Generic Name: paracetamol and codeine phosphate hemihydrate
Product Name: Panamax Co
Indication: What Panamax Co is used for
Action: How Panamax Co works
Paracetamol and codeine work together to stop the pain messages from getting through to the brain.
Panamax Co tablets contain 500 mg of the active ingredient paracetamol and 8 mg of the active ingredient codeine phosphate hemihydrate. It also contains the inactive ingredients starch-maize, starch- soluble maize, cellulose- microcrystalline, talc-purified, stearic acid, povidone, magnesium stearate, and potassium sorbate.
Panamax Co does not contain gluten, lactose, sucrose, tartrazine or any azo dyes.
Dose advice: How to use Panamax Co
Before you take Panamax Co tablets
When you must not take it
Do not take Panamax Co if you have an allergy to paracetamol or codeine or any of the ingredients listed here.
Some of the symptoms of an allergic reaction may include:
- Shortness of breath;
- Wheezing or difficulty breathing;
- Swelling of the face, lips, tongue, or other parts of the body;
- Rash, itching or hives on the skin.
Do not take this medicine if you have or have had any of the following medical conditions:
- Acute breathing difficulties such as bronchitis, unstable asthma, or emphysema;
- Liver failure;
- Chronic constipation;
- Diarrhoea caused by antibiotics or poisoning;
- Glucose-6-phosphate dehydrogenase deficiency (an enzyme deficiency);
- Known ultra-rapid metaboliser of CYP 2D6 (a fast metaboliser of codeine by the CYP 2D6 enzyme).
Do not take codeine if you have alcohol dependence.
Do not give Panamax Co to children under 12 years.
Do not give Panamax Co to children aged between 12-18 years who have undergone tonsillectomy and/or adenoidectomy to treat sleep apnoea.
Do not take Panamax Co during the third trimester of pregnancy.
Do not take codeine during labour, especially if the baby is premature. This medicine may produce withdrawal effects in the newborn baby.
Do not take it if you are breastfeeding or planning to breastfeed. Panamax Co passes into breast milk and there is a possibility your baby may be affected.
Do not use Panamax Co after the expiry date (EXP) printed on the pack. If you take it after the expiry date has passed, it may not work (as well). Do not use Panamax Co if the packaging is torn or shows signs of tampering. If it has expired or is damaged, return it to your pharmacist for disposal.
If you are not sure whether you should start taking Panamax Co, talk to your doctor or pharmacist.
Before you start to take it
Tell your doctor or pharmacist if you have allergies to aspirin, other NSAIDs, any other medicines, foods, preservatives or dyes.
Tell your doctor or pharmacist if you have or have had any of the following medical conditions:
- Difficulty breathing, wheezing, chronic cough, asthma, or other chronic breathing conditions;
- Compromised respiratory function (due to emphysema, kyphoscoliosis or obesity);
- Known analgesic intolerance;
- A history of drug dependence, including alcohol dependence;
- Pre-existing opioid dependence;
- Chronic alcohol use including recent cessation of alcohol intake;
- Low glutathione reserves;
- Gilbert’s syndrome;
- Recent surgery on the stomach, intestine or urinary tract;
- Chronic constipation;
- Head injury or trauma;
- Prostate problems;
- Heart, liver or kidney problems;
- Urinary, bowel or gallbladder conditions;
- Addison’s disease;
- Multiple sclerosis;
- Low blood pressure;
- Underactive thyroid;
- Are under 18 and have undergone adenoidectomy and/or tonsillectomy;
- If you know you are a CYP 2D6 ultra-rapid metaboliser;
- Convulsions, fits or seizures.
Tell your doctor or pharmacist if you plan to have surgery.
Tell your doctor or pharmacist if you take sedatives (medicines used to help you relax or sleep).
Tell your doctor or pharmacist if you are pregnant or intend to become pregnant. Your doctor or pharmacist will discuss the risks and benefits of taking it during pregnancy.
If you have not told your doctor or pharmacist about any of the above, tell them before start taking Panamax Co.
Taking other medicines
Tell your doctor or pharmacist if you are taking any other medicines, including any that you buy without a prescription from your pharmacy, supermarket or health food store.
Some medicines and Panamax Co may interfere with each other. These include:
- Medicines used to help you relax, sleep or relieve anxiety, such as barbiturates and sedatives;
- Benzodiazepines (medicines used as sedatives or to treat anxiety);
- Medicines containing alcohol (ethanol), e.g. some cough syrups;
- Medicines which thin the blood;
- Medicines to treat epilepsy or fits;
- Metoclopramide or domperidone, medicines used to control nausea and vomiting;
- Propantheline, a drug used to relieve stomach cramps or spasms;
- Medicines used to prevent travel sickness and to treat Parkinson’s disease;
- Medicines used to treat high blood pressure;
- Medicines for diarrhoea, such as kaolin, pectin, and loperamide;
- Medicines used to treat depression;
- Monoamine oxidase inhibitors, medicines used to treat depression, taken within the last 14 days;
- Other opioid analgesics used to treat pain;
- Quinidine, a medicine used to treat abnormal or irregular heartbeat;
- Phenothiazines and antipsychotic agents, medicines used to treat mental disorders;
- Chloramphenicol, an antibiotic used to treat ear and eye infections;
- Flucloxacillin, zidovudine or rifampicin, drugs used to treat infections;
- Chelating resin;
These medicines may be affected by Panamax Co or may affect how well Panamax Co works. You may need different amounts of your medicines, or you may need to take different medicines.
