It is pretty normal to visit a doctor for a pain complaint while your doctor advises you to take analgesics (painkillers) to alleviate your suffering. However, in certain cases, routine analgesics are rendered ineffective as they do not mitigate the pain sensation. This is when your doctor will prescribe you a stronger analgesic that usually contains an opioid component in it. 

The opioid class of analgesics though very effective at managing the pain, have the potential of addiction and abuse. Opioid medication can lead to the development of dependence so when you or someone you know is using an opioid medication either alone or in combination with other medicine then monitoring is required to ensure safe use of the drug. 

Solpadeine tablets are pain-relieving medications that contain paracetamol and codeine which are used for the short-term treatment of moderate pain that is not relieved by routine analgesics such as ibuprofen, paracetamol, or aspirin alone. It is used for the treatment of headaches including migraines, toothache, menstrual pain, rheumatic pain, and back pain. It is further used to treat sports injuries such as sprains, muscle cramps, and sciatica. 

Diazepam Addiction in UK

The generic name of Solpadeine is Co-codamol which is a combination painkiller containing Paracetamol and Codeine. Paracetamol, popularly known as acetaminophen, is a non-narcotic analgesic and anti-pyretic. Paracetamol is used as an alternative to NSAIDs in patients who have gastric complaints are those who do not desire the anti-inflammatory effect of NSAIDs.

Codeine is a naturally occurring opioid that has a weak analgesic effect as compared to morphine. Therefore, codeine is used to treat mild to moderate pain. The codeine component in Solpadeine has the potential to cause dependency and addiction, owing to the property associated with the opioid class of analgesics.

In the UK, Co-codamol is known by different brand names including, Panadol Ultra, Solpadol, and Solpadeine Max among others.

Different names are attributed to Solpadeine based on the composition and strength of paracetamol, codeine, and caffeine present in it. For instance, Solpadeine Plus contains 500mg Paracetamol, 8mg Codeine phosphate hemihydrate, and 30mg caffeine. Whereas, Solpadeine Max contains 500mg Paracetamol and 12.8mg Codeine phosphate hemihydrate with no caffeine component. Likewise, Solpadol contains 500mg of Paracetamol and 30mg of Codeine with no added caffeine. Since Solpadeine Max and Solpadol have the same components and are both brand names of Co-codamol of different strengths these names will be used interchangeably in this text. 

Solpadeine should not be used in children less than 12 years of age due to the presence of codeine which is an opioid component and carries the risk of developing toxicities that can be dangerous for the health of these individuals. 

  • For children aged 12 to 15 years- 1 tablet should be administered every 6 hours as per need. The maximum dose is 4 tablets in 24 hours and you should refrain from exceeding this prescribed limit.
  • For children aged 16 to 18 years- 1 to 2 tablets should be administered every 6 hours as per need. The maximum dose is 8 tablets in 24 hours and you should not exceed this prescribed limit.
  • For adults including the elderly- 2 tablets can be taken with an interval of 6 hours between the doses. The maximum dose is 8 tablets in 24 hours and you should not take more than prescribed. 

You must follow the regime prescribed by your doctor and do not use these opioid combination medications for more than 3 days as they carry potential risk for the development of dependency which paves the way to addiction and the outcomes can be deleterious to your health. Moreover, these tablets should be orally administered and should not be crushed or chewed. 

Solpadeine is a combination of paracetamol and codeine, with each medicine having its unique mechanism of action through which it acts and mediates its action and thus helps in pain relief. 

Paracetamol acts by blocking certain enzymes in the body that are involved in the synthesis of prostaglandin thereby hindering their release. Prostaglandins are chemicals in the body that play a vital role in the perception of pain and therefore when their production is reduced by the action of Paracetamol, the pain sensations are alleviated thereby providing pain relief. 

Codeine is a pro-drug of morphine hence it is first metabolized to morphine in the liver and then it produces its analgesic effect by acting on the opioid receptors present in the central nervous system. It acts by blocking the transmission of pain signals across neurons thereby providing pain relief. Moreover, codeine interferes with the brain’s reward system by increasing the release of dopamine which elevates the mood and creates a feeling of mild euphoria and a sense of generalized well-being. These effects of codeine are the reason for the misuse of Solpadeine and other drugs with opioid components as people often use it recreationally to achieve a high.

Solpadeine addiction is one of the most feared dangers associated with Solpadeine as it can be severely damaging since it poses the risk of overdose. Moreover, Solpadeine addiction has long-term outcomes that are deleterious to the health of an individual. Solpadeine addiction results in kidney damage and respiratory depression which can lead to difficulty in breathing and shallow breaths which ultimately result in decreased oxygen supply to the vital organs such as the heart and the brain and it results in a drop in heart rate and a fall in blood pressure.

Alcohol and Panic Attacks in the UK

In addition, increased doses of Solpadine can result in coma and death following respiratory depression. There is another danger associated with Solpadeine that under the ‘high’ caused by this drug people may indulge in risk-taking behaviour which can be damaging to their life. Moreover, there is a risk of the development of paracetamol hepatotoxicity after increased use of Solpadeine. 

