Consumer medicine information

SANDOZ PARACETAMOL PLUS CODEINE

Paracetamol; Codeine phosphate hemihydrate

BRAND INFORMATION

Brand name

Sandoz Paracetamol Plus Codeine

Active ingredient

Paracetamol; Codeine phosphate hemihydrate

Schedule

S4

 

Consumer medicine information (CMI) leaflet

Please read this leaflet carefully before you start using SANDOZ PARACETAMOL PLUS CODEINE.

What is in this CMI

This CMI answers some common questions about Sandoz Paracetamol Plus Codeine tablets. It does not contain all the available information. It does not take the place of talking to your doctor or pharmacist.

All medicines have risks and benefits. Your doctor or pharmacist has weighed the risks of you taking Sandoz Paracetamol Plus Codeine against the benefits this medicine is expected to have for you.

Keep this information with the medicine. You may need to read it again.

What are Sandoz Paracetamol Plus Codeine tablets used for

This medicine may be addictive if taken for more than a few days at a time. Sandoz Paracetamol Plus Codeine tablets are used to relieve moderate to severe pain.

Sandoz Paracetamol Plus Codeine tablets contain paracetamol and codeine. Paracetamol and codeine work together to stop the pain messages from getting through to the brain. Paracetamol also acts in the brain to reduce fever.

Your doctor or pharmacist may have given you this medicine for another use.

If you want more information, ask your doctor or pharmacist.

Before you take Sandoz Paracetamol Plus Codeine

When you must not take it

You should not take Sandoz Paracetamol Plus Codeine if you are allergic to paracetamol or codeine or any of the ingredients listed under "Product Description". The symptoms of an allergic reaction may include a rash, asthma attack or hay fever.

Do not use Sandoz Paracetamol Plus Codeine if you are breastfeeding. Sandoz Paracetamol Plus Codeine may be used during pregnancy. However, ask your pharmacist or doctor about the risks and benefits of taking Sandoz Paracetamol Plus Codeine while you are pregnant.

Do not use it after the expiry date (EXP) printed on the pack. If you take it after the expiry date it may have no effect at all, or worse, have an entirely unexpected effect.

Do not use Sandoz Paracetamol Plus Codeine if the packaging is torn or shows signs of tampering.

Before you start to take it

You must tell your pharmacist or doctor if:

  • You have allergies to any ingredients listed under "Product Description" at the end of this leaflet.
  • You have any of these conditions:
    - Lung, liver or kidney problems
    - You drink large quantities of alcohol.

You should tell your pharmacist or doctor if you are using any other medicines including any of the following medicines:

  • Any medicines causing sleepiness
  • Tranquillisers (medicines for anxiety and nerves)
  • Medicines which thin the blood
  • Medicines to treat epilepsy.

These medicines may be affected by Sandoz Paracetamol Plus Codeine or affect how well Sandoz Paracetamol Plus Codeine works.

Your doctor or pharmacist can tell you what to do if you are taking any of these medicines.

You should also tell your pharmacist or doctor about any other medicines that you have bought without a prescription from either your pharmacy, supermarket or health food shop.

If you have not told your pharmacist or doctor about any of these things, tell him/her before you take any Sandoz Paracetamol Plus Codeine.

How to take Sandoz Paracetamol Plus Codeine

The label on your pack Sandoz Paracetamol Plus Codeine will tell you how to take your medicine and how often. If you are unsure about the directions ask your doctor or pharmacist.

The usual dose of Sandoz Paracetamol Plus Codeine tablets are:

Adults: 2 tablets.

This dosage may be repeated in 4-6 hours if necessary. You should not take more than 8 tablets in a 24 hour period.

If Sandoz Paracetamol Plus Codeine tablets are not adequately controlling your pain, do not increase the dose. Please see your doctor.

Sandoz Paracetamol Plus Codeine is not recommended for children under 12 years.

Swallow tablets whole with a little water or other liquid.

The directions given to you by your pharmacist or doctor may be different from the information in this leaflet. If you are unsure what dose to take ask your pharmacist or doctor.

If you forget to take it

If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the dose you missed, and take your next dose when you are meant to.

