Stilpane combines paracetamol, codeine phosphate, promethazine and caffeine. It is used for moderate pain — headache, migraine, backache, period pain and dental pain. It contains an opioid and a sedating antihistamine, causes drowsiness, and is intended for short-term use only.
What is Stilpane?
Stilpane is a South African compound analgesic available as tablets and a syrup. It contains:
- Paracetamol — a simple painkiller
- Codeine phosphate — a weak opioid
- Promethazine hydrochloride — a sedating antihistamine
- Caffeine (in the tablet formulation)
Strengths differ between the tablet and the syrup, so check your own pack. The syrup is a paediatric-strength preparation, and the two are not interchangeable.
Each ingredient contributes something. Paracetamol acts centrally on pain perception. Codeine is converted by the liver into morphine and blocks pain signalling. Caffeine modestly enhances the effect of paracetamol and counters some drowsiness.
Promethazine is the ingredient that makes Stilpane distinctive, and it is worth understanding. It is a first-generation antihistamine with strong sedative and anti-nausea properties. In a painkiller it does three things: it settles the nausea that often accompanies migraine, it helps someone in pain sleep, and it has a mild effect of its own on pain perception.
That is genuinely useful for a migraine with vomiting. It also means Stilpane is considerably more sedating than most painkillers — enough to matter for driving, working and studying.
What is Stilpane commonly used for?
Stilpane is used for moderate pain, particularly where nausea or sleeplessness accompany it:
- Migraine, where the combination of pain relief and anti-nausea action suits the attack.
- Tension headache.
- Backache and muscular pain.
- Period pain.
- Dental pain.
- Pain that is disturbing sleep.
- Post-operative pain, short-term.
It is intended for short-term use, and two features make longer use a genuine problem.
Codeine causes dependence, and it does so without any decision to misuse anything. The usual pattern is someone who started for real pain, found it worked, and continued — with nothing in the way, since compound analgesics are widely available.
And regular use produces medication overuse headache. Taking any acute painkiller for headache on most days sets up headaches caused by the treatment itself. It feels like the migraine worsening, which prompts more tablets. For migraine sufferers specifically, this is a common and avoidable trap.
If you are treating headaches more than about two days a week, that is worth raising with a doctor. Migraine has specific acute treatments — triptans — and preventive options such as low-dose amitriptyline that reduce how often attacks occur. Both are better answers than escalating a compound painkiller.
How Stilpane fits into this medicine category
| Type | Examples | Note |
|---|---|---|
| Plain paracetamol | Donapan, Zypol | No opioid, no sedation |
| Plain anti-inflammatory | Ibuprofen (Brufen) | Better for inflammatory pain |
| Paracetamol + codeine | Cogesic, Synaleve | Opioid without the antihistamine |
| With a sedating antihistamine | Stilpane | Adds sedation and anti-nausea action |
| Triple combinations | Mybulen, Gen-Payne | Add an anti-inflammatory instead |
Start at the top of that list and move down only when a simpler option has genuinely failed. See the mental health and neurology medicines hub.
What to check before using Stilpane
Do not take any other paracetamol product, including cold and flu remedies and other combination painkillers. Stilpane already contains paracetamol, and duplicating it is the main way this product causes serious harm.
Do not drive after taking it. Between the codeine and the promethazine, the sedation is substantial and can persist into the next day.
Do not drink alcohol with it.
Check whether you have the tablet or the syrup, and note the strengths.
Speak to a pharmacist or doctor if:
- You have breathing problems — sleep apnoea, COPD, severe asthma. Both codeine and promethazine suppress breathing.
- You have a history of dependence on codeine, other opioids or alcohol.
- You have liver disease, or drink heavily.
- You have kidney disease.
- You have glaucoma, an enlarged prostate, or difficulty passing urine — the promethazine matters here.
- You have epilepsy.
- You are pregnant or breastfeeding. Codeine passes into breast milk and is generally avoided.
- The medicine is for a child or teenager. Codeine is not given under 12, nor to under-18s after tonsil or adenoid surgery, and promethazine is not given to children under 2.
- You are older, where sedation, confusion, constipation and falls are markedly more likely.
- You take other sedating medicines, a benzodiazepine, or another antihistamine.
Follow the pack instructions, and note the maximum in 24 hours.
Possible cautions and when to ask a pharmacist or doctor
A few days, not a few weeks. That is the central message.
Signs that use has become a problem: taking it most days, exceeding the pack maximum, needing it for pain it once handled easily, buying from several pharmacies, or feeling restless, achy, sweaty, anxious or unable to sleep without it. Those last symptoms are codeine withdrawal, and they are routinely misread as the original pain returning — which is exactly what sustains the cycle.
If that sounds familiar, speak to a doctor or pharmacist. It is common with codeine-containing painkillers, it is not a failure of character, and there is effective help.
Paracetamol overdose is a medical emergency with no early warning. Someone who has taken too much can feel entirely well for a day or more while liver damage develops. Go to an emergency department immediately with the packaging, even if they seem fine.
The sedation is real. Do not underestimate it because the product is familiar and easy to buy.
Constipation is common from the codeine.
Confusion and falls in older adults are a genuine risk with this combination of ingredients.
Seek urgent medical attention for slow or shallow breathing, extreme drowsiness or difficulty waking someone, confusion, a seizure, eye pain with blurred vision or halos, inability to pass urine, severe constipation with abdominal pain, or facial swelling with difficulty breathing.
Related medicine guides
Frequently asked questions
What is Stilpane used for? Moderate pain — migraine, headache, backache, period pain and dental pain — particularly where nausea or sleeplessness accompany it.
Does it contain codeine? Yes. Codeine is an opioid and causes dependence with regular use, which is why it is intended for short-term use only.
Why does it make me so sleepy? It contains promethazine, a strongly sedating antihistamine, as well as codeine. Do not drive after taking it.
Can I take paracetamol with it? No. It already contains paracetamol. Adding more, including through a cold and flu remedy, risks overdose.
Is the syrup the same as the tablets? No. The syrup is a paediatric-strength preparation with different amounts. Check your pack and do not substitute one for the other.
Can I use it regularly for migraine? No. Codeine-containing painkillers commonly cause medication overuse headache in migraine sufferers. Ask a doctor about triptans and preventive treatment.