Owing to the presence of Codeine in its formulation, Solpadol has significant potential for addiction. For this reason, it should never be the first-line treatment to manage mild to moderate pain and other regular analgesics with safer profiles should be prescribed first. 

However, in cases when Solpadol is prescribed there is an increased risk for the development of tolerance to the drug. Soon after taking the drug, the person becomes tolerant to the therapeutic effect of Solpadol such that they have to take increased doses to acquire the same effect of analgesia. When an individual increases their dose of Solpadol in an unsupervised setting he is likely to develop dependence and addiction to the drug. 

Developing dependence refers to the state when a person becomes physically dependent on the drug such that he may find it difficult to do the routine task without taking the drug. Due to this reason, people tend to continue taking the drug long after the prescribed period is over. 

In addition, the mild euphoric effect associated with Solpadol due to its interference with the release of dopamine has led to its use as a recreational drug. People wrongly assume that since Solpadol is prescribed to them by their doctor for a legitimate medicinal reason, so the misuse of this medicine for recreational purposes would not be harmful. However, the reality is contrary to the false beliefs since codeine being an opioid interferes with the central nervous system and depresses the functioning of the brain and this action poses a life-threatening risk to individuals who abuse Solpadol and other medicines with psychoactive components as these medicines depress the respiratory center in the brain producing deleterious consequences which can result in coma or even death.  

Moreover, it is advised that Solpadol should not be used for more than 3 to 5 days or should be used as directed by a general physician (GP) thus indicating that such a short span is required for the development of dependence after which withdrawal symptoms ensue upon discontinuing the drug. 

The risk of Solpadol dependence and addiction is higher in individuals who have a current or prior history of substance misuse disorder such as alcoholism or those struggling with a mental health disorder such as major depression.

Solpadeine Max is an over-the-counter combination analgesic available in the UK. Co-codamol, the generic form of this drug was considered to possess a little potential for addiction, however, this perception was rendered false when a rise in cases of co-codamol addiction was reported. 

The greatest reason favouring the addiction of Solpadeine Max and other co-codamol variants is the ease of availability of the drug. These combination drugs are easily available as over-the-counter medications and people tend to purchase and misuse these medicines thus promoting addiction to Solpadeine Max. The opioid component present in Solpadeine Max is responsible for its addiction potential.

According to statistics, there has been a rapid influx in the cases of opioid abuse and addiction in the UK. In 2020, 222 opioid-related deaths were reported. On the contrary, 91 deaths were reported 10 years ago highlighting a stark rise in the cases of mortality associated with opioid addiction and abuse. The trend is worrisome since opioid-related deaths which include codeine have doubled in the past decade.

As with abuse and addiction to other drugs, signs and symptoms of Solpadol are not very different. Certain red flag findings are indicative of addiction and such clues should not be overlooked as they help with early assessment and treatment of drug addiction. Following are the symptoms of Solpadeine Max addiction:

  • Taking increased doses of Solpadeine and more frequently
  • Taking Solpadeine long after the pain has subsided
  • Going to different pharmacies to get medicine supplies
  • Manipulating doctors to get Solpadeine prescription
  • Acquiring Solpadeine through illicit means such as the black web
  • Stealing, cheating, and lying to get hold of others’ prescription
  • Experiencing withdrawal symptoms when discontinuing the drug
  • Hiding medicines from family out of fear of being caught. 
  • Becoming withdrawn from family and isolating themselves
  • Poor personal hygiene and grooming

If you notice these findings in anyone you know then it is high time that you arrange treatment for them and help them on the path to recovery. 

Like every other medicine, Solpadol also has side effects along with its benefits. Certain side effects are quite serious and need medical intervention promptly, whereas other side effects are less severe and tolerable and do not need medical help.

Side effects of Solpadol include:

  • Constipation
  • Nausea
  • Vomiting
  • Light-headedness, dizziness
  • Fainting
  • Confusion
  • Drowsiness
  • Difficulty urinating
  • Developing dependence on the codeine component 
  • Difficulty breathing
  • Chest tightness
  • Wheezing- a sign of bronchospasm
  • Swelling of hands, feet, ankles, face, lips, along with difficulty swallowing with an itchy, lumpy rash indicate anaphylaxis- which means an allergic reaction has developed against the drug
  • It makes the headache worse when used too often
  • Bruising easily-blood problems (thrombocytopenia-low platelets count)

Solpadol is a psychoactive substance and a central nervous system depressant and so is alcohol. As Solpadol binds to the opioid receptors in the brain and produces its effect and inhibits the signaling of certain messages across the brain, similarly, alcohol also produces an inhibitory effect on the brain, albeit through a different mechanism of action. 

Alcohol act on the GABA receptors in the central nervous system. GABA is an inhibitory neurotransmitter so alcohol acts by increasing the effectiveness of this neurotransmitter thus producing relaxation and sedation by depressing the central nervous system. 

When the two depressants Alcohol and Solpadol are combined, detrimental consequences may ensue as they both synergize each other’s potential side effects thus creating trouble and posing a risk to your health. 

