Consumer medicine information

Prodeine

Paracetamol; Codeine phosphate hemihydrate

BRAND INFORMATION

Brand name

Prodeine

Active ingredient

Paracetamol; Codeine phosphate hemihydrate

Schedule

S4

 

Consumer medicine information (CMI) leaflet

Please read this leaflet carefully before you start using Prodeine.

SUMMARY CMI

Prodeine®

Consumer Medicine Information (CMI) summary

The full CMI on the next page has more details. If you are worried about using this medicine, speak to your doctor or pharmacist.

WARNING: Important safety information is provided in a boxed warning in the full CMI. Read before using this medicine.

1. Why am I using Prodeine?

Prodeine contains the active ingredients paracetamol and codeine phosphate hemihydrate. Prodeine is used to relieve acute moderate pain and fever.

For more information, see Section 1. Why am I using Prodeine? in the full CMI.

2. What should I know before I use Prodeine?

Do not use if you have ever had an allergic reaction to Prodeine or any of the ingredients listed at the end of the CMI.

Talk to your doctor if you have any other medical conditions, take any other medicines, or are pregnant or plan to become pregnant or are breastfeeding.

For more information, see Section 2. What should I know before I use Prodeine? in the full CMI.

3. What if I am taking other medicines?

Some medicines may interfere with Prodeine and affect how it works.

A list of these medicines is in Section 3. What if I am taking other medicines? in the full CMI.

4. How do I use Prodeine?

Adults and children 12 years or over:

One or two tablets every 3 to 4 hours as needed for relief. Do not take more than 8 caplets in 24 hour period

More instructions can be found in Section 4. How do I use Prodeine? in the full CMI.

5. What should I know while using Prodeine?

Things you should do
  • Remind any doctor, dentist or pharmacist you visit that you are using Prodeine.
  • Tell your doctor or pharmacist if you are taking any other medicines that you use to help you relax, anything that contains alcohol (like cough syrup) or other medicines that treat pain.
Things you should not do
  • Do not take more than the recommended dose unless your doctor tells you to.
  • Do not give this medicine to children under 12 years of age.
  • Do not take Prodeine during the third trimester of pregnancy or if you are in labour, especially if the baby is expected to be premature.
Driving or using machinesProdeine may cause drowsiness in some people. If this happens, do not drive or operate machinery.
Drinking alcohol
  • Do not drink alcohol while taking Prodeine as it may interfere with the effects of the medicine and may increase the risk of liver side effects.
Looking after your medicine
  • Store below 30° C.
  • Store in a cool, dry place away from young children.

For more information, see Section 5. What should I know while using Prodeine? in the full CMI.

6. Are there any side effects?

Prodeine may be habit forming if taken frequently or over long periods. Tell your doctor or pharmacist if you notice any of the following and they worry you: nausea or vomiting; drowsiness or dizziness; constipation; stomach pain; skin rashes; sweating. For more information, including what to do if you have any side effects, see Section 6. Are there any side effects? in the full CMI.

WARNING:

Limitations of use

Prodeine should only be used if your doctor decides other treatment options are not able to effectively manage your pain or you cannot tolerate them.

Hazardous and harmful use

Prodeine contains codeine which may be habit forming. Prodeine poses risks of abuse, misuse and addiction which can lead to overdose and death. Your doctor will assess your risks and monitor you regularly during treatment.

Life threatening respiratory depression

Serious, life-threatening, or fatal respiratory depression (shallow or difficulty breathing) may occur with the use of Prodeine even when used as recommended. These problems can occur at any time during use, but the risk is higher when first starting Prodeine and after a dose increase, if you are older, or have an existing problem with your lungs. Your doctor will monitor you and change the dose as appropriate.

Use of other medicines while using Prodeine

Using Prodeine with other medicines that can make you feel drowsy such as sleeping tablets (e.g. benzodiazepines), other pain relievers, antihistamines, antidepressants, antipsychotics, gabapentinoids (e.g. gabapentin and pregabalin), cannabis and alcohol may result in severe drowsiness, decreased awareness, breathing problems, coma and death. Your doctor will minimize the dose and duration of use and monitor you regularly for signs and symptoms of breathing difficulties and sedation. You must not drink alcohol while taking Prodeine.



FULL CMI

Prodeine®

Active ingredient(s): paracetamol and codeine phosphate hemihydrate


Consumer Medicine Information (CMI)

This leaflet provides important information about using Prodeine. You should also speak to your doctor or pharmacist if you would like further information or if you have any concerns or questions about using Prodeine.

Where to find information in this leaflet:

1. Why am I using Prodeine?
2. What should I know before I use Prodeine?
3. What if I am taking other medicines?
4. How do I use Prodeine?
5. What should I know while using Prodeine?
6. Are there any side effects?
7. Product details

1. Why am I using Prodeine?

Prodeine is a type of analgesic intended for short term use to relieve acute moderate pain and fever.

Prodeine contains the active ingredients paracetamol and codeine phosphate hemihydrate.

Codeine phosphate hemihydrate belongs to a group of medicines called analgesics. It is an opioid analgesic and it acts by blocking pain and your emotional response to pain.

Paracetamol works to stop the pain messages from getting through to the brain. It also acts in the brain to reduce fever.

Paracetamol and codeine work together to stop the pain messages from getting through to the brain.

Prodeine is for the short term relief of acute moderate pain and fever.

2. What should I know before I use Prodeine?

Warnings

Do not use Prodeine if:

  • you are allergic to paracetamol or codeine phosphate hemihydrate, or any of the ingredients listed at the end of this leaflet.
    Always check the ingredients to make sure you can use this medicine.
  • you are allergic to aspirin or anti-inflammatory medications
  • you have severe and/or acute respiratory diseases
  • you have acute breathing difficulties such as bronchitis, unstable asthma, emphysema (serious lung disease), respiratory depression (shallow breathing) or respiratory insufficiency (difficulty breathing).
  • you have a Glucose-6-phosphate dehydrogenase deficiency (an enzyme deficiency)
  • you are an ultra-rapid metaboliser of CYP 2D6 (a fast metaboliser of codeine by the CYP 2D6 enzyme)
  • you have had your tonsils or adenoids removed and are aged between 12 and 18 years of age
  • you have severe liver or kidney disease
  • you are suffering from diarrhea caused by poisoning or antibiotics
  • you have chronic constipation

Do not take codeine if you have a history of drug dependence, including alcohol dependence.

Do not give Prodeine to children under 12 years of age.

