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What you need to know before you take Paramol

• This medicine contains dihydrocodeine which can cause addiction if you take it continuously for more than three days. This can give you withdrawal symptoms from the medicine when you stop taking it. • If you take a pain killer for headaches for more than three days it can make them worse. Do not take Paramol Tablets if you: – are allergic to paracetamol, dihdyrocodeine or any of the other ingredients in the product (see section 6) – are suffering from diarrhoea caused by poisoning or have watery and severe diarrhooea which may be bloody, especially if you have been taking antibiotics (Pseudomembranous colitis) – are dependent on alcohol – suffer from raised pressure within your head or from convulsion and acute abdominal conditions – are taking antidepressants from a group called Monoamine Oxidase Inhibitors (MAOIs) or have taken them in the last 14 days – are pregnant or breastfeeding – are suffering from breathing difficulties – suffer from delayed stomach emptying and decreased movement in your intestines – are under 18 years of age and have had your tonsils or adenoids removed for Obstructive Sleep Apnoea Syndrome – know that you metabolise codeine into morphine very rapidly Speak to your doctor or pharmacist if you… – have allergies – have asthma (do not take the tablets if you are having an asthma attack) – have liver or kidney problems – have an underactive thyroid gland – have low blood pressure or if your adrenal glands are not working properly – have an enlarged prostate, bowel problems, have had recent surgery, have gallstones, difficulty passing urine – have myasthenia gravis, a history of arrythmias, a history of convulsions – have a history of drug use or mood swings – are elderly – before giving to a child with any sort of breathing problem Taking other medicines – Monoamine oxidase inhibitors e.g. Pethidine, warfarin (to thin the blood), domperidone or metoclopramide (to threat nausea and vomiting), cholerstyramine (to reduce cholesterol) – Hydroxyzine (to treat anxiety), central nervous system depressants such as alcohol, aneasthetics, hypnotics and sedatives – Phenothiazine (an antipsychotic), diuretics and medicines taken to reduce high blood pressure – loperamide or kaolin (to treat diarrhoea) – a drug from the antimuscarinic family (a type of drug that temporarily block nerve endings) e.g. atropine or any other kind of neuromuscular blocking medication (e.g. tracrium) – quinidine (to treat malaria), mexiletine (to treat high blood pressure or irregular heartbeat), cisapride and cimetidine (to treat reflux) – naloxone (used to treat addiction to opioids) or naltrexone (a drug used to treat alcohol addiction). – benzodiazepines (to treat depression, anxiety) or related sedative medicines. – flucloxacillin (antibiotic), due to a serious risk of blood and fluid abnormality (high anion gap metabolic acidosis) that must have urgent treatment and which may occur particularly in case of severe renal impairment, sepsis (when bacteria and their toxins circulate in the blood leading to organ damage), malnutrition, chronic alcoholism, and if the maximum daily doses of paracetamol are used. Take special care • If you take a painkiller for headaches for more than three days it can make them worse. Other medicines and Paramol Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. Concomitant use of Paramol and opioids (strong pain killers, medicines for substitution therapy and some cough medicines) or sedative medicines such as benzodiazepines or related drugs increases the risk of drowsiness, difficulties in breathing (respiratory depression), coma and may be life-threatening. Because of this, concomitant use should only be considered when other treatment options are not possible. However if your doctor does prescribe Paramol together with opioids or sedative medicines the dose and duration of concomitant treatment should be limited by your doctor. Please tell your doctor about all opioid or sedative medicines you are taking, and follow your doctor’s dose recommendation closely. It could be helpful to inform friends or relatives to be aware of the signs and symptoms stated above. Contact your doctor when experiencing such symptoms. If you are pregnant or breast feeding… – do not use this product if you are pregnant or breast feeding Driving and using machines These tablets can impair mental function and can cause blurred or double vision, hallucinations, convulsions, confusion, drowsiness, dizziness and may make you sleepy. • Do not drive while taking this medicine until you know how it affects you • If you feel affected, do not drive or operate machinery • It may be an offence to drive when taking this medicine • However, you would not be committing an offence if: – The medicine has been taken to treat a medical or dental problem and – You have taken it according to the information provided with the medicine and – It was not affecting your ability to drive safely Talk to your doctor or pharmacist if you are not sure whether it is safe for you to drive while taking this medicine. Details regarding a new driving offence concerning driving after drugs have been taken in the UK may be found here: https://www.gov.uk/drug-driving-law