You should not drink alcohol with anything that has codeine or any opioid component in it as the outcomes can be life-threatening. Some people accidentally mix Solpadol and Alcohol while others intentionally mix the two substances to achieve a greater euphoric effect for recreational purposes not knowing that the concomitant use of Solpadol and alcohol can depress the central nervous system which depresses the respiratory centers thereby decreasing the oxygen supply to vital organs and reduced perfusion which results in hypotension and decreased heart rate after which the person may progress into a coma.

Moreover, the paracetamol component of Solpadol is equally unsafe to be used with alcohol. The reason being that both alcohol and Solpadol are metabolized by the liver enzymes. An overdose of one compound results in toxicity of the other since the enzyme used in the metabolism of both the compounds is the same. When a person overdoses alcohol and Solpadol simultaneously then very soon glutathione will reach its maximum limit of oxidation and one of the compounds will not be completely metabolized and so it will build up eventually in the system producing negative outcomes. Alcohol weakens the liver and its detoxification ability by damaging the liver cells beyond their ability to regenerate and hence a paracetamol overdose in alcoholics can be simply fatal.

Some side effects of the Codeine component in Solpadol and Alcohol are listed below:

  • Drowsiness
  • Lightheadedness
  • Difficulty breathing and shallow breaths
  • Poor concentration 
  • Fainting
  • Decreased heart rate
  • Low blood pressure
  • Clouding of the brain
  • Coma
  • Death

Some side effects of Paracetamol in Solpadol and Alcohol are listed below:

  • Hepatotoxicity
  • Jaundice
  • Fatigue and lethargy
  • Weight loss
  • Reduced glutathione levels
  • Nausea and vomiting 

If you are using Solpadol under the supervision of your general practitioner (GP) then the risk of an overdose is less likely. However, if you take an excessive dose of the Solpadol, or if you have combined it with other substances that contain paracetamol or CNS depressants such as Alcohol and sedatives then the chance of an overdose is quite likely. 

Since Solpadol consists of Paracetamol and Codeine therefore both the substances present with separate overdose signs and symptoms. 

Paracetamol overdose is likely to happen if someone ingests more than 10g of paracetamol. This happens when patient take two or more medicines containing paracetamol simultaneously hence it is advised to discuss your current medication history with your doctor so that your doctor may change your medicine or would advise you to stop using the previous medicine to prevent the deleterious consequences that results after taking too much paracetamol.

In the early 24 hours following paracetamol overdose, symptoms such as pallor, nausea, abdominal pain, and anorexia appear. It takes 12 to 48 hours for the liver damage to become apparent and it presents with deranged liver tests, abnormalities in glucose metabolism, and metabolic acidosis. 

In cases of severe paracetamol poisoning, liver failure progresses to encephalopathy (diffuse disease of the brain that alters brain functioning), hemorrhage, hypoglycemia, cerebral oedema (swelling of brain tissue), gastrointestinal bleeding, disseminated intravascular coagulation, and death. Renal failure and acute tubular necrosis may also present in the absence of liver damage. Cardiac arrhythmias (abnormal conduction of electrical impulses in the heart) have also been reported with paracetamol overdose. 

Codeine overdose is aggravated with the concomitant use of alcohol and psychoactive drugs that are CNS depressants. Signs and symptoms of Codeine overdose include pinpoint pupils, nausea, vomiting, central nervous system depression, respiratory depression that results in shallow breathing. Hypotension and tachycardia may also be a finding in Solpadol overdose. 

It is necessary to be well informed about the signs and symptoms of overdose of Solpadol and other medications that you and your loved ones are prescribed so that when signs develop you can take prompt action and save their life. 

When you discontinue taking Solpadeine you may experience withdrawal symptoms which is a sign that your body has become dependent on the drug and after the interruption in the supply of Solpadeine the body finds it hard to function normally. In an attempt to regulate the functioning, the body adapts to working without the drug and certain signs and symptoms ensue that are characteristic of withdrawal episodes following discontinuation of Solpadeine. 

Since Solpadeine contains codeine, so when this drug is used for more than 3 days dependence develop rapidly as the dopamine levels in the brain fluctuate thereby altering the brain chemistry and resulting in a myriad of withdrawal symptoms that are as follows:

  • Diarrhea
  • Restlessness 
  • Difficulty sleeping
  • Irritability
  • Agitation
  • Anxiety
  • Palpitations (feeling your heartbeat)
  • Increased blood pressure
  • Shaking
  • Shivering
  • Nausea
  • Vomiting
  • Sweating
  • Watery eyes
  • Loss of appetite
  • Cravings for Solpadeine

The physical withdrawal symptoms last for 7 days usually. However, the psychological symptoms may extend over a month. Since withdrawal symptoms of Solpadeine can be painful, it is advised not to stop Solpadeine abruptly rather consult your general practitioner (GP) who will taper you doses gradually to mitigate the chances of experiencing withdrawal episodes. Moreover, seeking professional help during these withdrawal episodes remains the mainstay of treatment since it can be a rough patch and under the supervision of skilled medical professionals, the withdrawal process becomes more endurable and less painful. 

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