Do not take Prodeine during the third trimester of pregnancy.

Do not take it during labour, especially if the baby is premature.

Do not take it if you are breastfeeding or planning to breastfeed.

Do not take this medicine after the expiry date (EXP) printed on the pack.

If you take it after the expiry has passed, it may not work as well.

Do not take this medicine if the packaging is torn or shows signs of tampering.

  • If it has expired or is damaged, return it to your pharmacist for disposal.

Check with your doctor if you:

  • plan to have surgery
  • have difficulty breathing, experience wheezing, chronic cough, asthma or other chronic breathing conditions.

have any form of problems with breathing as a result of emphysema, kyphoscoliosis or obesity

  • have a known analgesic intolerance
  • have or have had heart, liver or kidney problems
  • underactive thyroid
  • have a history of drug dependence, including alcohol dependence
  • experience chronic alcohol use including recent cessation of alcohol intake
  • have a pre-existing opioid dependence
  • have low glutathione reserves
  • have Gilbert's syndrome
  • have had recent surgery of the stomach or intestine
  • have prostate problems
  • have multiple sclerosis
  • have low blood pressure
  • have had a head injury or trauma
  • have urinary, bowel or gallbladder conditions
  • have chronic constipation
  • have problems with the adrenal glands
  • have myasthenia gravis, a muscle disorder
  • have convulsions, fits or seizures
  • if you know you are a CYP 2D6 ultra-rapid metaboliser

Tell your doctor or pharmacist about anything listed above before you start taking Prodeine.

During treatment, you may be at risk of developing certain side effects. It is important you understand these risks and how to monitor for them. See additional information under Section 6. Are there any side effects?

Pregnancy and breastfeeding

Check with your doctor if you are pregnant or intend to become pregnant.

Talk to your doctor if you are breastfeeding or intend to breastfeed. Prodeine passes into breast milk and there is a possibility your baby may be affected.

Do not take Prodeine during the third trimester of pregnancy.

Do not take Prodeine during labour, especially if the baby is premature.

This may produce withdrawal effects in the newborn baby.

If you are over 65 years of age

Talk to your doctor or pharmacist about how much to take.

Elderly patients are more likely to have less effective kidney function due to age. This may increase the risk of side effects.

Addiction

You can become addicted to Prodeine even if you take it exactly as prescribed. Prodeine may become habit forming causing mental and physical dependence. If abused it may become less able to reduce pain.

Dependence

As with all other opioid containing products, your body may become used to you taking Prodeine. Taking it may result in physical dependence. Physical dependence means that you may experience withdrawal symptoms if you stop taking Prodeine suddenly, so it is important to take it exactly as directed by your doctor.

Tolerance

Tolerance to Prodeine may develop, which means that the effect of the medicine may decrease. If this happens, more may be needed to maintain the same effect.

Withdrawal

Continue taking your medicine for as long as your doctor tells you. If you stop having this medicine suddenly, your pain may worsen and you may experience some or all of the following withdrawal symptoms:

  • nervousness, restlessness, agitation, trouble sleeping or anxiety
  • body aches, weakness or stomach cramps
  • loss of appetite, nausea, vomiting or diarrhoea
  • increased heart rate, breathing rate or pupil size
  • watery eyes, runny nose, chills or yawning
  • increased sweating.

Prodeine given to the mother during labour can cause breathing problems and signs of withdrawal in the newborn.

3. What if I am taking other medicines?

Tell your doctor or pharmacist if you are taking any other medicines, including any medicines, vitamins or supplements that you buy without a prescription from your pharmacy, supermarket or health food shop.

Some medicines may interfere with the absorption of Prodeine. These include:

  • medicines used to help relax, sleep or relieve anxiety, such as barbiturates, sedatives, tranquillisers, hypnotics, gabapentinoids, cannabis and centrally-active anti-emetics
  • benzodiazepines (medicines used as sedatives or to treat anxiety)
  • medicines containing alcohol (ethanol), e.g. some cough syrups
  • antihistamines (medicines used to treat allergies)
  • medicines used to treat epilepsy or fits
  • medicines which thin the blood such as warfarin
  • other opioid analgesics used to treat pain
  • monoamine oxidase inhibitors, medicine used to treat depression, taken within the last 14 days
  • flucloxacillin, zidovudine or rifampicin, medicines used to treat infections
  • metoclopramide or domperidone, medicines used to control nausea and vomiting
  • quinidine, a medicine used to treat abnormal or irregular heartbeat
  • phenothiazines and antipsychotic agents, medicines used to treat mental disorders
  • medicines used to treat depression
  • chloramphenicol, an antibiotic used to treat ear and eye infection
  • medicines used to relieve stomach cramps or spasms, to prevent travel sickness and to treat Parkinson's disease
  • medicines used to treat high blood pressure
  • cholestyramine, a medicine used to lower high cholesterol levels
  • chelating resin
  • medicines used to treat alcohol and/or opioid dependence (e.g. naltrexone, buprenorphine or methadone)
  • medicines for diarrhoea, such as kaolin, pectin and loperamide
  • medicines used to control electrolytes levels in kidney disease

These medicines may be affected by Prodeine or may affect how well Prodeine works.

You may need to use different amounts of your medicine, or take different medicines. Your pharmacist or doctor will advise you.

Your doctor or pharmacist will have more information on medicines to be careful with or avoid while taking Prodeine.

Check with your doctor or pharmacist if you are not sure about what medicines, vitamins or supplements you are taking and if these affect Prodeine.

4. How do I use Prodeine?

How much to take

Adults and children 12 years or over:

  • One or two tablets every 3 to 4 hours as needed for relief.
  • Do not take more than 8 caplets in 24 hour period

Follow the instructions provided and use Prodeine until your doctor tells you to stop.

When to take Prodeine

  • Prodeine should be used for the temporary relief of acute moderate pain and fever as per the instructions given to you by your doctor.
  • Prodeine is not recommended for children under 12 years of age.
  • Prodeine is not recommended for use over an extended period of time.

Do not take more than the recommended dose.

How to take Prodeine

Swallow the tablets whole with a full glass of water or other liquid.

  • Prodeine can be taken with or without food.

If you forget to use Prodeine

Prodeine should be used exactly as your doctor has instructed.

You may take Prodeine as soon as you remember or if you think you need it.

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

This may increase the chance of getting unwanted side effect.

If you are not sure what to do, ask your pharmacist or doctor.

