Napacod Tablets Used For

Napacod Tablets Used For: Uses, Ingredients and Safety in South Africa

Napacod tablets are combination pain-relief medicines commonly used in South Africa. They are classified as Schedule 2 medicines and are available from pharmacies without a doctor’s prescription, but under pharmacist supervision. This article explains what Napacod tablets are used for, how they work, and important safety considerations, based only on verifiable information from recognised South African and international sources.

Note: Brand formulations can differ between countries and manufacturers. Always refer to the specific patient information leaflet packaged with your medicine and consult a healthcare professional before use.

What Are Napacod Tablets?

Napacod is a branded combination analgesic that contains:

Paracetamol (acetaminophen)
Codeine phosphate

Multiple credible medicine information sources list Napacod as a paracetamol–codeine combination. For example, the DailyMed database in the United States lists “NAPACOD” as a tablet containing 325 mg paracetamol and 30 mg codeine phosphate per tablet, supplied under an FDA application by a pharmaceutical company in the US market, with strengths such as “NAPACOD C35” and “NAPACOD C40” specifying different codeine content per tablet, but the base combination remains paracetamol and codeine phosphate as active ingredients
(DailyMed product information).

While exact strengths and pack sizes may differ by market and manufacturer, South African combination analgesics that pair paracetamol with codeine are regulated under Schedule 2 when the codeine content per dosage unit remains within specified limits, according to the South African Health Products Regulatory Authority (SAHPRA) scheduling framework and subsequent Department of Health regulations on over‑the‑counter medicines containing codeine
(SAHPRA guidance and schedules referenced in Department of Health communications).

Napacod Tablets Used For: Main Indications

Relief of Mild to Moderate Pain

Based on the known actions of its active ingredients, Napacod is used for the relief of mild to moderate pain, where a stronger analgesic is needed than paracetamol alone.

Paracetamol–codeine combinations are widely indicated for short‑term treatment of pain such as:

Headache and tension headache
Toothache and dental procedures
Musculoskeletal pain, such as sprains and strains
Post‑operative or post‑injury pain when appropriate
Dysmenorrhoea (painful menstrual periods)

The World Health Organization (WHO) and many national formularies describe codeine, often in combination with paracetamol, as a step‑2 analgesic in the WHO pain ladder for mild to moderate pain, particularly when non‑opioid analgesics alone are insufficient
(WHO pain ladder and analgesic guidance).

In the South African context, combination analgesics containing codeine are commonly stocked by community pharmacies for these indications. Professional guidance from the South African Pharmacy Council and Pharmaceutical Society of South Africa emphasises that Schedule 2 codeine‑containing analgesics are for short‑term symptomatic relief and should not be used chronically without medical supervision
(Pharmaceutical Society of South Africa guidance on responsible codeine use).

Relief of Pain With Associated Fever

Paracetamol is an effective antipyretic (fever‑reducing) medicine. As a result, Napacod tablets may be used in situations where there is pain associated with fever, provided no contraindications exist and dosage recommendations are followed.

The National Department of Health’s Standard Treatment Guidelines and Essential Medicines List describes paracetamol as a first‑line medicine for relief of mild to moderate pain and for reduction of fever in adults and children, with codeine‑containing combinations used only in specific cases and under guidance
(Adult Hospital Level Standard Treatment Guidelines and Essential Medicines List).

How Napacod Tablets Work

Paracetamol Component

Paracetamol (also known as acetaminophen) works predominantly in the central nervous system to:

Reduce pain perception
Lower fever by acting on the hypothalamic heat‑regulating centre

The South African Medicines Formulary (SAMF), published by the South African Medical Association, identifies paracetamol as a non‑opioid analgesic and antipyretic, recommended as a first‑line option for a wide range of pain conditions due to its favourable safety profile at recommended doses
(SAMF overview via South African Medical Association).

Codeine Component

Codeine is an opioid analgesic. It is a weak opioid that is partly converted in the body to morphine by the liver enzyme CYP2D6. This conversion contributes significantly to its analgesic effect.

International prescribing references, such as the British National Formulary (BNF) and systematic information summarised by the National Library of Medicine, describe codeine as suitable for mild to moderate pain when non‑opioid analgesics alone do not provide adequate relief
(National Library of Medicine – codeine information).

In South Africa, codeine‑containing medicines are controlled because of their potential for dependence and misuse, and because genetic differences in CYP2D6 can cause some people to convert codeine to morphine more rapidly, increasing the risk of adverse effects. Regulatory communications from SAHPRA and the Department of Health highlight concerns about overuse of codeine‑containing over‑the‑counter products and reinforce pharmacist responsibilities to screen for inappropriate use
(Department of Health and SAHPRA communications on codeine control).