Do not take a double dose to make up for the dose missed.

If you have trouble remembering when to take your medicine, ask your pharmacist for some hints.

If you take too much (Overdose)

Immediately telephone your doctor or Poisons Information Centre (telephone 13 11 26) for advice or go to Accident and Emergency at your nearest hospital, if you think that you or anyone else may have taken too much Sandoz Paracetamol Plus Codeine.

Do this even if there are no signs of discomfort or poisoning. You may need urgent medical attention.

Keep telephone numbers of these places handy.

If you take too many tablets you may feel nauseous, light headed, dizzy or drowsy.

While you are taking Sandoz Paracetamol Plus Codeine

Things you must do

Take Sandoz Paracetamol Plus Codeine exactly as your pharmacist or doctor has told you to.

Tell all your doctors, dentists and pharmacists that you are taking Sandoz Paracetamol Plus Codeine.

Tell your doctor or pharmacist if you become pregnant while taking Sandoz Paracetamol Plus Codeine.

Things you must NOT do

Do not use this medicine to treat any other complaint unless your doctor or pharmacist says it is safe. Do not give this medicine to anyone else even if they have the same symptoms as you.

Things to be careful of

Sandoz Paracetamol Plus Codeine may cause dizziness or drowsiness in some people, especially after the first dose.

If affected do not drive a car, operate machinery or do anything else that could be dangerous if you are dizzy or drowsy. Children should not ride bikes if affected and should be supervised to avoid potential harm. Do not drink alcohol.

Drinking alcohol increases the likelihood of becoming drowsy.

Sandoz Paracetamol Plus Codeine may be habit forming if taken in high doses for extended periods of time.

Please ask your doctor or pharmacist if you are concerned about this.

About 8% of people are poor metabolisers of codeine. Sandoz Paracetamol Plus Codeine may not work as well if you are one of those people.

Side Effects

Tell your doctor or pharmacist as soon as possible if you do not feel well while taking Sandoz Paracetamol Plus Codeine.

Like other medicines, Sandoz Paracetamol Plus Codeine can cause some side effects. If they occur, they are most likely minor and temporary. However, sometimes they are serious and need medical treatment.

Ask your doctor or pharmacist to answer any questions you may have.

Tell your pharmacist or doctor if you notice any of the following and they worry you:

Stomach problems such as:

  • Nausea
  • Vomiting
  • Stomach pain
  • Constipation

If you are taking Sandoz Paracetamol Plus Codeine regularly, you may also need to take laxatives to prevent constipation.

Difficulty thinking or working because of:

  • Dizziness
  • Drowsiness

Be careful driving or operating machinery until you know how Sandoz Paracetamol Plus Codeine affects you.

Other problems such as:

  • Skin rashes

If you believe Sandoz Paracetamol Plus Codeine is not working well for you, do not increase the dose. Please see your pharmacist or doctor.

Some people may get other side effects not listed above.

Tell your pharmacist or doctor you notice anything else that making you feel unwell.

After taking Sandoz Paracetamol Plus Codeine

Storage

Keep your tablets in the blister pack until it is time to take them. If you take the tablets out of the box or the blister pack they will not keep well.

Keep Sandoz Paracetamol Plus Codeine in a cool dry place where the temperature stays below 30°C. Heat and dampness can destroy some medicines.

Do not leave Sandoz Paracetamol Plus Codeine in the car on hot days.

Do not store Sandoz Paracetamol Plus Codeine or any other medicine in the bathroom or near a sink.

Keep Sandoz Paracetamol Plus Codeine where young children cannot reach it. A locked cupboard at least one and a half metres above the ground is a good place to store medicines.

Disposal

If your pharmacist or doctor tells you to stop taking the tablets, ask your pharmacist what to do with any tablets that are left over.

This is not all the information that is available on Sandoz Paracetamol Plus Codeine. If you have any more questions or are not sure about anything, ask your doctor or pharmacist.

Product Description

Sandoz Paracetamol Plus Codeine comes as white to off white capsule shaped uncoated tablets, plain on one side and breakline on the other side.

It is available in packs of 20 and 40 tablets.