If you take too much Prodeine

If you or someone else receive too much (overdose), and experience one or more of the symptoms below, immediately call triple zero (000) for an ambulance. Keep the person awake by talking to them or gently shaking them every now and then. You should follow the above steps even if someone other than you have accidentally used Prodeine that was prescribed for you. If someone takes an overdose they may experience one or more of the following symptoms:

  • Slow, unusual or difficult breathing
  • Drowsiness, dizziness or unconsciousness
  • Slow or weak heartbeat
  • Nausea or vomiting
  • Convulsions or fits

If you think that you have taken too much Prodeine, you may need urgent medical attention.

You should immediately:

  • phone the Poisons Information Centre
    (by calling 13 11 26), or
  • contact your doctor, or
  • go to the Emergency Department at your nearest hospital.

You should do this even if there are no signs of discomfort or poisoning.

When seeking medical attention, take this leaflet and remaining medicine with you to show the doctor. Also tell them about any other medicines or alcohol which have been taken.

Large amounts of paracetamol, one of the active ingredients, can cause liver damage. Children who take too much Prodeine can also suffer extreme drowsiness, rash or have trouble seeing.

Depending on your body's individual ability to break down codeine, you may experience signs of overdose even when you take Prodeine as recommended by your doctor. If overdose symptoms occur, seek immediate medical advice.

5. What should I know while using Prodeine?

Things you should do

Tell your doctors, dentists and pharmacists who are treating you that you are taking Prodeine.

If you are about to be started on any new medicine, tell your pharmacist or doctor that you are taking Prodeine.

If you plan to have surgery that needs a general anaesthetic, tell your doctor or dentist that you are taking this medicine.

Talk to your pharmacist or doctor about pain control if Prodeine is not helping.

Your pharmacist or doctor will assess your condition and decide if you should continue to take Prodeine.

Things you should not do

Children:

  • Do not give this medicine to children under 12 years of age
  • Do not give this medicine for more than 48 hours unless a doctor tells you.

Adults:

Do not take more than a few days at a time unless your doctor tells you to.

  • Do not take more than the recommended dose unless your pharmacist or doctor tells you to.
  • Do not give this medicine to anyone else, even if they have the same condition as you.
  • Do not use this medicine to treat any other complaints unless your pharmacist or doctor tells you to.

Driving or using machines

Be careful before you drive or use any machines or tools until you know how Prodeine affects you.

Prodeine may cause drowsiness in some people. If this happens, do not drive or operate machinery.

Drinking alcohol

Tell your doctor if you drink alcohol.

Do not drink while taking Prodeine.

Drinking large quantities of alcohol while taking Prodeine may increase the risk of liver side effects due to paracetamol.

Looking after your medicine

  • Store below 30° C.

Follow the instructions in the carton on how to take care of your medicine properly.

Keep your tablets in the blister pack until it's time to take them.

Store it in a cool dry place away from moisture, heat or sunlight; for example, do not store it:

  • in the bathroom or near a sink, or
  • in the car or on windowsills.

Keep it 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.

Getting rid of any unwanted medicine

If you no longer need to use this medicine or it is out of date, take it to any pharmacy for safe disposal.

Do not use this medicine after the expiry date.

6. Are there any side effects?

All medicines can have side effects. If you do experience any side effects, most of them are minor and temporary. However, some side effects may need medical attention.

See the information below and, if you need to, ask your doctor or pharmacist if you have any further questions about side effects.

Do not be alarmed by this list of possible side effects.

You may not experience any of them.

Tell your pharmacist or doctor as soon as possible if you do not feel well while you are taking Prodeine.

Less serious side effects

Less serious side effectsWhat to do
Stomach and urinary related:
  • constipation
  • vomiting or nausea
  • indigestion
  • difficulty in passing urine
Head and neurology related:
  • ringing in the ear
  • dizziness
  • drowsiness
  • dry mouth
  • headache
Allergy related
  • sweating
Speak to your doctor if you have any of these less serious side effects and they worry you.
These are mild side effects of this medicine and usually short-lived.

Serious side effects

Serious side effectsWhat to do
Allergy related
  • wheezing or difficulty breathing, shallow breathing or shortness of breath, swelling of the face, lips, tongue or other parts of the body
  • flushing of the face
Skin related
  • painful red areas with blisters and peeling layers of skin which may be accompanied by fever and/or chills
  • severe blisters and bleeding in the lips, eyes, mouth, nose and genitals
  • skin rashes
Stomach and liver related
  • hepatitis (symptoms include loss of appetite, itching, yellowing of the skin and eyes, light coloured bowel motions, dark coloured urine)
  • severe stomach pain, nausea and vomiting
Neurological and behavioural
  • unusual or extreme mood swings
  • dizziness, light-headedness
  • fast heartbeat
Metabolism related:
  • Symptoms of rapid breathing, rapid heart rate and changes in consciousness caused by pyroglutamic acidosis (an accumulation of pyroglutamic acid due to low levels of a protein called glutathione).
Call your doctor straight away, or go straight to the Emergency Department at your nearest hospital if you notice any of these serious side effects.

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

Other side effects not listed here may occur in some people.

Reporting side effects

After you have received medical advice for any side effects you experience, you can report side effects to the Therapeutic Goods Administration online at www.tga.gov.au/reporting-problems. By reporting side effects, you can help provide more information on the safety of this medicine.

Always make sure you speak to your doctor or pharmacist before you decide to stop taking any of your medicines.

7. Product details

This medicine is only available with a doctor's prescription.

What Prodeine contains

Active ingredient
(main ingredient)
Paracetamol and codeine phosphate hemihydrate.
Other ingredients
(inactive ingredients)
COMPAP L, sodium starch glycollate, purified talc, magnesium stearate

Do not take this medicine if you are allergic to any of these ingredients.

What Prodeine looks like

Prodeine is available as white capsule shaped tablets plain on one side and a break line on the other (Aust R 200605).

Prodeine is available in packs of 24 and 40* tablets.

*pack size currently not marketed

Who distributes Prodeine

sanofi-aventis australia pty ltd
12-24 Talavera Road
Macquarie Park NSW 2113
Toll Free Number (medical information): 1800 818 806
Email: [email protected]

This leaflet was prepared in December 2021.

prodeine-ccdsv5-cmiv12-03dec21

Published by MIMS January 2022

BRAND INFORMATION

Brand name

Prodeine

Active ingredient

Paracetamol; Codeine phosphate hemihydrate

Schedule

S4

 

1 Name of Medicine

Paracetamol, codeine phosphate hemihydrate.

