Co-dydramol: prescribe and dispense by strength to minimise risk of medication error

Previously co-dydramol (dihydrocodeine/paracetamol) was available only in the ratio 1:50 (co-dydramol 10/500 mg). Two products are now available with a higher strength of dihydrocodeine (co-dydramol 20/500 mg and 30/500 mg tablets). It is therefore important that co-dydramol products are prescribed and dispensed by strength to minimise dispensing errors and the risk of accidental opioid overdose.

Advice for healthcare professionals:

  • new co-dydramol products are available with a higher dose of dihydrocodeine (co dydramol 20/500 mg and co-dydramol 30/500 mg tablets)
  • when prescribing co-dydramol, clearly indicate tablet strength and dose
  • when dispensing co-dydramol, ensure patients receive the prescribed strength of co dydramol, and, if in doubt, contact the prescriber
  • report suspected adverse drug reactions with opioids, including any harm from medication error, via the Yellow Card Scheme

The ratio of dihydrocodeine to paracetamol in co-dydramol was previously fixed at 1:50 (ie, 10 mg/500 mg). Marketing authorisations have recently been approved for co-dydramol 20 mg/500 mg tablets and co-dydramol 30 mg/500 mg tablets.

The packaging for different co-dydramol products has been designed to clearly differentiate between the strengths. However, you should be vigilant when prescribing and dispensing to ensure patients receive the correct dose of dihydrocodeine.

New products are only just becoming available and we have not received any Yellow Card reports of dosing error with new formulations of co-dydramol. If a dosing error occurs and a patient has signs of opioid toxicity, consult the Summary of Product Characteristics and follow local care guidance for opioid overdose. Instruct patients to always read the leaflet that accompanies their medicine and to never exceed the recommended dose.

Article citation: Drug Safety Update volume 11 issue 6; January 2018: 4.

Published 9 January 2018