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Codeine Over The Counter – 17 OTC Products

Codeine Over The Counter – 17 OTC Products

Without a doubt, Codeine-containing products are one of the most commonly sold medicines in the UK. Codeine can be purchased over the counter in the UK. Most codeine products are combination products of Codeine and another drug. Codeine over the counter can only be purchased on its own in one form; please read on. I will list most of the Codeine over the counter product in the UK; specifically,

The main focus of this post is to introduce the most common over-the-counter Codeine-containing products in the UK and review their Codeine content. Please refer to product information leaflet(s) or speak to the pharmacist for more details, such as dosage instructions, warnings, and possible side effects.

What Form Of Codeine Can You Buy Over The Counter In The UK?

The following over the counter combination products with Codeine will be reviewed:

Codeine linctus (syrup)

Codeine linctus

As I already mentioned in the introductory part, Codeine can be purchased on its own only in one form. Codeine Linctus (syrup) can be bought from pharmacies. Each 5ml of Codeine linctus contains 15mg of Codeine Phosphate.

Quick FAQ

Is codeine an anti inflammatory?
Yes, Codeine is anti-inflammatory.

Co-codamol (Paracetamol & Codeine)

The most common form of Codeine-containing medicine is Co-codamol, which can be purchased over the counter from pharmacy counters. Co-codamol is a combination product containing 8mg of Codeine and 500mg of Paracetamol per tablet.

Co-codamol

Many other Codeine containing-products are available in pharmacies. Many branded products are sold, which are equivalent to Co-codamol. Some branded products contain more than 8mg of Codeine phosphate per tablet.

Codeine And Ibuprofen Over The Counter

Co-codamol

It is possible to get Codeine in combination with Ibuprofen. Ibuprofen belongs to a different class of drugs than Paracetamol, called nonsteroidal anti-inflammatory drugs (NSAIDs), which additionally to its pain-relieving properties, have anti-inflammatory action.

Few products are currently available in the UK with both ingredients – Codeine and Ibuprofen.

Codeine And Aspirin

Like Ibuprofen, Aspirin belongs to the NSAID group of drugs. Aspirin can be taken at higher doses to manage pain, fever, and inflammation.
The above list is a general list of Codeine and Codeine-containing products. More specific products are reviewed in the latter part of this post.

Where To Buy Codeine Over The Counter From?

All Codeine-containing products are pharmacy-only medicines (P). P medicines are sold in pharmacies only, including online chemists, which operate under the supervision of a responsible pharmacist. Pharmacy-only medicines are not available for self-selection by customers.

Restrictions On The Supply Of Codeine-containing Products

A few years back, the Government introduced ‘tighter controls’ for over-the-counter medicines containing Codeine (and dihydrocodeine).

The restrictions were to minimize the risk of overuse and addiction, which is possible with Codeine use. Restrictions that are currently in place for over the counter Codeine products:

  • Codeine-containing products are only licensed for acute pain (for example, to relieve a toothache), which is not relieved by Paracetamol, Ibuprofen, or Aspirin alone, except for Codeine linctus, which can be used to manage non-productive coughs.
  • Codeine products are pharmacy-only medicines, with the sales restricted to pharmacies and online chemists only.
  • Use of Codeine-containing products is restricted to three days only
  • Products containing Codeine over the counter are limited to 32 tablets.
  • Codeine-containing products should not be used by children under 12 years of age, except for a combination of Aspirin and Codeine, which adults and children can only take over 16 years of age.
  • Codeine linctus is licensed for adults 18 years of age and over.

Is Codeine Over The Counter The Best Pain Killer?

Quick FAQ

What are the side effects of codeine?
Some of the side effects are Agitation, cold, clammy skin, darkened urine, and even darkening of the skin.

As per licensing restrictions, combination products with Codeine are recommended if simple analgesics such as Paracetamol or Ibuprofen fail to control the pain. Combination of Codeine and Paracetamol may provide better pain relief than Paracetamol alone.

A systemic review (review of all existing evidence) looked at 24 different clinical trials (single dose trials) concluded that the analgesic effect between Paracetamol-codeine combinations and ParParacetamolone was small.

This review included a range of codeine products, including higher doses of codeine combination drugs, which are not available over the counter (de Craen et al., 1996).

In multi-dose studies (patient takes more than one dose of the drug), treatment with the Paracetamol-codeine combination was associated with a significantly higher number of side effects than ParParacetamolone.

Differences In Response To Codeine Treatment

A small proportion of Codeine is changed in the body into Morphine. It has to be noted that there is a significant variation in how people ‘process’ Codeine. Some people (10% of white people, 2% of Asian people, and 1% of Arabic) are ‘poor metabolizers’ of Codeine, which means that Codeine will have a little effect in this group of people.