2 Qualitative and Quantitative Composition

Prodeine contains paracetamol 500 mg and codeine phosphate hemihydrate 9.6 mg.
Prodeine is aspirin-free.
For the full list of excipients, see Section 6.1 List of Excipients.

3 Pharmaceutical Form

The caplets are white capsule shaped tablets, plain on one side and a breakline on the other.

4 Clinical Particulars

4.1 Therapeutic Indications

For the relief of acute moderate pain and fever.

4.2 Dose and Method of Administration

Adults and children 12 years of age and older.

One or two caplets every 3 to 4 hours as needed for relief. Do not exceed 8 caplets in 24-hour period.
Prodeine is not recommended for use over extended periods of time.
Use in children under 12 years is contraindicated.

4.3 Contraindications

Prodeine is contraindicated in patients:
with known hypersensitivity to paracetamol, codeine or any of the excipients used in this product;
with severe respiratory disease, acute respiratory disease and respiratory depression for example an acute asthma attack;
with glucose-6-phosphate-dehydrogenase deficiency;
with severely impaired liver or renal function;
with diarrhoea caused by pseudomembranous colitis or poisoning (until the causative organism or toxin has been eliminated from the gastrointestinal tract, since codeine may slow down the elimination, thereby prolonging the diarrhoea);
with chronic constipation;
with active alcoholism;
during labour when delivery of a premature infant is anticipated as it may produce codeine withdrawal symptoms in neonate;
during breast-feeding (see Section 4.6 Fertility, Pregnancy and Lactation, Use in lactation);
aged between 12 - 18 years in whom respiratory function might be compromised, including post-tonsillectomy and/or adenoidectomy for obstructive sleep apnoea, due to an increased risk of developing serious and life-threatening adverse reactions (see Section 4.4 Special Warnings and Precautions for Use, Paediatric use);
who are CYP2D6 ultra-rapid metabolisers (see Section 4.4 Special Warnings and Precautions for Use, CYP2D6 metabolism).
Prodeine is contraindicated for use in patients younger than 12 years (see Section 4.4 Special Warnings and Precautions for Use, Paediatric use).

4.4 Special Warnings and Precautions for Use

Hepatotoxicity may occur with paracetamol even at therapeutic doses, after short treatment duration and in patients without pre-existing liver dysfunction. This medication may be dangerous when used in large amounts or for long periods. Hepatotoxicity may develop following a dose of 10 g of paracetamol and hepatic failure is known to occur occasionally with the long term use of paracetamol.

To avoid the risk of overdose.

Check that paracetamol is absent from the composition of other medicinal products taken concomitantly.
Codeine should be used with caution in patients with CNS depression or decreased respiratory reserve e.g. emphysema, kyphoscoliosis, or severe obesity.
Codeine should be administered with caution in patients with impaired cardiac, hepatic or renal function, hypotension, urethral stenosis, gallbladder conditions, multiple sclerosis, hypothyroidism, adrenocortical insufficiency, shock, acute alcohol intoxication or benign prostatic hyperplasia, hypotension, myasthenia gravis, inflammatory or obstructive bowel disorders, recent gastrointestinal tract surgery, raised intracranial pressure or head injury.
Patients who have had a cholecystectomy should be treated with caution. The contraction of the sphincter of Oddi can cause symptoms resembling those of myocardial infarction or intensify the symptoms in patients with pancreatitis.
Codeine should be used with caution in patients with convulsive disorders.
Extensive use of analgesics to relieve headaches or migraines, especially at high doses, may induce headaches that must not be treated with increased doses of the drug. In such cases the analgesic should not continue to be taken without medical advice.
Monitoring after prolonged use should include blood count, liver function and renal function.
Codeine should only be used after careful risk-benefit assessment in case of:
Opioid dependence.
Conditions with elevated intracranial pressure and head trauma. Codeine can increase the pressure of cerebrospinal fluid and may increase the respiratory depressant effect. Like other narcotics, it causes adverse reactions that can obscure the clinical course of patients with head injury.
Impaired consciousness.
Compromised respiratory function (due to emphysema, kyphoscoliosis, severe obesity) and chronic obstructive airway disease.
Patients with known analgesic intolerance or known bronchial asthma must only use Prodeine after having consulted a physician (hypersensitivity reactions including bronchospasm are possible).
Caution is advised in patients with underlying sensitivity to aspirin and/or to non-steroidal anti-inflammatory drugs (NSAIDs).*
*Changes of clinical significance.

Severe cutaneous adverse reactions (SCARs).

Life threatening cutaneous reactions Stevens-Johnson syndrome (SJS), and Toxic Epidermal Necrolysis (TEN) have been reported with the use of paracetamol. Patients should be advised of the signs and symptoms and monitored closely for skin reactions. If symptoms or signs of SJS and TEN (e.g. progressive skin rash often with blisters or mucosal lesions) occur, patients should stop paracetamol treatment immediately and seek medical advice.
Paracetamol should be used upon medical advice in patients with:
mild to moderate hepatocellular insufficiency (see Section 4.4 Special Warnings and Precautions for Use, Use in hepatic impairment);
severe renal insufficiency (see Section 4.4 Special Warnings and Precautions for Use, Use in renal impairment);
chronic alcohol use including recent cessation of alcohol intake;
low glutathione reserves;
Gilbert's syndrome.

CYP2D6 metabolism.

Prodeine is contraindicated for use in patients who are CYP2D6 ultra-rapid metabolisers.
Codeine is metabolised by the liver enzyme CYP2D6 into morphine, its active metabolite. If a patient has a deficiency or is completely lacking this enzyme an adequate analgesic effect will not be obtained.
However, if the patient is an extensive or ultra-rapid metaboliser, there is an increased risk of developing side effects of opioid toxicity even at commonly prescribed doses. These patients convert codeine into morphine rapidly resulting in higher than expected serum morphine levels. General symptoms of opioid toxicity include confusion, somnolence, shallow breathing, small pupils, nausea, vomiting, constipation and lack of appetite. In severe cases this may include symptoms of circulatory and respiratory depression, which may be life-threatening and very rarely fatal. Children are particularly susceptible due to their immature airway anatomy. Deaths have been reported in children with rapid metabolism who were given codeine for analgesia post adenotonsillectomy. Morphine can also be ingested by infants through breast milk, causing risk of respiratory depression to infants of rapid metaboliser mothers who take codeine. The prevalence of codeine ultra-rapid metabolism by CYP2D6 in children is not known, but is assumed to be similar to that reported in adults. The prevalence of ultra-rapid metabolisers differs according to racial and ethnic group.
It is estimated to be 1% in those of Chinese, Japanese and Hispanic descent, 3% in African Americans and 1%-10% in Caucasians. The highest prevalence (16%-28%) occurs in North African, Ethiopian and Arab populations. (Also see Section 4.4 Special Warnings and Precautions for Use, Paediatric use; Section 4.6 Fertility, Pregnancy and Lactation, Use in lactation).

