I bought some OTC pain meds for backache. Each tablet contains 500mg paracetamol and 7.5mg dihydrocodeine tartrate. Apparently, these are the strongest painkillers you can buy without prescription in the UK.
However, I recall a conversation I had with a nurse a few years ago wherein she said that the minimum effective dose for codeine was 30mg, and anything less than that wasn’t worth taking.
On the packaging, it says I can only take two tablets every 4-6 hours. Therefore, I’d only be taking half the minimum effective dose of codeine, and, QED, I’d be no worse off if I’d just bought generic 500mg paracetamol tablets.
My hunch is that these tablets are BS, and they just put a nominal amount of codeine in them to trick you into thinking that they’re stronger than they are.
Not a pain expert, but seeing that the standard oral codeine dosage for pain in adults is 15 to 60 mg every 4-6 hours, 7.5 mg x 2 is at the low end of expected effectiveness, but not a placebo.
I’m surprised that any codeine-containing med is available OTC in the UK (not permitted in the U.S.). It also seems risky in that someone might be tempted to increase self dosage to get more codeine, thereby risking a hepatotoxic dose of paracetamol (acetaminophen).
I’m more of a journeyman than an expert when it comes to pain management, but I have managed a lot of patients with chronic pain, including malignant pain.
Dihydrocodeine is reported to be 2-3 x more potent than codeine, so 7.5 mg of it would be equivalent to about 15-20 mg of codeine. For an opioid-naive patient, that’s enough to provide some effect. However, if the patient’s been popping oxycodone for pain relief, they won’t even feel that dose of dihydrocodeine. I’ve not seen dihydrocodeine used in the US since the 1980s, when they were marketing it under the brand name Synalgos-DC, as a ‘safer’ opioid (laughing bitterly at that). It didn’t really take off but they still market it in the US.
It’s certainly not just a placebo, as it’s easy enough to take a fatal dose of it (with either the opioid or the acetaminophen in it capable of knocking one off).
I really don’t know why they insist on combining opioids with acetaminophen. Arguments that it discourages abuse of such meds because people are afraid of dying from the tylenol in it rarely stopped an opioid addict from taking 40 tabs at once. I’ve seen plenty of them in the ER, in need of acetylcysteine to keep the tylenol from killing them.
A certain percentage of folks (10-20%) get little to no effect from codeine at all due to genetic inability to metabolize it into morphine and norcodeine. Without that metabolic step, codeine doesn’t cross the blood-brain barrier so don’t activate opioid receptors. Dihydrocodeine is also metabolized into morphine in most people, but does cross the barrier so is still somewhat effective for folks who can’t metabolize it.
Are completely meaningless if the users don’t know how dangerous Tylenol is. Which most people don’t. Addiction might lead people to take a known-lethal dose of Tylenol with Codeine, but it’d definitely lead people to take a dose that they didn’t know was lethal. Hopefully, the ones lucky enough to end up in the ER learn better for next time, but I’m sure there are plenty for whom there never is a next time.
Tylenol (paracetamol) may be a placebo for back pain anyway (low quality study cite). It’s also ineffective for headaches for me, too. Advil or aspirin for headaches for me, Advil or Aleve for back pain for me.
I understand that it’s safer for your gut, though, but so is nothing.
I don’t know about the opioid side of it, but the Tylenol part may well be a high-dose placebo for back pain.
My sister used to smuggle the otc codeine pain killers from Ireland to the US because it was the only thing she had found that helped her menstrual cramps. She’s not the type to read all the fine print and then try a new product. I’m sure someone handed her a pain pill, and she said, “wow, that really worked, what is it?” So i assume the stuff is not just a placebo.
That was infuriating for my mother, who had on and off through her life taken low-dose codeine for pain, with no negative side effects through all those years – including that she never wanted a higher dose, and never had any problem with stopping it for months on end when she didn’t need it. But acetominophen made her feel ill. She did manage, with some difficulty, to get a prescription for straight codeine and to get a pharmacy to fill it – that was back in the 1990’s/early 20-oughts.