On the opposite, some people are ‘ultra‐metabolizers’, which converts Codeine into more Morphine in the body. This group of people is at risk of Codeine toxicity, even at standard doses (Wiffen et al., 2016).

What Is The Highest Amount Of Codeine Available Over The Counter?

Codeine linctus contains the highest amount of Codeine phosphate (15mg/5ml), although its licensed use is limited (see more in the next paragraph). The highest amount of Codeine in Codeine & Paracetamol combination products is 12.8mg of Codeine per tablet.

Are Combination Products With Codeine Good For Neuropathic (nerve) Pain?

I previously discussed the management of nerve pain with amitriptyline (a prescription-only antidepressant). In this post, I briefly talked about using over the counter analgesics such as ParParacetamol to manage nerve pain. Paracetamol alone is unlikely to provide pain relief from nerve pain. There is no sufficient data to support the use of Codeine in neuropathic pain. Codeine is not recommended as the standard treatment of nerve pain.

Codeine Over The Counter: UK List Of Products

Codeine Over The Counter – Cough Medicine

1. Codeine linctus

Codeine over the ciOUE

 

Codeine linctus is a pharmacy-only medicine licensed for the management of dry coughs. Codeine linctus is the only medicine, which contains Codeine only, without any other active ingredients.

  • Active ingredients (per tablet): Codeine phosphate
  • Codeine content: 15mg of Codeine per 5ml of linctus
  • Age restrictions: Codeine linctus is licensed in adults 18 years of age and over for symptomatic relief of non-productive (dry) coughs.

Other notes: Many pharmacies do not stock Codeine linctus. Likewise, a pharmacist may not agree to sell Codeine linctus over the counter due to potential misuse of this medication.

2. Pulmo Bailly

Pulmo Bailly is an oral solution (syrup) containing two active ingredients:

  • Codeine content: 7mg per 5ml of syrup and
  • Guaiacol (1949): 75mg per 5ml of syrup.

Pulmo Bailly - codeine cough syrup

Pulmo Bailly is used for managing coughs caused by colds, including Influenza (flu) and other respiratory tract infections.

Pulmo Bailly is licensed for adults over 18 years of age.

Combination products containing Codeine and Paracetamol

3. Co-codamol

Co-codamol - most popular codeine product

 

Most pharmacies sell Co-codamol and supermarket pharmacies as its own branded product, for example, Tesco Co-codamol, Lloyds Co-codamol, etc., Tesco co-codamol is one of the cheapest options for this medicine. A box of 32 co-codamol tablets costs under £3 (2020).

  • Active ingredients (per tablet): Codeine phosphate (8mg) and Paracetamol (500mg).
  • Codeine content: 8mg per tablet.

 4. Veganin

In addition to a 'standard' amount of Paracetamol and Codeine, Veganin tablets contain Caffeine. Vegan tablets are suitable for vegans and vegetarians. Learn more about Vegan in a separate post.

Veganin - vegan and vegetarian co-codamol

 

  • Active ingredients (per tablet): Codeine phosphate (8mg), Paracetamol (500mg) and Caffeine (30mg).
  • Codeine content: 8mg per tablet. The exact amount of Codeine content as Co-codamol tablets.

4. Syndol tablets

Syndol tablets contain a combination of Paracetamol and Codeine, and additionally, Doxylamine succinate, which is the main difference to Syndol Headache Relief Tablets (next paragraph). Doxylamine is an antihistamine, which acts as an antiemetic agent (stops nausea), which can be associated with, for example, Migraines.

  • Active ingredients (per tablet): Codeine phosphate (10mg), Doxylamine succinate (5mg), Paracetamol (450mg) and Caffeine (30mg).
  • Codeine content: 10mg per tablet.  It has higher concentration of Codeine than in 'standard' Co-codamol.

Syndol - combination of paracetamol, doxylamine and codeine over the counter

5. Syndol Headache Relief tablets

Syndol Headache relief tablets with codeine

  • Active ingredients (per tablet): Codeine phosphate (10mg) Paracetamol (500mg) and Caffeine (30mg).
  • Codeine content: 8mg per tablet. It has the same amount of Codeine phosphate as in 'standard' Co-codamol.

6. Solpadeine Max tablets

 

Solpadeine range of tablets (Solpadeine Max and Plus) is one of the best-known brands of combination medicines containing Paracetamol and Codeine. Solpadeine Max tablets do not contain Caffeine, but a soluble version of Solpadeine Max does contain Caffeine.