Hazardous and harmful use.

Prodeine contains the opioid codeine and is a potential drug of abuse, misuse and addiction. Addiction can occur in patients appropriately prescribed Prodeine at recommended doses.
The risk of addiction is increased in patients with a personal or family history of substance abuse (including alcohol and prescription and illicit drugs) or mental illness. The risk also increases the longer the drug is used and with higher doses. Patients should be assessed for their risks for opioid abuse or addiction prior to being prescribed Prodeine.
There have been reports of drug abuse with codeine, including cases in children and adolescents. Caution is particularly recommended for use in children, adolescents, young adults and in patients with a history of drug and/or alcohol abuse. See Section 4.4 Special Warnings and Precautions for Use, Paediatric use.
All patients receiving opioids should be routinely monitored for signs of misuse and abuse. Opioids are sought by people with addiction and may be subject to diversion. Strategies to reduce these risks include prescribing the drug in the smallest appropriate quantity and advising the patient on the safe storage and proper disposal of any unused drug (see Section 6.4 Special Precautions for Storage; Section 6.6 Special Precautions for Disposal). Caution patients that abuse of oral or transdermal forms of opioids by parenteral administration can result in serious adverse events, which may be fatal.
Patients should be advised not to share Prodeine with anyone else.

Respiratory depression.

Serious, life-threatening or fatal respiratory depression can occur with the use of opioids even when used as recommended. It can occur at any time during the use of Prodeine but the risk is greatest during initiation of therapy or following an increase in dose. Patients should be monitored closely for respiratory depression at these times.
The risk of life-threatening respiratory depression is also higher in elderly, frail, or debilitated patients, in patients with hepatic and renal impairment (see Use in hepatic impairment and Use in renal impairment) and in patients with existing impairment of respiratory function (e.g. chronic obstructive pulmonary disease; asthma). Opioids should be used with caution and with close monitoring in these patients. The use of opioids is contraindicated in patients with severe respiratory disease, acute respiratory disease and respiratory depression (see Section 4.3 Contraindications).
The risk of respiratory depression is greater with the use of high doses of opioids, especially high potency and modified release formulations, and in opioid naïve patients. Initiation of opioid treatment should be at the lower end of the dosage recommendations with careful titration of doses to achieve effective pain relief. Careful calculation of equianalgesic doses is required when changing opioids or switching from immediate release to modified release formulations, together with consideration of pharmacological differences between opioids. Consider starting the new opioid at a reduced dose to account for individual variation in response.

Risks from concomitant use of benzodiazepines or other CNS depressants, including alcohol.

Concomitant use of opioids and benzodiazepines or other CNS depressants, including alcohol, may result in sedation, respiratory depression, coma and death. Because of these risks, concomitant prescribing of Prodeine with CNS depressant medicines, such as other opioid analgesics, benzodiazepines, gabapentinoids, cannabis, sedatives, hypnotics, tricyclic antidepressants, antipsychotics, antihistamines, centrally-active anti-emetics and other CNS depressants, should be reserved for patients for whom other treatment options are not possible. If a decision is made to prescribe Prodeine concomitantly with any of the medicines, the lowest effective dose should be used, and the duration of treatment should be as short as possible. Patients should be followed closely for signs and symptoms of respiratory depression and sedation. Patients and their caregivers should be made aware of these symptoms. Patients and their caregivers should also be informed of the potential harms of consuming alcohol while taking Prodeine.

Use of opioids in chronic (long-term) non-cancer pain (CNCP).

Opioid analgesics have an established role in the treatment of acute pain, cancer pain and palliative and end-of-life care. Current evidence does not generally support opioid analgesics in improving pain and function for most patients with chronic non-cancer pain. The development of tolerance and physical dependence and risks of adverse effects, including hazardous and harmful use, increase with the length of time a patient takes an opioid. The use of opioids for long-term treatment of CNCP is not recommended.
The use of an opioid to treat CNCP should only be considered after maximised non-pharmacological and non-opioid treatments have been tried and found ineffective, not tolerated or otherwise inadequate to provide sufficient management of pain. Opioids should only be prescribed as a component of comprehensive multidisciplinary and multimodal pain management.
Opioid therapy for CNCP should be initiated as a trial in accordance with clinical guidelines and after a comprehensive biopsychosocial assessment has established a cause for the pain and the appropriateness of opioid therapy for the patient (see Hazardous and harmful use, above). The expected outcome of therapy (pain reduction rather than complete abolition of pain, improved function and quality of life) should be discussed with the patient before commencing opioid treatment, with agreement to discontinue treatment if these objectives are not met.
Owing to the varied response to opioids between individuals, it is recommended that all patients be started at the lowest appropriate dose and titrated to achieve an adequate level of analgesia and functional improvement with minimum adverse reactions. Immediate-release products should not be used to treat chronic pain, but may be used for a short period in opioid-naïve patients to develop a level of tolerance before switching to a modified-release formulation. Careful and regular assessment and monitoring is required to establish the clinical need for ongoing treatment. Discontinue opioid therapy if there is no improvement of pain and/or function during the trial period or if there is any evidence of misuse or abuse. Treatment should only continue if the trial has demonstrated that the pain is opioid responsive and there has been functional improvement. The patient's condition should be reviewed regularly and the dose tapered off slowly if opioid treatment is no longer appropriate (see Ceasing opioids).

Tolerance, dependence and withdrawal.

Neuroadaptation of the opioid receptors to repeated administration of opioids can produce tolerance and physical dependence. Tolerance is the need for increasing doses to maintain analgesia. Tolerance may occur to both the desired and undesired effects of the opioid.
Physical dependence, which can occur after several days to weeks of continued opioid usage, results in withdrawal symptoms if the opioid is ceased abruptly or the dose is significantly reduced. Withdrawal symptoms can also occur following the administration of an opioid antagonist (e.g. naloxone) or partial agonist (e.g. buprenorphine). Withdrawal can result in some or all of the following symptoms: dysphoria, restlessness/agitation, lacrimation, rhinorrhoea, yawning, sweating, chills, myalgia, mydriasis, irritability, anxiety, increasing pain, backache, joint pain, weakness, abdominal cramps, insomnia, nausea, anorexia, vomiting, diarrhoea, increased blood pressure, increased respiratory rate and increased heart rate.
When discontinuing Prodeine in a person who may be physically-dependent, the drug should not be ceased abruptly but withdrawn by tapering the dose gradually (see Ceasing opioids).

