1. About ibuprofen and codeine
You can buy ibuprofen and codeine combined as a single medicine from pharmacies.
It's used to treat a range of aches and pains, including:
It's usually taken when everyday painkillers, such as paracetamol, ibuprofen or aspirin, have not worked on their own.
Each tablet normally contains 200mg of ibuprofen and 12.8mg of codeine.
Ibuprofen belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs). It works by reducing hormones that cause pain and swelling in the body.
Codeine is from a group of medicines called opiates, or narcotics. It works in the central nervous system and the brain to block pain signals to the rest of the body. It also reduces the anxiety and stress caused by pain.
2. Key facts
- If you buy combined ibuprofen and codeine from a pharmacy and your pain is not better after 3 days, it's important to ask your doctor for advice about ongoing pain relief.
- It's possible to become addicted to the codeine in this medicine, if you take it for too long. Only take it when you need it for pain relief.
- Do not take more than 6 combined ibuprofen and codeine tablets in 24 hours.
- It's best to take your tablets with food or a drink of milk. You'll be less likely to get mild indigestion or stomach pain.
- The most common side effects are indigestion, feeling sleepy and constipation.
- It's best not to drink alcohol when you're taking combined ibuprofen and codeine. You're more likely to get side effects like feeling sleepy.
3. Who can and cannot take ibuprofen and codeine
Adults and children aged 12 years and over can take combined ibuprofen and codeine.
Only give it to a child or young person aged 12 to 17 years old if painkillers like paracetamol or ibuprofen alone have not worked.
Important: Not suitable for young children
Never give combined ibuprofen and codeine to children under 12 years old.
Combined ibuprofen and codeine is not suitable for some people. To make sure combined ibuprofen and codeine is safe for you, tell your pharmacist or doctor if you:
- have ever had an allergic reaction to ibuprofen, other non-steroidal anti-inflammatories (NSAIDs), codeine or any other medicine
- are trying to get pregnant, already pregnant, or breastfeeding
- are 18 years old or under and have had your tonsils or adenoids taken out to treat a sleep problem called obstructive sleep apnoea
- have asthma
- have a head injury
- have adrenal gland problems
- have a condition that causes seizures or fits
- have ever had bleeding in your stomach, a stomach ulcer, or a hole (perforation) in your stomach
- have a health problem that means you have an increased chance of bleeding such as haemophilia or thrombocytopenia
- have liver problems, such as liver fibrosis, cirrhosis or liver failure
- have heart disease or severe heart failure
- have kidney failure
- have Crohn's disease or ulcerative colitis
- regularly drink more than the maximum recommended amount of alcohol (14 units a week)
4. How and when to take ibuprofen and codeine
Follow the instructions that come with your medicine. This is particularly important because the codeine in combined ibuprofen and codeine can be addictive.
Combined ibuprofen and codeine contains 200mg of ibuprofen and 12.8mg of codeine.
Dosage
Different brands have different doses, so it's important to read the instructions that come with your medicine.
However, generally the usual dose for adults and children aged 12 years and older is 1 or 2 tablets taken every 4 to 6 hours.
If you're not sure how much to take, talk to your pharmacist or doctor.
Important
Do not take more than 6 combined ibuprofen and codeine tablets in 24 hours.
How long to take it for
If you have bought combined ibuprofen and codeine from a pharmacy, do not use it for more than 3 days. If you still have pain, talk to your pharmacist or doctor. It's important to ask them for advice about ongoing pain relief.
What if I forget to take it?
Take the missed dose as soon as you remember, unless it's almost time for your next dose. In this case, skip the missed dose and take your next one as normal.
Never take a double dose to make up for a forgotten one.
What if I take too much?
Taking too much combined ibuprofen and codeine can be dangerous.
It can cause side effects, such as:
- feeling very sleepy, sick or dizzy
- finding it difficult to breathe or changes in your heart rate (it can become slower or faster)
- becoming unconscious, if you take a lot
The amount of ibuprofen and codeine that can lead to an overdose varies from person to person.
Urgent advice: Contact 111 for advice now if:
- you take too much ibuprofen and codeine
Call 111 or to to 111.nhs.uk.
If you need to go to A&E, do not drive. Ask someone to drive you or call 999 and ask for an ambulance.
Bring the ibuprofen and codeine packet or leaflet inside it, any remaining medicine, and any other medicines you take.
5. Taking ibuprofen and codeine with other painkillers
It's safe to take combined ibuprofen and codeine with paracetamol.
Do not take combined ibuprofen and codeine with ibuprofen, aspirin or naproxen.
Ibuprofen, aspirin and naproxen belong to the same group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs).
If you take them together, the ibuprofen plus aspirin or naproxen may increase the chance of you getting side effects, like stomach ache, or serious issues such as stomach bleeds.