Solpadine range of paracetamol and codeine

  • Active ingredients (per tablet): Codeine phosphate (12.8mg) Paracetamol (500mg).
  • Codeine content: 12.8mg per tablet.  The highest amount of Codeine phosphate which can be bought over the counter in combination with parParacetamol. Solpadeine Plus capsules
  • Active ingredients (per capsule): Codeine phosphate (8mg) Paracetamol (500mg) and Caffeine (30mg)
  • Codeine content: 8mg per tablet.  The same amount of codeine phosphate as in standard Co-codamol.

8. Migraleve tablets

Migraleve range of tablets is mostly known for their use in the symptomatic management of Migraines. Migraleve, like other Codeine products, can be used to treat moderate pain, which is not relieved by Paracetamol, Ibuprofen, or Aspirin alone. Migraleve range includes three different products:

Migraleve Pink & Yellow - paracetamol & codeine OTC

 

  • Migraleve (Pink and Yellow)
  • Migraleve Pink tablets
  • Migraleve Yellow tablets

All Migraleve products are pharmacy-only medicines, which adults and children can use over 12 years of age. Migraleve was out of stock for most of 2019 due to licensing issues, which are now resolved, and there is no stock issue with Migraleve products. At that time, I wrote a post about Migraleve Pink alternative products, which may interest you.
Migraleve contains two different tablets inside one pack: pink and yellow tablets.

Active ingredients in PINK Migraleve tablets:

  • Active ingredients (per tablet): codeine phosphate (8mg), paracetamol (500mg) and buclizine hydrochloride (6.25mg)
  • Codeine content: 8mg per tablet.

Other notes: Buclizine hydrochloride is an antihistamine included in the formulation to relieve symptoms of nausea associated with Migraines.
Active ingredients in YELLOW Migraleve tablets:

  • Active ingredients (per tablet): Codeine phosphate (8mg) and Paracetamol (500mg).
  • Codeine content: 8mg per tablet. An equal amount of Codeine to ‘standard’ Co-codamol tablets.

Which Migraleve tablet should you take first: Pink or Yellow?

Pink Migraleve tablet(s) should be taken on the onset of a Migraine; if more tablets are needed to control the symptoms, one should take a yellow Migraleve tablet(s) every four hours.

For more detail, please refer to the product information leaflet.
As you can tell from the above, there is no difference between Miraleve Yellow tablets and co-codamol in terms of their active ingredients.
Patients who do not respond to Migraleve or other Codeine-containing products or analgesics may try Sumatriptan over the counter, which works differently to stop migraines.

9. Panadol Ultra tablets

Panadol Ultra tablets (Codeine and parParacetamolave not been on the market for a long time. Therefore this product is not well known.

  • Active ingredients (per tablet): Codeine phosphate (12.8mg), Paracetamol (500mg).
  • Codeine content: 12.8mg per tablet. It has the highest amount of Codeine phosphate available over the counter in the form of Codeine & Paracetamol combination.

Soluble (effervescent) Codeine over the counter

Soluble (effervescent) tablets dissolve in the water giving a solution (water + drug). Generally, it can be said that soluble tablets are absorbed and get to work faster than standard tablets.

10. Solpadeine Max soluble

Solpadeine Max soluble tablets have similar composition of active ingredients to Solpadine Max tablets. However, Solpadine Max soluble contains Caffeine.

Solpadeine Max soluble tablets - paracetamol with highest amount of codeine over the counter

  • Active ingredients (per tablet): codeine phosphate (12.8mg), Paracetamol (500mg) and Caffeine (30mg).
  • Codeine content: 12.8mg per tablet.  It has the highest amount of Codeine phosphate available over the counter in the form of Codeine & Paracetamol combination.

11. Solpadeine Plus soluble

Solpadeine Plus soluble tablets have the same composition of active ingredients as Solpadine Plus tablets (non-effervescent):

  • Active ingredients (per tablet): Codeine phosphate (8mg), Paracetamol (500mg) and Caffeine (30mg)
  • Codeine content: 8mg per tablet.  It has the same amount of Codeine phosphate as in standard Co-codamol or generic Co-codamol effervescent (next paragraph).

Soluble Solpadeine Plus

12. Co-codamol effervescent (‘generic’)

Generic, including, cheap(er) supermarket and pharmacy version of Co-codamol effervescent usually contain 8mg of Codeine and 500mg of ParParacetamolr tablet.
There are many generic and branded versions of Co-codamol effervescent (with or without Caffeine), for example, Ultramol soluble tablets, Paracodol tablets. Their availability varies between pharmacies.

Combination of Codeine and Ibuprofen

In the last part of this post, I will list the most common combination medicines, which contain Ibuprofen and Codeine as an active ingredient. Ibuprofen belongs to a group of drugs called Nonsteroidal Anti-inflammatory Drugs (NSAIDs) and, unlike ParParacetamolan be taken to help with inflammation in addition to its properties as a painkiller.