Accidental ingestion/exposure.

Accidental ingestion or exposure of Prodeine, especially by children, can result in a fatal overdose of codeine. Patients and their caregivers should be given information on safe storage and disposal of unused Prodeine (see Section 6.4 Special Precautions for Storage; Section 6.6 Special Precautions for Disposal).

Hyperalgesia.

Hyperalgesia may occur with the use of opioids, particularly at high doses. Hyperalgesia may manifest as an unexplained increase in pain, increased levels of pain with increasing opioid dosages or diffuse sensitivity not associated with the original pain. Hyperalgesia should not be confused with tolerance (see Tolerance, dependence and withdrawal). If opioid induced hyperalgesia is suspected, the dose should be reduced and tapered off if possible. A change to a different opioid may be required.

Ceasing opioids.

Abrupt discontinuation or rapid decreasing of the dose in a person physically dependent on an opioid may result in serious withdrawal symptoms and uncontrolled pain (see Tolerance, dependence and withdrawal). Such symptoms may lead the patient to seek other sources of licit or illicit opioids. Opioids should not be ceased abruptly in a patient who is physically dependent but withdrawn by tapering the dose slowly. Factors to take into account when deciding how to discontinue or decrease therapy include the dose and duration of the opioid the patient has been taking, the type of pain being treated and the physical and psychological attributes of the patient. A multimodal approach to pain management should be in place before initiating an opioid analgesic taper. During tapering, patients require regular review and support to manage any increase in pain, psychological distress and withdrawal symptoms.
There are no standard tapering schedules suitable for all patients and an individualised plan is necessary. In general, tapering should involve a dose reduction of no more than 10 percent to 25 percent every 2 to 4 weeks. If the patient is experiencing increased pain or serious withdrawal symptoms, it may be necessary to go back to the previous dose until stable before proceeding with a more gradual taper.
When ceasing opioids in a patient who has a suspected opioid use disorder, the need for medication assisted treatment and/or referral to a specialist should be considered.

Use in hepatic impairment.

Prodeine should be used with caution in hepatic dysfunction.

Use in renal impairment.

Prodeine should be used with caution in renal dysfunction.

Use in the elderly.

Dosage should be reduced in elderly or debilitated patients because of the danger of respiratory or cardiac depression. Elderly people may be more sensitive to the effects of this medicinal product, especially respiratory depression. They are also more prone to suffering hypertrophy, prostatic obstruction and age-related renal impairment and they have a higher likelihood of undesirable effects due to opioid-induced urinary retention.

Paediatric use.

This product is contraindicated for use in children:
younger than 12 years;
aged between 12 - 18 years in whom respiratory function might be compromised, including post tonsillectomy and/or adenoidectomy for obstructive sleep apnoea. Respiratory depression and death have occurred in some children who received codeine following tonsillectomy and/or adenoidectomy and had evidence of being ultra-rapid metabolisers of codeine due to a CYP2D6 polymorphism.
(Also see Section 4.4 Special Warnings and Precautions for Use, CYP2D6 metabolism.)

Effects on laboratory tests.

Uric acid and blood glucose.

Intake of paracetamol may affect the laboratory determination of uric acid by phosphotungstic acid and of blood glucose by glucose oxidase-peroxidase.

4.5 Interactions with Other Medicines and Other Forms of Interactions

Patients receiving other opioid analgesics, antitussives, antihypertensives, antihistamines, antipsychotics, antianxiety or other CNS depressants eg. gabapentinoids, cannabis, centrally-active anti-emetics, hypnotics, sedatives, tranquillisers, including alcohol, may exhibit an additive CNS depression and increases the risk of sedation, respiratory depression, coma and death (see Section 4.4 Special Warnings and Precautions for Use, Risks from concomitant use of benzodiazepines or other CNS depressants, including alcohol).

Morphinic agonists-antagonists.

Concomitant use of codeine with a partial agonist (e.g. buprenorphine) or antagonist (e.g. naltrexone) can precipitate or delay codeine effects.
The concomitant use of benzodiazepines and opioids increases the risk of sedation, respiratory depression, coma and death because of additive CNS depressant effect. Limit dosage and duration of concomitant use of benzodiazepines and opioids (see Section 4.4 Special Warnings and Precautions for Use).
The concomitant use of alcohol and opioids increases the risk of sedation, respiratory depression, coma and death because of additive CNS depressant effect. Concomitant use with alcohol is not recommended (see Section 4.4 Special Warnings and Precautions for Use).
Concurrent administration or use within 14 days of ceasing monoamine oxidase inhibitors (MAOIs) may enhance the potential respiratory depressant effects of codeine and other side effects of unpredictable severity.
A codeine-induced respiratory depression can be potentiated by tricyclic antidepressants.
Codeine may increase the hypotensive effects of antihypertensive agents.
Other potential interactions with codeine include anticholinergic agents or antidiarrhoeal agents (due to the risk of severe constipation and CNS depression); metoclopramide (as codeine may antagonise the effects of this medicine on gastrointestinal motility); and drugs that can inhibit CYP2D6 such as quinidine, phenothiazines and antipsychotic agents as they can interfere with the metabolism of codeine to morphine, reducing the analgesic effect of codeine.
The risk of paracetamol toxicity may be increased in patients receiving other potentially hepatotoxic drugs or drugs that induce liver microsomal enzymes, such as barbiturates and other antiepileptics (such as phenobarbital, phenytoin, carbamazepine, topiramate), rifampicin and alcohol.
Paracetamol may increase the risk of bleeding in patients taking warfarin and other antivitamin K. Patients taking paracetamol and antivitamin K should be monitored for appropriate coagulation and bleeding complications.
Paracetamol may considerably slow down the excretion of chloramphenicol, entailing the risk of increased toxicity. When used concurrently with zidovudine, an increased tendency for neutropenia may develop. Combination of Prodeine and zidovudine should be avoided.
Concurrent intake of drugs, which delay gastric emptying, such as propantheline, may slow down the uptake of paracetamol, thereby retarding its onset of action. Conversely, drugs, which accelerate gastric emptying, such as metoclopramide or domperidone, may accelerate the absorption rate of paracetamol and its onset of action.
Cholestyramine reduces the absorption of paracetamol if given within 1 hour of paracetamol. Paracetamol excretion may be affected and plasma concentrations altered when given with probenecid.
Chelating resin can decrease the intestinal absorption of paracetamol and potentially decrease its efficacy if taken simultaneously. In general, there must be an interval of more than 2 hours between taking the resin and taking paracetamol, if possible.
Co-administration of flucloxacillin with paracetamol may lead to metabolic acidosis, particularly in patients presenting risk factors of glutathione depletion, such as sepsis, malnutrition or chronic alcoholism.