– years before, when things were a lot looser, she used to give me some of her codeine for menstrual cramps. I reacted to it the same way that she did: pain went away, no side effects, no desire to keep taking it once the cramps were gone. Acetaminophen doesn’t make me ill, but it does nothing at all noticeable to me; it’s not helpful at all for pain. Luckily, by the time codeine got harder to get, I could get ibuprofen, which does for me work on menstrual cramps, if not quite as well; but I’ve never found anything for a bad cough that works a tenth as well for me as codeine cough syrup, which has also become next to impossible to get. Its substitutes apparently were at least as susceptible to abuse; and now as near as I can tell all you can get is stuff that doesn’t work at all, or no better than hot tea with honey, which won’t get you a good night’s sleep.
Luckily I haven’t had a bad cough in years. I now dread ever getting one.
Neither my mother nor I knew that was possible at home; nor did we, or I now, know how to do it.
For me: ibuprofen works best for headaches (I no longer have menstrual cramps, thank you menopause); aspirin works best for muscle aches, which is what back pain generally is in me, though I sometimes have other muscle aches from physical work. I’ve never had any problems taking aspirin, though I know some people do.
I recently filled a (small) prescription for codeine cough syrup, to keep around the house in case i get a cough bad enough that i can’t sleep. I don’t like to use it for a productive cough, since i feel it’s good to move that crap out of my lungs. But sometimes a cold ends with a persistent non-productive cough, and a good cough suppressant is great. The last time i used a lot of codeine is when i had whooping cough, but I’ve had a spoonful before bed a couple of times since then.
Anyway, talk to your doctor. The stuff is still on the market, and you might be able to score some.
I’m afraid to do that, because I don’t want to be put down as drug-seeking.
And my long-term doctor retired; I’m now on the second replacement attempt. So it isn’t somebody who’s known me for years.
I really would like to be able to get a bottle to keep in the house in case, and to be able to replace it when it becomes out of date.
The last time I managed to pry such a prescription out of the previous long-term doctor, it was mixed with acetominaphen and I couldn’t get it until I’d already been up all night with a non-productive cough for two nights (she made me try something else first.) And that was before this latest opiod panic.
Ah. Codeine keeps forever. Now that cough syrup isn’t dissolved in alcohol, i mix it 50/50 with whiskey to keep crap from growing in it. And i ignore the expiration date. That little bottle is going to be my cough syrup stash for many years.
Thanks – I’ll remember that technique if I ever get another one. It was a very small bottle, though, and I used most of it with that first cough, and I think finished the rest off a year or two later.
My issue isn’t that the OTC stuff doesn’t work, by the way, it’s that it’s too potent. I grew up with codeine cough syrup and never had any problems with it. Then times changed, and i had a really bad cough, and called my doctor seeking help. He gave me a prescription for dextromethorphan, which is the cough suppressant in most of the otc stuff. I’m sure i took an overdose. (i mean, i took the dose he prescribed, but it was an overdose for me.) It was an AWESOME cough suppressant, better than codeine. And i also had disphoria and disassociation, and i couldn’t concentrate enough to work and i was too twitchy to sleep. I was miserable. So i begged him for codeine, and I’ve kept a stash of codeine cough syrup ever since. I don’t take much of it, and i haven’t changed doctors often, so that hasn’t been too hard.
Sometimes it has other crap in it, but the amount i take is little enough that the other crap is basically irrelevant.
I’m also one of those for whom OTC cough syrup does jack shit. I only once had a codeine prescription for cough, and I was floored at how well it worked, or just that it even had a discernable effect. I tried getting a refill months later without seeing my doctor and found out that he had his medical license suspended for over prescribing opiates. Oh well. And that was the last time I had anything that worked for my cough.
To the OP. Have you tried using them? Does it work? If it does work, what is the problem?
If it doesn’t work, it just may not be the pain killer your body reacts to.
For years I was given hydrocodone for cases of severe pain- post operations, kidney stone attack, etc… I told the doctors that it wasn’t doing anything for me compared to how other people said it worked for them. Had another kidney stone and the doctor upped the prescription and I broke out in a severe case of hives, apparently I am allergic to hydrocodone and that may have been the reason why it wasn’t effective. Luckily there are other pain medicines that do work for me.