South African Regulatory and Access Considerations

Schedule 2 Status and Pharmacy Supply

In South Africa, most combination paracetamol–codeine analgesics used for mild to moderate pain are classified as Schedule 2 medicines under the Medicines and Related Substances Act. Schedule 2 medicines:

May be sold only in pharmacies
Require that a pharmacist (or pharmacist intern under supervision) is involved in the sale
Do not require a doctor’s prescription, but the pharmacist must assess suitability and can refuse supply where misuse is suspected

Scheduling information and updates are overseen by SAHPRA and published in government gazettes and SAHPRA schedules
(SAHPRA – Regulatory frameworks and schedules).

Responsible Use and Public‑Health Concerns

South Africa has experienced public‑health concerns related to codeine misuse and dependence, particularly with over‑the‑counter combination products. The South African Medical Research Council (SAMRC) and collaborating researchers have reported patterns of non‑medical use and the need for stricter control and public education regarding codeine‑containing medicines
(SAMRC reports on codeine use).

For this reason, pharmacists are encouraged to:

Limit the quantity supplied
Ask about symptoms, duration of pain, and other medicines
Refer patients for medical assessment when pain is persistent, severe, or recurrent

Safety, Warnings and Precautions

Because Napacod contains both paracetamol and codeine, safety considerations relate to each component and to their combined effects.

Risk of Paracetamol Overdose

Paracetamol is generally safe at recommended doses, but overdose can cause serious liver damage. The National Department of Health’s Standard Treatment Guidelines and numerous international toxicology references emphasise that paracetamol overdose is a leading cause of acute liver failure
(National Department of Health – STG/EML guidance).

Important points:

Do not exceed the maximum total daily dose of paracetamol from all sources (including other cold and flu preparations).
Patients with liver disease, chronic alcohol use, or malnutrition should use paracetamol cautiously and only under medical advice.

Opioid‑Related Risks from Codeine

Codeine, as an opioid, can cause:

Drowsiness and dizziness
Constipation
Nausea and vomiting
Respiratory depression at high doses or in susceptible individuals

International safety advisories from regulators such as the European Medicines Agency and US Food and Drug Administration (FDA) warn that:

Children and adolescents, especially post‑tonsillectomy or adenoidectomy, are at higher risk of life‑threatening respiratory depression from codeine.
Ultra‑rapid metabolisers of CYP2D6 may convert codeine to morphine more quickly, increasing risk of toxicity
(FDA safety communication on codeine use in children).

South African prescribing practice has followed similar cautionary trends, with clinicians advised to avoid or strictly limit codeine use in younger patients and in individuals with underlying respiratory compromise.

Dependence and Misuse Potential

Because of its opioid component, long‑term or high‑dose use of codeine‑containing products can lead to:

Tolerance (needing higher doses for the same effect)
Dependence and withdrawal symptoms upon stopping
Behaviour patterns seeking repeated supply

Research and policy discussions summarised by the SAMRC and professional pharmacy bodies have highlighted the importance of:

Using codeine‑containing analgesics like Napacod for the shortest possible duration
Avoiding use for chronic, unexplained pain without proper medical diagnosis
Monitoring for signs of repeated, unsupervised use
(SAMRC work on substance use and medicines).

When to Seek Medical Advice

Napacod, like similar paracetamol–codeine combinations, is intended for short‑term relief of mild to moderate pain. In South Africa, pharmacists will often advise you to seek further medical care if:

Pain persists beyond a few days despite treatment
You need to use a product like Napacod frequently or continuously
Pain is severe, unexplained, or associated with other worrying symptoms (such as weight loss, night sweats, neurological symptoms, chest pain, or abdominal swelling)
You have chronic liver disease, kidney disease, respiratory disease, or substance‑use disorder
You are pregnant, breastfeeding, elderly, or taking multiple other medicines

Standard treatment guidance from the National Department of Health stresses that persistent pain should be properly investigated and that opioids, including codeine, should be used judiciously and often as part of a broader pain‑management plan
(Adult Hospital Level Standard Treatment Guidelines and Essential Medicines List).

Summary

Napacod tablets are a paracetamol–codeine combination analgesic used for:

Short‑term relief of mild to moderate pain, including headache, toothache and musculoskeletal pain
Relief of pain associated with fever, when appropriate

In South Africa, medicines of this type are regulated as Schedule 2, supplied by pharmacies without a prescription but under pharmacist oversight, as directed by SAHPRA. While effective, Napacod must be used responsibly due to:

The risk of paracetamol‑induced liver injury at high doses or in combination with other paracetamol products
The opioid‑related risks of codeine, including drowsiness, respiratory depression, and dependence
Public‑health concerns around codeine misuse, prompting stricter monitoring by pharmacists and healthcare providers

For safe use, follow the dosage instructions on the packaging or patient information leaflet, avoid simultaneous use of other paracetamol‑containing products, and consult a healthcare professional if pain persists, recurs, or is associated with other concerning symptoms.