CYP2D6 inhibitors.

Codeine is metabolized by the liver enzyme CYP2D6 to its active metabolite morphine. Medicines that inhibit CYP2D6 activity may reduce the analgesic effect of codeine. Patients taking codeine and moderate to strong CYP2D6 inhibitors (such as quinidine, fluoxetine, paroxetine, bupropion, cinacalcet, methadone) should be adequately monitored for reduced efficacy and withdrawal signs and symptoms. If necessary, an adjustment of the treatment should be considered.

CYP3A4 inducers.

Medicines that induce CYP3A4 activity may reduce the analgesic effect of codeine. Patients taking codeine and CYP3A4 inducers (such as rifampin) should be adequately monitored for reduced efficacy and withdrawal signs and symptoms. If necessary, an adjustment of the treatment should be considered.

4.6 Fertility, Pregnancy and Lactation

Effects on fertility.

No data available.
(Category A)
There have been no observations of an increase in the frequency of malformations or other direct or indirect harmful effects on the foetus in pregnant women and women of child-bearing age who have taken the active ingredients in Prodeine.
However, prolonged high-dose use of codeine prior to delivery may produce codeine withdrawal symptoms in the neonate. Opioid analgesics may cause respiratory depression in the newborn infant. Codeine may cause respiratory depression and withdrawal syndrome in neonates born to mothers who use codeine during the third trimester of pregnancy. As a precautionary measure, use of Prodeine should be avoided during the third trimester of pregnancy and during labour. Prodeine should only be used during pregnancy under medical supervision if the potential benefit justifies the potential risk to the foetus. If administered during pregnancy, morphinomimetic properties of codeine should be taken into account.
Prodeine is contraindicated during breast-feeding (see Section 4.3 Contraindications; Section 4.4 Special Warnings and Precautions for Use, CYP2D6 metabolism) due to risk of respiratory depression in the infant. There is no data available on the use of Prodeine during lactation. If Prodeine is administered to a breastfeeding mother, alternative arrangements should be made for feeding the infant.
Paracetamol and codeine pass into breast milk. Analgesic doses excreted in breast milk are generally low. However, infants of breastfeeding mothers taking codeine may have an increased risk of morphine overdose if the mother is an ultrarapid metaboliser of codeine. Codeine is excreted into human breast milk. Codeine is partially metabolized by cytochrome P450 2D6 (CYP2D6) into morphine, which is excreted into breast milk. If nursing mothers are CYP2D6 ultra-rapid metabolisers, higher levels of morphine may be present in their breast milk. This may result in symptoms of opioid toxicity in both mother and the breast-fed infant. Life-threatening adverse events or neonatal death may occur even at therapeutic doses (see Section 4.4 Special Warnings and Precautions for Use, CYP2D6 metabolism).
Therefore, Prodeine is contraindicated for use during breastfeeding. However, in circumstances where a breastfeeding mother requires codeine therapy, breastfeeding should be suspended and alternative arrangements should be made for feeding the infant for any period during codeine treatment. Breastfeeding mothers should be told how to recognise signs of high morphine levels in themselves and their babies. For example, in a mother symptoms include extreme sleepiness and trouble caring for the baby. In the baby, symptoms include signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties or limpness. Medical advice should be sought immediately.

4.7 Effects on Ability to Drive and Use Machines

The codeine in Prodeine may cause drowsiness, disturbances of visuomotor coordination and visual acuity, impairing the mental and or physical ability required for the performance of potentially dangerous tasks, in some people. Those affected should not drive or operate machinery or engage in activities which require them to be alert.

4.8 Adverse Effects (Undesirable Effects)

Reports of adverse reactions with paracetamol are rare. Dyspepsia, nausea, sweating, erythema, urticaria, anaphylactic shock, angioneurotic oedema, difficulty in breathing, skin rashes, drop in blood pressure, allergic and haematological reactions (thrombocytopenia, leukopenia, neutropenia, anaemia, agranulocytosis and pancytopenia) have been reported. A causal relationship to the administration of paracetamol has not been confirmed. Toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome (SJS), acute generalised exanthematous pustulosis, fixed drug eruption (see Section 4.4 Special Warnings and Precautions for Use) and cytolytic hepatitis, which may lead to acute hepatic failure, have also been reported.
Bronchospasm may be triggered in patients having a tendency of analgesic asthma.
Constipation, dry mouth, nausea and vomiting, dizziness, hypotension and drowsiness may occur in association with codeine. Other side effects are rare, especially at dosage levels provided with Prodeine. These include cough suppression, respiratory depression, confusional state, seizure, headache, somnolence, fatigue, sedation, euphoria, dysphoria, skin rashes, pruritus, histamine release (hypotension, flushing of the face, tachycardia, breathlessness) and other allergic reactions. Long term use also entails the risk of drug dependence.
Tinnitus and miosis have been associated with codeine use. Visuomotor coordination and visual acuity may be adverse affected in a dose-dependent manner at higher doses or in particularly sensitive patients.
Very rarely, skin rashes may occur in patients hypersensitive to codeine. Pancreatitis has been reported very rarely.
Renal failure, uraemia, urinary retention or hesitance have been reported less frequently to rarely when both paracetamol and codeine have been administered.
Haemolytic anaemia, particularly in patients with underlying glucose 6-phosphate-dehydrogenase deficiency has been reported. Kounis syndrome has been reported, as has pyroglutamic acidosis in patients with pre-disposing factors for glutathione depletion. Bronchospasm has also been reported.

Reporting suspected adverse effects.

Reporting suspected adverse reactions after registration of the medicinal product is important. It allows continued monitoring of the benefit-risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions at www.tga.gov.au/reporting-problems.