Your doctor or pharmacist will have more information on medicines to be careful with or avoid while taking this medicine.
If you have not told your doctor or pharmacist about any of these things, tell them before you take any Panamax Co.
How to take Panamax Co
Follow all directions given to you by your doctor or pharmacist carefully. They may differ from the information contained here.
How much to take
The label on your pack of Panamax Co will tell you how to take your medicine and how often. If you do not understand the instructions on the pack, ask your doctor or pharmacist for help.
The usual dose of Panamax Co is 1 to 2 tablets (adults). This dosage may be repeated every 4-6 hours if necessary.
You should not take more than 8 tablets in 24 hours.
Do not give Panamax Co to children under 12 years.
Do not take more than the recommended dose.
Talk to your doctor or pharmacist about pain control if Panamax Co is not helping.
If your body cannot metabolise codeine properly, you may be getting reduced benefit from the medicine.
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.
How long to take it
Only take Panamax Co for a few days at a time unless your doctor tells you to take it longer.
Only give Panamax Co to children for up to 48 hours unless a doctor has told you to give it longer.
How to take it
Swallow tablets with a little water or other liquid.
If you take too much (overdose)
Immediately telephone your doctor or Poisons Information Centre (telephone 13 11 26) for advice, or go to Accident and Emergency at your nearest hospital, if you think that you or anyone else has taken too much Panamax Co. Do this even if there are no signs of discomfort or poisoning. You may need urgent medical attention.
Keep telephone numbers of these places handy.
If you take too many tablets you may feel nauseous, lightheaded, dizzy or drowsy.
While you are taking it
Things you must do
Tell all the doctors, dentists and pharmacists who are treating you that you are taking Panamax Co.
Talk to your doctor or pharmacist if your symptoms don’t improve. Your pharmacist or doctor will assess your condition and decide if you should continue to take the medicine.
If you are about to be started on any new medicine, tell your doctor and pharmacist that you are taking Panamax Co.
If you plan to have surgery that needs a general anaesthetic, tell your doctor or dentist that you are taking this medicine.
Things you must not do
Do not give Panamax Co for more than 48 hours unless a doctor has told you to.
Do not take for more than a few days at a time unless your doctor tells you to.
Do not drink alcohol while taking Panamax Co. Drinking alcohol while taking paracetamol (which is contained in Panamax Co) may increase the risk of liver side effects.
Do not take more than the recommended dose unless your doctor tells you to.
Do not take Panamax Co to treat any other complaints unless your doctor or pharmacist tells you to.
Do not give your medicine to anyone else, even if they have the same condition as you.
Things to be careful of
Be careful driving or operating machinery until you know how this medicine affects you. This medicine may cause dizziness or light-headedness in some people.
Be careful if you are elderly, unwell or taking other medicines. Some people may experience side effects such as drowsiness, confusion, dizziness and unsteadiness, which may increase the risk of a fall.
After taking Panamax Co
Keep your tablets in the blister pack until it is time to take them.
Keep Panamax Co in a cool, dry place where the temperature stays below 25°C. Do not store Panamax Co or any other medicine in the bathroom or near a sink. Do not leave it on a windowsill or in the car. Heat and dampness can destroy some medicines.
Keep Panamax Co 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.
Ask your pharmacist what to do with any tablets left over, or if the expiry date has passed.
Schedule of Panamax Co
Panamax Co is a prescription only medicine (Schedule 4).
Side effects of Panamax Co
Tell your doctor or pharmacist as soon as possible if you do not feel well while taking Panamax Co. This medicine helps most people with pain and fever, but it may have unwanted side effects in a few people. All medicines can have side effects. Sometimes they are serious, most of the time they are not. You may need medical attention if you get some of the side effects.
Do not be alarmed by the following list of side effects. You may not experience any of them.
Ask your doctor or pharmacist to answer any questions you may have.
Tell your doctor or pharmacist if you notice any of the following and they worry you:
The above list includes the more common side effects of your medicine. They are usually mild.
Tell your doctor as soon as possible if you notice any of the following:
- Shallow breathing or shortness of breath;
- Unusual or extreme mood swings;
- Dizziness, light-headedness;
- Flushing of the face;
- Fast heartbeat;
- Painful red areas with blisters and peeling layers of skin which may be accompanied by fever and/or chills;
- Loss of appetite, itching, yellowing of the skin and eyes, light coloured bowel motions, dark coloured urine.
The above list includes serious side effects that may require medical attention. These side effects are rare.
If any of the following happen, tell your doctor immediately or go to Accident and Emergency at your nearest hospital:
- Wheezing or difficulty breathing;
- Swelling of the face, lips, tongue or other parts of the body;
- Severe blisters and bleeding in the lips, eyes, mouth, nose and genitals;
- Skin rashes.
The above list includes very serious side effects. You may need urgent medical attention or hospitalisation. These side effects are very rare.
Tell your doctor if you notice anything else that is making you feel unwell. Other side effects not listed above may also occur in some people.
For further information talk to your doctor.