Active ingredients:
Each tablet contains:

  • Paracetamol 500 mg
  • Codeine Phosphate 15 mg

Other ingredients:

  • Starch - Potato,
  • Lactose,
  • Povidone,
  • Docusate Sodium,
  • Silica - colloidal anhydrous,
  • Magnesium Stearate.

Sandoz Paracetamol Plus Codeine does not contain any gluten, sucrose, tartrazine or any azo dyes.

Supplier

Sandoz Pty Ltd
ABN 60 075 449 553
19 Harris Street
Pyrmont NSW 2009
Australia
Tel: 1800 634 500

This leaflet was prepared in July 2013.

Australian Register Number
Tablets: AUST R 212684 (blister)

Published by MIMS February 2014

BRAND INFORMATION

Brand name

Sandoz Paracetamol Plus Codeine

Active ingredient

Paracetamol; Codeine phosphate hemihydrate

Schedule

S4

 

Name of the medicine

Paracetamol 500 mg, codeine phosphate 15 mg.

Excipients.

Potato starch, lactose, povidone, docusate sodium, anhydrous colloidal silica, magnesium stearate.

Description

Codeine phosphate.

Molecular formula: C18H21NO3, H3PO4,½H2O. MW: 406.4. CAS: 41444-62-6. Codeine phosphate is a white or almost white, crystalline powder or small, colourless crystals. It is freely soluble in water, slightly soluble or very slightly soluble in ethanol (96%). Codeine phosphate is a cough suppressant and an analgesic.

Paracetamol.

Molecular formula: C8H9NO2 Relative molecular mass: 151.2. CAS: 103-90-2. Paracetamol is a white or almost white crystalline powder. It is sparingly soluble in water, freely soluble in alcohol, very slightly soluble in methylene chloride. Paracetamol is an analgesic and antipyretic.

Pharmacology

Paracetamol's analgesic mechanism of action has not been fully elucidated, but may involve blocking impulse generation at the bradykinin sensitive chemoreceptors that evoke pain.
The antipyretic effect of paracetamol rises from its ability to block the action of prostaglandin synthetase and so prevent the synthesis of prostaglandins in response to the pyrogen stimulus in the region of the anterior hypothalamus.
Codeine acts centrally. It produces analgesia by dulling the response to painful stimuli at several loci in the central nervous system. This causes an alteration in the sensation and affective response of pain.
There is evidence to suggest that a combination of paracetamol with codeine is superior in analgesic action to either drug administered alone.

Pharmacokinetics.

Paracetamol.

After oral administration, paracetamol is absorbed rapidly and completely from the small intestine; peak plasma levels occur 30 to 120 minutes after administration. Paracetamol is uniformly distributed throughout most body fluids; the apparent volume of distribution is 1 to 1.2 L/kg.
Paracetamol can cross the placenta and is excreted in milk. Plasma protein binding is negligible at usual therapeutic concentrations, but increases with increasing concentrations.
Paracetamol is metabolised by the hepatic microsomal enzyme system. In adults, at therapeutic doses, paracetamol is mainly conjugated with glucuronide (45 to 55%) or sulfate (20 to 30%). A minor proportion (less than 20%) is metabolised to catechol derivatives and mercapturic acid compounds via oxidation. Paracetamol is metabohised differently by infants and children compared to adults, the sulfate conjugate being predominant.
Paracetamol is excreted in the urine mainly as the glucuronide and sulfate conjugates. Less than 5% is excreted as unchanged paracetamol, with 85 to 90% of the administered dose eliminated in the urine within 24 hours of ingestion. The elimination half-life varies from one to four hours. Food intake delays paracetamol absorption.

Codeine.

Codeine has about one-sixth of morphine's analgesic activity. It is well absorbed from the gastrointestinal tract and does not interfere with paracetamol absorption.
It is metabolised in the liver to morphine and norcodeine which, with codeine, are excreted in the urine, partly as conjugates with glucuronic acid. Excretion is almost complete within 24 hours. Patients who metabolise drugs poorly via CYP2D6 are likely to obtain reduced benefit from codeine due to reduced formation of the active metabolite. This may be the case in about 8% of patients.