4.9 Overdose

Elderly persons, small children, patients with liver disorders, chronic alcohol consumption or chronic malnutrition, as well as patients concomitantly treated with enzyme-inducing drugs are at an increased risk of intoxication, including fatal outcome.
It has been reported that paracetamol may produce symptoms of acute toxicity in adults, following the ingestion of more than 15 g. Hepatotoxicity may develop after the ingestion of a single dose of 10 to 15 g (200 to 250 mg/kg) and a dose of more than 25 g is potentially fatal. Nausea, vomiting, anorexia, pallor and abdominal pain generally appear during the first 24 hours of overdosage with paracetamol. Overdosage with paracetamol may cause hepatic cytolysis which can lead to hepatocellular insufficiency, gastrointestinal bleeding, metabolic acidosis, encephalopathy, disseminated intravascular coagulation, coma and death. Increased levels of hepatic transaminases, lactate dehydrogenase and bilirubin with a reduction in prothrombin level can appear 12 to 48 hours after acute overdosage. It can also lead to pancreatitis, acute renal failure and pancytopenia. Patients may be asymptomatic for several days following ingestion of large doses of paracetamol and laboratory evidence of hepatotoxicity may be delayed for up to one week. Non-fatal hepatic damage is usually reversible. The antidote, N-acetylcysteine, should be administered as early as possible.
Despite lack of significant early symptoms, patients should be referred to hospital urgently for immediate medical attention.
Determinations of the plasma concentration of paracetamol are recommended.
Plasma concentration of paracetamol should be measured at 4 hours or later after ingestion (earlier concentrations are unreliable).
Where paracetamol intoxication is suspected, intravenous administration of SH group donators such as acetylcysteine within the first 10 hours after ingestion is indicated. Although acetylcysteine is most effective if initiated within this period, it can still offer some degree of protection if given as late as 48 hours after ingestion; in this case it is taken for longer.
In an evaluation of codeine intoxication in children, symptoms ranked by decreasing order of frequency included sedation, rash, miosis, vomiting, itching, ataxia and swelling of the skin. Respiratory failure may occur. Blood concentrations of codeine ranged from 1.4 to 5.6 microgram/mL in eight adults whose deaths were attributed primarily to codeine overdosage.
The ingestion of very high doses of codeine can cause initial excitation, anxiety, insomnia followed by drowsiness in certain cases, areflexia progressing to stupor or coma, headache, miosis, alterations in blood pressure, arrhythmias, dry mouth, hypersensitivity reactions, cold clammy skin, bradycardia, tachycardia, convulsions, gastrointestinal disorders, nausea, vomiting and respiratory depression.
Severe intoxication can lead to apnoea, circulatory collapse, cardiac arrest and death.
Relating to codeine component. In general, treatment should be symptomatic: re-establish adequate respiratory exchange by ensuring a clear airway and using mechanical ventilation. When treatment for paracetamol toxicity has been initiated the opioid antagonist naloxone hydrochloride is an antidote to respiratory depression; naloxone 400 microgram may be administered SC, IM or IV.
Further measures will depend on the severity, nature and course of clinical symptoms of intoxication and should follow standard intensive care protocols.
For information on the management of overdose, contact the Poisons Information Centre on 131126 (Australia).

5 Pharmacological Properties

5.1 Pharmacodynamic Properties

Mechanism of action.

Paracetamol is an analgesic and antipyretic. It reduces fever by a direct effect on the heat-regulating centres to increase dissipation of body heat.
Codeine phosphate hemihydrate acts centrally on opiate receptors. Its analgesic effect is thought to be due mainly to its partial metabolic conversion to morphine. Codeine has about one-sixth the analgesic activity of morphine.

Clinical trials.

No data available.

5.2 Pharmacokinetic Properties

Absorption.

Paracetamol is rapidly absorbed from the gastrointestinal tract with peak plasma levels usually reached half to one hour after oral administration. Food intake delays paracetamol absorption.
Codeine is well absorbed from the gastrointestinal tract and does not interfere with paracetamol absorption.

Distribution.

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.

Metabolism.

Paracetamol is metabolised by the hepatic microsomal enzyme system. In adults at therapeutic doses, paracetamol is mainly conjugated with glucuronide (45-55%) or sulfate (20-30%). A minor proportion (less than 20%) is metabolised to catechol derivatives, and mercapturic acid compounds via oxidation. The metabolites of paracetamol include a minor hydroxylated intermediate which has hepatotoxic activity. This intermediate metabolite is detoxified by conjugation with glutathione, however, it can accumulate following paracetamol overdosage (more than 150 mg/kg or 10 mg total paracetamol ingested) and if left untreated can cause irreversible liver damage. Paracetamol is metabolised differently by infants and children compared to adults, the sulfate conjugate being predominant.

Excretion.

Paracetamol is excreted in the urine mainly as the glucuronide and sulphate conjugates. Less than 5% is excreted as unchanged paracetamol with 85-90% of the administered dose eliminated in the urine within 24 hours of ingestion. The elimination half-life varies from 1 to 4 hours.
Codeine 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.
The plasma half-life of codeine has been reported to be between 3 and 4 hours after oral administration.

5.3 Preclinical Safety Data

Genotoxicity.

No data available.

Carcinogenicity.

No data available.

6 Pharmaceutical Particulars

6.1 List of Excipients

Prodeine also contains Compap L, sodium starch glycollate, purified talc and magnesium stearate.

6.2 Incompatibilities

Incompatibilities were either not assessed or not identified as part of the registration of this medicine.

6.3 Shelf Life

In Australia, information on the shelf life can be found on the public summary of the Australian Register of Therapeutic Goods (ARTG). The expiry date can be found on the packaging.

6.4 Special Precautions for Storage

Store below 30°C.

6.5 Nature and Contents of Container

Prodeine is available as caplets of 12*, 24, 36*, or 40*.
*Not marketed.

6.6 Special Precautions for Disposal

In Australia, any unused medicine or waste material should be disposed of by taking to your local pharmacy.

6.7 Physicochemical Properties

Paracetamol is an odourless, crystalline powder or crystals with a bitter taste. Codeine phosphate hemihydrate is an odourless, crystalline powder or small colourless crystals with a bitter taste.

Chemical structure.


Paracetamol MW 151.17.
Codeine phosphate hemihydrate MW 406.37.

CAS number.

CAS - 103-90-2 (paracetamol). CAS 41444-62-6 (codeine phosphate hemihydrate).

7 Medicine Schedule (Poisons Standard)

Prescription Only Medicine (Schedule 4).

Summary Table of Changes