; max 4g daily
2nd choicesCo-codamol 8/500 tablets (codeine 8mg with paracetamol 500mg) Dose:
Co-codamol 8/500, 1-2 tablets every 4-6 hours; max 8 tablets daily
Co-codamol 30/500 tablets (codeine 30mg with paracetamol 500mg) Co-codamol 30/500, 1-2 tablets every 4-6 hours; max 8 tablets daily

Prescribing Notes

  • Paracetamol taken regularly appears to be as effective as co-codamol 8/500 with less side-effects.
  • Management of postoperative pain should follow hospital acute pain guidelines.
  • Codeine is an inefficient analgesic in approximately 10% of patients who are unable to convert it to morphine. Consider tramadol as an alternative in these patients.
  • IV paracetamol should only be prescribed by specialists for the short-term treatment of moderate and severe pain following surgery when administration by the intravenous route is clinically justified by an urgent need to treat pain and/or when other routes of administration are not possible.
  • The IV paracetamol dose is NOT equivalent to the oral or rectal dose in all patients. For further information see Drug Safety Update Intravenous paracetamol (Perfalgan ▼): risk of accidental overdose.

Cautions

  • Some patients may be at increased risk of experiencing toxicity at therapeutic doses of paracetamol, particularly those with a body-weight under 50 kg and those with risk factors for hepatotoxicity. Clinical judgement should be used to adjust the dose of oral and intravenous paracetamol in these patients.
  • Each effervescent tablet can contain a sodium content of up to 400mg. Persons on a low sodium diet should be aware of this if they wish to take effervescent tablets as a daily intake can exceed 3g sodium per day. Effervescent tablets are significantly more expensive than tablets/caplet preparations.
  • Codeine should not be used by breastfeeding mothers because it can pass to the baby through breast milk and potentially cause respiratory depression. For further information see Drug Safety Update – Codeine for analgesia: restricted use in children because of reports of morphine toxicity.