Napacod combines paracetamol 500 mg with codeine phosphate 10 mg. It is used for moderate pain that paracetamol alone has not relieved — headache, backache, muscular pain, period pain and dental pain. It contains an opioid, is intended for short-term use, and you must not take other paracetamol with it.

What is Napacod?

Adco-Napacod is registered in South Africa as Schedule 2, available from a pharmacist:

Contains	Per tablet
Paracetamol	500 mg
Codeine phosphate	10 mg

Two ingredients working differently, which is the point of combining them.

Paracetamol relieves pain and fever, acting mainly within the central nervous system.

Codeine is a weak opioid. On its own it does relatively little — codeine is a prodrug, converted in the liver by an enzyme called CYP2D6 into morphine, which is what actually relieves the pain.

That conversion step explains a great deal about codeine, including why it works unpredictably:

Around 5 to 10% of people are “poor metabolisers” who convert very little. For them codeine gives almost no pain relief — they get the constipation and drowsiness without the benefit.
A smaller proportion are “ultra-rapid metabolisers” who convert unusually fast, producing much more morphine than expected from a standard dose. This is the origin of codeine’s most serious safety concerns.

This is genuinely why codeine works well for one person and not another — it is a real biological difference, not imagination or tolerance.

Combination analgesics like this are intended for short-term use, typically no more than three days without advice. Codeine carries dependence potential, and paracetamol limits what else you can safely take.

What is Napacod commonly used for?

Moderate pain not relieved by paracetamol alone.
Headache and tension headache.
Backache and muscular pain.
Period pain.
Dental pain, as short-term relief while awaiting treatment.
Pain after minor injury or a procedure.
Joint and rheumatic pain, where an anti-inflammatory is unsuitable.

It relieves symptoms and does not treat causes. Persistent pain needs a diagnosis.

Codeine-containing painkillers are a leading cause of medication-overuse headache. Taking painkillers for headache on most days can itself perpetuate the headache — producing a cycle where the treatment sustains the problem, and where stopping temporarily makes things worse before they improve. If you take painkillers on more than about 10 days a month, mention it to a doctor. This is common, frequently unrecognised, and treatable.

How Napacod fits into this medicine category

Group	Examples	Notes
Simple analgesics	Paracetamol (Donapan)	Pain and fever; no dependence risk
NSAIDs	Ibuprofen, naproxen	Pain and inflammation
Paracetamol + codeine	Napacod, Stilpane, Painamol Co	Moderate pain; opioid component
Paracetamol + tramadol	Tamoltra, Tramacet	Stronger combination; prescription-only
Muscle relaxant combinations	Norflex Co, Lenaspasm	Painful muscle spasm
Corticosteroids	Prednisone	Powerful anti-inflammatory, as courses

An anti-inflammatory may be more effective than codeine for inflammatory pain — a sprain, a swollen joint, period pain — since codeine does nothing for inflammation. See the pain, inflammation and musculoskeletal medicines hub.

What to check before using Napacod

Check everything else you take for paracetamol. This is the most important point. Paracetamol appears in many cold and flu remedies, sinus products and painkillers, and taking one alongside Napacod means taking paracetamol twice — the most common route to serious accidental overdose.

Do not drink alcohol with it. Alcohol compounds the sedation from codeine and adds to the risk of liver harm from paracetamol.

Use it for no more than three days without medical advice.

Speak to a pharmacist or doctor first if you:

Have liver disease, or drink heavily.
Have kidney disease.
Have breathing problems — asthma, COPD or sleep apnoea. Codeine suppresses respiration.
Have a history of substance or alcohol dependence.
Have constipation, or a bowel condition.
Have a head injury, or raised pressure in the brain.
Have an underactive thyroid, or low blood pressure.
Are elderly, where sedation, confusion, constipation and falls are more likely.
Weigh under 50 kg.
Are pregnant. Codeine is generally avoided, particularly near delivery.
Are breastfeeding. Codeine passes into breast milk, and an ultra-rapid metabolising mother can produce enough morphine to seriously harm a baby. It is generally avoided.
Are giving it to a child. Codeine is contraindicated under 12, and after tonsil or adenoid surgery in children.
Take any other sedating medicine, or an MAOI antidepressant.

Do not drive or operate machinery until you know how it affects you.

Possible cautions and when to ask a pharmacist or doctor

Common effects are constipation, drowsiness, nausea, dizziness and dry mouth. Constipation from codeine does not settle on its own — increase fluid and fibre, and ask a pharmacist about a laxative if it persists.

Seek medical attention urgently if you notice:

Slow, shallow or difficult breathing, or unusual difficulty waking someone. This is an emergency, particularly in a child or where alcohol or another sedative is involved.
Marked confusion, or hallucinations.
Swelling of the face, lips or tongue, or difficulty breathing.
A severe rash or blistering skin.
Severe constipation with abdominal pain, or a swollen abdomen.

Paracetamol overdose is a medical emergency and does not feel like one at first. Someone who has taken too much may feel entirely well for a day or more while liver damage develops silently. Go to an emergency department immediately with the packaging if too much has been taken — even accidentally, even if the person seems fine. The antidote works best given early.

Dependence on codeine-containing painkillers is common and easy to slide into, precisely because they are effective and available from a pharmacy. Needing them more often, needing more for the same effect, taking them for tension or sleep rather than pain, or feeling unable to manage without them are all reasons to speak to a doctor. This is a treatable situation, not a failing, and raising it early makes it far easier to resolve. Stopping after prolonged regular use can cause withdrawal — restlessness, aches, sweating, insomnia and diarrhoea — which a doctor can help you manage.

See a doctor if pain lasts more than a few days, worsens, or if you are using painkillers on most days.

Related medicine guides

Frequently asked questions

What is Napacod used for? Moderate pain not relieved by paracetamol alone — headache, backache, muscular pain, period pain and dental pain. Each tablet contains paracetamol 500 mg with codeine 10 mg.

Is Napacod addictive? It contains codeine, an opioid with dependence potential. It is intended for short-term use, no more than three days without advice.

Can I take paracetamol with it? No. It already contains paracetamol, and adding more risks serious overdose. Check cold and flu remedies too.

Can I take ibuprofen with it? Usually yes, as they work differently — but check with a pharmacist. What you must avoid is extra paracetamol.

Why does it not work for me? Around 5 to 10% of people convert very little codeine into morphine and get almost no benefit from it. This is a genuine biological difference.

Can I give it to my child? No. Codeine is contraindicated under 12, and after tonsil or adenoid surgery.

Can I take it while breastfeeding? Generally not. Codeine passes into breast milk, and some mothers produce enough morphine to harm a baby. Ask your doctor.

Can I drink alcohol with it? No. Alcohol adds to the sedation and increases the risk of liver harm from paracetamol.

What Is Napacod Used For?