Indications

Temporary relief of moderate to severe acute pain associated with strong headaches, migraine headaches, dental surgery or toothache, menstrual pain and sports injuries (e.g. backaches and muscular pain).

Contraindications

Hypersensitivity to paracetamol or codeine or other ingredients (see Excipients).

Precautions

Paracetamol 500 mg and Codeine Phosphate 15 mg Tablets should be administered with caution to patients with hepatic or renal dysfunction. Codeine should be used with caution in patients with CNS depression or decreased respiratory reserve. Prolonged use of high doses of codeine may produce dependence.
Due to the preparation's sedative action, impairment of the mental and/or physical abilities required for the performance of potentially hazardous activities may occur. Hence, children engaging in bike riding and other hazardous activities should be supervised to avoid potential harm.
Adults should not drive, operate machinery or drink alcohol while taking this medication.

Use in pregnancy.

(Category A)
Both paracetamol and codeine have been taken by a large number of pregnant women and women of childbearing age without any proven increase in the frequency of malformations or other direct or indirect harmful effects on the foetus having been observed.
Opioid analgesics may cause respiratory depression in the newborn infant. Prolonged high dose use of codeine prior to delivery may produce codeine withdrawal symptoms in the neonate.

Use in lactation.

Paracetamol and codeine both appear in breast milk in low concentrations. Maternal ingestion of paracetamol in recommended doses does not appear to present a risk to breastfed infants. However, codeine may cause respiratory depression in newborn infants.
Paracetamol 500 mg and Codeine Phosphate 15 mg Tablet is therefore not recommended for breastfeeding mothers unless the potential benefits to the patient outweigh the possible risk to the infant.

Interactions

Anticoagulant dosage may require reduction if this medication is prolonged. Paracetamol absorption is increased by drugs which increase gastric emptying, e.g. metoclopramide, and decreased by drugs which decrease gastric emptying, e.g. propantheline, antidepressants with anticholinergic properties and narcotic analgesics.
Paracetamol may increase chloramphenicol concentrations. The likelihood of paracetamol toxicity may be increased by the concomitant use of enzyme inducing agents, such as alcohol or antiepileptic drugs.
It is possible that interactions could occur between drugs that can inhibit CYP2D6 (such as quinidine, phenothiazines and antipsychotic agents) and codeine.
Concurrent administration of sedatives or tranquillizers may enhance the potential respiratory depressant effects of codeine.

Adverse Effects

Paracetamol.

Reports of adverse reactions are rare. Although the following reactions have been reported, a causal relationship to the administration of paracetamol has been neither confirmed nor refuted: dyspepsia, nausea, allergic and hematological reactions.

Codeine.

Nausea and vomiting, constipation, dizziness and drowsiness have been reported at therapeutic doses of codeine. Very rarely, skin rashes may occur in patients hypersensitive to codeine. Prolonged use of large doses of codeine may result in physiological dependence.

Dosage and Administration

Adults and children over 12 years.

2 tablets four times a day if required (maximum 8 tablets in 24 hours).
Not recommended for children under 12 years of age.

Overdosage

Symptoms.

Toxic symptoms include vomiting, abdominal pain, hypotension, sweating, central stimulation with exhilaration and convulsions in children, drowsiness, respiratory depression, cyanosis and coma. The most serious adverse effect of acute overdosage of paracetamol is a dose dependent, potentially fatal hepatic necrosis.
In adults, hepatotoxicity may occur after ingestion of a single dose of paracetamol 10 to 15 g (30 tablets); a dose of 25 g (50 tablets) or more is potentially fatal.
Symptoms during the first two days of acute poisoning by paracetamol do not reflect the potential seriousness of the intoxication. Major manifestations of liver failure, such as jaundice, hypoglycemia and metabolic acidosis, may take at least three days to develop.

Treatment.

In case of overdosage, contact the Poisons Information Centre (131 126).

Presentation

Tablets (paracetamol 500 mg, codeine phosphate 15 mg) (white to off white, capsule shaped, uncoated, plain on one side, scored on reverse): 20's, 24's*, 40's (blister pack).
*Not currently marketed in Australia.

Storage

Store below 30°C.

Poison Schedule

S3.