📋 Indications & Clinical Dosage
*Mild to moderate pain:*
Adult: 8/500-16/1000 mg every 4-6 hours as required; max. 64/4000 mg per day; alternatively, 15/500-30/1000 mg every 4-6 hours as required; max. 120/4000 mg per day.
*Severe pain (using co-codamol 30/500 preparations only):*
Adult: 30/500-60/1000 mg every 4-6 hours as required; max. 240/4000 mg per day.
⛔ Contraindications
Acute ulcerative colitis, abdominal distention, conditions where inhibition of peristalsis should be avoided, known ultra-rapid codeine metabolisers, respiratory depression, obstructed airways, acute alcoholism, head injury, raised intra cranial pressure, biliary tract surgery.
⚠️ Precautions & Warnings
Cardiac arrhythmias, chronic alcoholism, chronic dehydration, chronic malnutrition, convulsive disorders, gallstones, hepatocellular insufficiency, hypothyroidism, renal or hepatic impairment, BPH, inflammatory or obstructive bowel disease, elderly, labour, sodium restricted diets.
🔄 Drug Interactions
MAOIs or CNS depressants.
⚠️ Adverse Reactions / Side Effects
Abdominal pain, anorexia, blood disorders, depression, hypothermia, leucopenia, malaise, muscle fasciculation, neutropenia, pancreatitis, seizures, thrombocytopenia, dependence, constipation, nausea, dry mouth, dizziness, sedation, blurred vision, confusion, urinary retention.
🤰 Pregnancy & Lactation Safety
Pregnancy Risk:
Risk of respiratory depression and withdrawal symptoms in the neonate, risk of gastric stasis and inhalation pneumonia in the mother if opioid analgesics are used during labour and delivery
Lactation / Breastfeeding:
Not recommended
📚 Official Regulatory & Clinical References
- Drug Regulatory Authority of Pakistan (DRAP): Drug Registration, S.R.O. Price Gazettes & National Essential Medicines List (NEML).
- World Health Organization (WHO): Collaborating Centre for Drug Statistics Methodology (ATC/DDD Index).
- Formulary Standards: British National Formulary (BNF) & Pakistan National Formulary (PNF) guidelines.