13. Nurofen Plus

Nurofen Plus is probably the best-known brand of Codeine and Ibuprofen combination medicine.

Nurofen Plus - Ibuprofen & Codeine OTC

  • Active ingredients (per tablet): Codeine phosphate (12.8mg) and Ibuprofen (200mg).
  • Codeine content: 12.8mg per tablet. The highest amount of Codeine phosphate available over the counter
  • Similar to Paracetamol-codeine medicines, Nurofen Plus can be taken by adults and children over 12 years of age.

14. Solpadeine Migraine Ibuprofen & Codeine Tablets

Solpadeine Migraine Ibuprofen & Codeine tablets have the same active ingredients as Nurofen Plus:

 

  • Active ingredients (per tablet): Codeine phosphate (12.8mg) and Ibuprofen (200mg).
  • Codeine content: 12.8mg per tablet. The highest amount of Codeine phosphate available over the counter.

Solpadeine for migraines

15. Boots ibuprofen and codeine tablets

Boots Ibuprofen and Codeine tablets represent the same combination of active ingredients as Nurofen Plus tablets, namely Ibuprofen 200mg per tablet and Codeine phosphate 12.8mg per tablet.

Combination of Codeine and Aspirin

Aspirin belongs to the same class of drugs as Ibuprofen – NSAIDs. At higher doses (more than 300mg daily), Aspirin is usually taken to help with pain (headache, toothache, etc.), to reduce temperature (antipyretic effect), and to reduce inflammation.

A lower dose of Aspirin, baby Aspirin (75mg) may be recommended by a GP to prevent cardiovascular disease, for example, in patients who had a heart attack or stroke.

16. Codis 500 soluble tablets

Codis 500 contains two active ingredients:

  • Aspirin: 500mg per tablet
  • Codeine content: 8mg per tablet

As with other codeine products, Codis 500 is recommended for short-term pain management, which is not relieved by other analgesics such as parParacetamolone. Codis 500, Aspirin, and other Aspirin-containing products should not be used in children under the age of 16.
Codis 500 are soluble tablets and need to be dissolved in the water before administration.

17. Boots Aspirin & Codeine tablets

Boots Aspirin and Codeine tablets are licensed for adults and children over 16 years of age. Two main active ingredients were found:

  • Codeine content: 8mg per tablet
  • Aspirin: 400mg per tablet

The licensed use for Boots and Aspirin and Codeine tablets is the same as previously discussed Codeine products.

Quick FAQ

Does Syndol have muscle relaxant?
Yes, they do have muscle relaxers in them.

Prescription-only Codeine

Codeine available on prescription can be prescribed on its own or in combination with ParParacetamolhen prescribed; there are no restrictions in terms of the quantity that a GP can prescribe.
Codeine is usually available in a pack of 28 tablets.

Prescription-only Co-codamol exists in pack sizes of up to 100 tablets or capsules. POM versions of codeine & Co-codamol medicines include:

  • Codeine 15mg tablets
  • Codeine 30mg tablets
  • Codeine 60mg tablets
  • Codeine & ParParacetamolo-codamol) is available in the form of tablets and capsules with 500mg of ParParacetamolr tablet/capsule, and either 8mg, 15mg, 30mg of Codeine.

Conclusion

Except for codeine linctus, Codeine over the counter can only be purchased as a combination product with Paracetamol, Ibuprofen, or Aspirin. Some evidence supports better analgesic effectiveness of Codeine & Paracetamol compared to ParParacetamolone.

A number of restrictions are in place to control over the counter supply of Codeine-containing products. The use of Codeine is associated with a number of common side effects and addiction.

References
  • de Craen AJ, Di Giulio G, Lampe-Schoenmaeckers JE, Kessels AG, Kleijnen J. Analgesic efficacy and safety of paracetamol-codeine combinations versus paracetamol alone: a systematic review. BMJ. 1996 Aug 10;313(7053):321-5. doi: 10.1136/BMJ.313.7053.321. PMID: 8760737; PMCID: PMC2351742. Available at: https://doi.org/10.1136/bmj.313.7053.321 Accessed on 17/12/2020
  • Wiffen PJ, Knaggs R, Derry S, Cole P, Phillips T, Moore RA. Paracetamol (acetaminophen) with or without Codeine or dihydrocodeine for neuropathic pain in adults. Cochrane Database of Systematic Reviews 2016, Issue 12. Art. No.: CD012227. DOI: 10.1002/14651858.CD012227.pub2. Accessed 17 December 2020. Available at: https://doi.org/10.1002/14651858.CD012227.pub2 Accessed on 17/12/2020