Panadeine Forte is a combination pain medication used short-term to treat acute pain. Each tablet of Panadeine Forte contains 30 mg codeine phosphate hemihydrate and 500 mg paracetamol (known as acetaminophen in the U.S.)
Paracetamol is a simple painkilling medicine used to relieve mild to moderate pain. Despite its widespread use for over 100 years, we still don’t fully understand how paracetamol works to relieve pain. However, it is now thought that it works by reducing the production of prostaglandins in the brain and spinal cord.
The body produces prostaglandins in response to injury and certain diseases. One of the effects of prostaglandins is to sensitize nerve endings, causing pain (presumably to prevent us from causing further harm to the area). As paracetamol reduces the production of these nerve-sensitizing prostaglandins, it is thought it may increase our pain threshold, so that although the cause of the pain remains, we don’t feel it as much.
Codeine phosphate is a slightly stronger painkiller known as an opioid. Opioid painkillers work by mimicking the action of naturally occurring pain-reducing chemicals called endorphins. Endorphins are found in the brain and spinal cord and reduce pain by combining with opioid receptors. Codeine mimics the action of natural endorphins by combining with the opioid receptors in the brain and spinal cord. This blocks the transmission of pain signals sent by the nerves to the brain. Therefore, even though the cause of the pain may remain, less pain is actually felt.
Panadeine Forte is used to treat various types of pain, including:
- Low back pain
- Joint pain
- Menstrual cramps
How is Panadeine Forte taken?
The dosage recommended by the doctor may be different from the recommended dosage.
The recommended dose of Panadeine Forte is:
Adults: 1 tablet for mild to moderate pain, 2 tablets for severe pain. This dosage may be repeated in 4-6 hours if necessary. Do not take more than 8 tablets in 24 hours.
Do not take more than the recommended dose. Taking more than the recommended dose may cause liver damage. Talk to your doctor about pain control if the medicine is not helping.
If your body cannot metabolize codeine properly, you may be getting reduced benefits from the medicine. Panadeine Forte is metabolized by an enzyme in the liver known as CYP2D6. This process converts Panadeine Forte to the active drug, morphine. In certain people, this conversion happens more quickly than usual. They are classified as CYP2D6 rapid metabolizers. This quicker metabolism can lead to unsafe morphine levels in the body. People who are CYP2D6 rapid metabolizers should not take Panadeine Forte.
It is recommended that the lowest effective dose for the shortest possible time be prescribed.
The following chart shows the maximum recommended amounts of acetaminophen and codeine:
|Maximum amount per dose
|Maximum amount per day
|300 mg to 1,000 mg
|30 mg to 60 mg
Panadeine Forte is a schedule III controlled substance. Due to the potential for addiction, abuse, and misuse, the Food and Drug Administration (FDA) requires a Risk Evaluation and Mitigation Strategy (REMS) for these products.
What should I do if I forget a dose?
This medication usually is taken as needed. If your doctor has told you to take Panadeine Forte regularly, take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.
What side effects can Panadeine Forte cause?
Panadeine Forte may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
• difficulty urinating
Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately or get emergency medical help:
• nausea, vomiting, loss of appetite, weakness, or dizziness
• agitation, hallucinations (seeing things or hearing voices that do not exist), fever, sweating, confusion, fast heartbeat, shivering, severe muscle stiffness or twitching, loss of coordination, nausea, vomiting, or diarrhea
• red, peeling or blistering skin
• swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
• difficulty breathing or swallowing
• inability to get or keep an erection
• irregular menstruation
• decreased sexual desire
Panadeine Forte may cause other side effects. Call your doctor if you have any unusual problems while you are taking this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).
In case of emergency/overdose
In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can’t be awakened, immediately call emergency services at 911.
While taking Panadeine Forte, you should talk to your doctor about having a rescue medication called naloxone readily available. Naloxone is used to reverse the life-threatening effects of an overdose. It works by blocking the effects of opiates to relieve dangerous symptoms caused by high levels of opiates in the blood. Your doctor may also prescribe you naloxone if you are living in a household where there are small children or someone who has abused street or prescription drugs. You should make sure that you and your family members, caregivers, or the people who spend time with you know how to recognize an overdose, how to use naloxone, and what to do until emergency medical help arrives. Your doctor or pharmacist will show you and your family members how to use the medication. Ask your pharmacist for the instructions or visit the manufacturer’s website to get the instructions. If symptoms of an overdose occur, a friend or family member should give the first dose of naloxone, call 911 immediately, and stay with you and watch you closely until emergency medical help arrives. Your symptoms may return within a few minutes after you receive naloxone. If your symptoms return, the person should give you another dose of naloxone. Additional doses may be given every 2 to 3 minutes if symptoms return before medical help arrives.
If someone takes more than the recommended dose of Panadeine Forte, get medical help immediately, even if the person does not have any symptoms. Symptoms of overdose may include the following:
• loss of appetite
• unusual bleeding or bruising
• pain in the upper right part of the stomach
• yellowing of skin or eyes
• slow or shallow breathing
• difficulty breathing
• unable to respond or wake up
• loss of muscle tone
• narrowed or widened pupils
• cold and clammy skin
• slow heartbeat
Can a pregnant or breastfeeding woman take Panadeine Forte?
No, Panadeine Forte is not recommended for use during pregnancy. Do not take Panadeine Forte while you are breastfeeding. Codeine and morphine pass into breast milk.