Co-codamol for children

Co-codamol is a mixture of 2 different painkillers – paracetamol and codeine.

It's used to treat aches and pains including headaches, migraine, muscle pain and toothache.

Children and young people aged 12 to 17 years old can take co-codamol but only if everyday painkillers, such as ibuprofen or paracetamol on its own, have not worked.

Do not give co-codamol to children under 12 years old. It can cause severe breathing problems.

This medicine comes as tablets and capsules. Co-codamol tablets and capsules come in 3 strengths. You can buy the lowest strength from pharmacies but higher strengths are only available on prescription.

Most children and young people aged 12 years old and over can take co-codamol if other everyday painkillers have not worked.

Co-codamol is not suitable for some children. To make sure it's safe for your child, tell their doctor or a pharmacist before giving them co-codamol if your child has:

• ever had an allergic reaction to co-codamol or any other medicine
• lung problems or breathing difficulties
• a head injury
• adrenal gland problems
• a condition that causes fits or seizures
• liver problems
• had their tonsils or adenoids removed because of a sleep problem called obstructive sleep apnoea

Co-codamol tablets and capsules come in 3 different strengths, containing 8mg, 15mg or 30mg of codeine.

All 3 strengths contain 500mg of paracetamol – the same as in a standard paracetamol tablet or capsule.

The strength of co-codamol appears as 2 numbers on the packet. For example, 8/500 means each tablet or capsule contains 8mg of codeine and 500mg of paracetamol.

You can buy the lowest strength of co-codamol (8/500) without a prescription but only from a pharmacy. The higher strengths (15/500 and 30/500) are only available on prescription from a doctor.

The normal dose for children aged 12 to 15 years old is 1 tablet or capsule of co-codamol (of any strength) up to 4 times in 24 hours.

The normal dose for young people aged 16 to 17 years old is 1 to 2 tablets or capsules (of any strength) up to 4 times in 24 hours.

Always leave at least 6 hours between doses.

Giving your child too much co-codamol can be very dangerous. That's because the paracetamol in it can cause liver damage.

Do not increase the dose or give 2 doses at once, even if their pain is very bad. Speak to a doctor if their pain is very bad or getting worse.

The maximum dose of co-codamol for children aged 12 to 15 years old is normally 4 tablets or capsules (of any strength) in 24 hours. The maximum dose for young people aged 16 to 17 years old is normally 8 tablets or capsules (of any strength) in 24 hours. Wait at least 6 hours between doses.

Co-codamol tablets and capsules are swallowed whole with a drink of water. They can be taken with or without food.

If your child finds it difficult to swallow tablets or capsules, co-codamol also comes as soluble tablets that you dissolve in a glass of water to make a drink.

If your child's doctor prescribes co-codamol, give it to your child for as long as they recommend.

If you've bought co-codamol from a pharmacy, do not give it to a child for more than 3 days. If they still have pain after 3 days, talk to a pharmacist or doctor.

If your child has been taking co-codamol for more than a few weeks, it's important they do not stop taking it without speaking to a doctor first.

Taking more than the recommended dose of co-codamol can be dangerous.

Your child has taken more than the recommended dose of co-codamol and:

• they're seeing things that are not there
• they're finding it hard to breathe

• your child has taken more than the recommended dose of co-codamol

Go to 111 online or call 111 .

If you need to go to A&E, do not drive. Ask someone to drive you or call 999 and ask for an ambulance.

Bring the co-codamol packet or leaflet inside it, any remaining medicine, and any other medicines you take.

These common side effects of co-codamol happen in more than 1 in 100 children. There are things you can do to help your child cope with them:

Give your child plenty of high-fibre foods such as fresh fruit and vegetables and cereals. Get them to drink several glasses of water or other liquids each day.

Give co-codamol with or just after a meal or snack. Stick to simple meals and do not give them rich or spicy food.

If they're being sick, give them small frequent sips of water to avoid dehydration. Signs of dehydration include peeing less than usual or having dark, strong-smelling pee.

Feelings of sickness should normally wear off after a few days. Talk to your doctor about giving your child an anti-sickness medicine if it carries on for longer.

This side effect should wear off as your child gets used to co-codamol. Talk to their doctor if it carries on.

Make sure your child rests and drinks plenty of fluids. Talk to their doctor if the headaches are severe.

Speak to a doctor or pharmacist if the advice on how to cope does not help and a side effect is still bothering your child or does not go away.

Serious side effects are rare and happen in less than 1 in 100 children.

Call a doctor or call 111 straight away if your child has:

• a skin rash
• difficulty peeing
• changes in their eyesight
• dizziness

Serious allergic reaction

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to co-codamol.

Call 999 now if:

• your child's lips, mouth, throat or tongue suddenly become swollen
• they're breathing very fast or struggling to breathe (they may become very wheezy or seem like they're choking or gasping for air)
• their throat feels tight or they're struggling to swallow
• their skin, tongue or lips turn blue, grey or pale (if they have black or brown skin, this may be easier to see on the palms of their hands or soles of their feet)
• they suddenly become very confused, drowsy or dizzy
• they faint and cannot be woken up
• they're limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)

Your child may also have a rash that's swollen, raised, itchy, blistered or peeling.

These can be signs of a serious allergic reaction and may need immediate treatment in hospital.

If you've bought co-codamol from a pharmacy, do not give it to your child for more than 3 days. If your child's pain has not gone away, talk to a pharmacist or doctor.

If your child needs to take co-codamol for a long time, their body can become tolerant to the codeine in it. That means they need higher doses to control their pain over time.

Some people can become more sensitive to pain (hyperalgesia). If this happens, your child's doctor will reduce the dose gradually to help these symptoms.

It is possible to become addicted to the codeine in co-codamol. For this reason, your child's dose will be reviewed to make sure they're only taking the amount they need to control their pain.

Your child's treatment plan may include details of how and when they will stop taking co-codamol.

If they're having treatment for cancer pain or other severe pain, their pain control will be carefully monitored. Speak to your doctor if you're worried about tolerance, hyperalgesia or becoming addicted.

These are not all the side effects of co-codamol. For a full list, see the leaflet inside the medicine packet.

Some medicines affect the way co-codamol works. Co-codamol can also stop some medicines working as well as they should.

Tell your child's doctor if your child is taking:

• epilepsy medicines
• medicines for anxiety or sleep problems
• medicines to stop them feeling or being sick such as domperidone or metoclopramide
• medicines to treat infection, particularly rifampicin or ciprofloxacin
• antidepressants

It's safe to give children co-codamol with ibuprofen.

Never give aspirin to a child under 16 years old (unless their doctor prescribes it). It can cause serious, even fatal, side effects.

Do not give children co-codamol with paracetamol or other medicines that contain paracetamol, unless you've been advised to by a doctor. Co-codamol already contains paracetamol so your child could get a paracetamol overdose.

Medicines that have paracetamol in them include some painkillers like Tramacet and co-dydramol, some migraine remedies, and some cough and cold remedies like Lemsip and Night Nurse.

Before giving a child any other medicines together with co-codamol, check the label to see whether they contain paracetamol.

It's not possible to say whether complementary medicines, herbal remedies and supplements are safe to take with co-codamol. They're not tested in the same way as pharmacy and prescription medicines. They're generally not tested for the effect they have on other medicines.

Tell a pharmacist or doctor if your child is taking any other medicines, including herbal remedies, vitamins or supplements.