Many medicines you can buy from pharmacies list NSAIDs as ingredients. These include cough and cold remedies such as Nurofen Cold & Flu or Beechams Powders.
Important
Before taking any other medicines, check the label to see if they contain codeine, ibuprofen, aspirin or other NSAIDs.
6. Side effects of ibuprofen and codeine
Like all medicines, combined ibuprofen and codeine can cause side effects. But because you only take it for a very short time (up to 3 days), you're unlikely to have any side effects.
Common side effects
Talk to your pharmacist or doctor if these side effects bother you or do not go away:
- headaches
- feeling dizzy
- feeling sleepy
- constipation
- feeling or being sick (nausea or vomiting)
- indigestion and heartburn (acid reflux)
- wind
Serious side effects
Stop taking the medicine and call a doctor straight away if you have:
- black poo or blood in your vomit – these can be signs of bleeding in your stomach
- swollen ankles, blood in your pee, or not peeing at all – these can be signs of a kidney problem
Immediate action required: Call 999 now if:
- you have severe chest or stomach pain – these can be signs of a hole in your stomach or gut
Do not drive to A&E. Ask someone to drive you or call 999 and ask for an ambulance.
Bring all the medicines you take with you.
Serious allergic reaction
In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to ibuprofen and codeine.
Immediate action required: Call 999 now if:
- your lips, mouth, throat or tongue suddenly become swollen
- you're breathing very fast or struggling to breathe (you may become very wheezy or feel like you're choking or gasping for air)
- your throat feels tight or you're struggling to swallow
- your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
- you suddenly become very confused, drowsy or dizzy
- someone faints and cannot be woken up
- a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)
You or the person who's unwell may also have a rash that's swollen, raised, itchy, blistered or peeling.
These can be signs of a serious allergic reaction and may need immediate treatment in hospital.
Do not drive yourself to A&E.
The person you speak to at 999 will give you advice about what to do.
Long-term side effects
The ibuprofen in this medicine can cause ulcers in your stomach or gut, especially if you take it for a long time or in big doses. However, if you take it correctly, with food, for short periods of time, the risk is very low.
If you buy combined ibuprofen and codeine from a pharmacy, do not use it for more than 3 days. If your pain has not gone away, talk to a pharmacist or doctor.
If you need to take combined ibuprofen and codeine for a long time, your body can get used to (known as tolerance) to codeine. That means you need higher doses to control your pain over time.
Some people can become more sensitive to pain (hyperalgesia). If this happens, your doctor will reduce your dose gradually to help these symptoms.
It's possible to become addicted to the codeine in this medicine. For this reason, your dose will be reviewed to make sure you're only taking the amount you need to control your pain.
Your treatment plan may include details of how and when to stop taking combined ibuprofen and codeine.
If you're having treatment for cancer pain or other severe pain, your pain control will be carefully monitored. Speak to your doctor if you're worried about tolerance, hyperalgesia or becoming addicted.
Always follow the instructions that come with your medicine.
If you need to take it for a long time your doctor may also prescribe a medicine to help protect your stomach.
Other side effects
These are not all the side effects of combined ibuprofen and codeine. For a full list, see the leaflet inside your medicines packet.
Reporting side effects
You can report any suspected side effect using the Yellow Card safety scheme.
Visit the Yellow Card website for more information about reporting side effects.
7. How to cope with side effects
What to do about:
- headaches – if you get headaches after taking combined ibuprofen and codeine, do not take any more and see if the headache goes away. It might be better to try another painkiller, like paracetamol. Talk to your doctor if the headaches do not go away or are severe.
- feeling sleepy – do not drive, cycle or use tools or machinery if you're feeling drowsy. Do not drink any alcohol as this will make you feel more tired.
- feeling dizzy – if you begin to feel dizzy, lie down so you do not faint. If you feel dizzy when you stand up, try getting up very slowly or stay sitting down until you feel better. Do not drive or use tools or machinery while you feel like this.
- constipation – eat more high-fibre foods, such as fresh fruit and vegetables and cereals. Try to drink several glasses of water or another non-alcoholic liquid each day. If you can, it may also help to increase your level of exercise. Watch a short video on how to treat constipation.
- feeling or being sick – take ibuprofen and codeine with or just after a meal or snack. Feelings of sickness normally wear off. Talk to your doctor if it bothers you. Take small, frequent sips of water or squash if you're being sick to avoid dehydration. Signs of dehydration include peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat vomiting without speaking to a pharmacist or doctor.
- indigestion and heartburn (acid reflux) – stop taking the medicine and speak to your pharmacist or doctor if it does not go away. If you need something to ease the discomfort, try taking an antacid, but do not put off speaking to your pharmacist or doctor if the symptoms do not go away.
- wind – try not to eat foods that cause wind (like lentils, beans and onions). Eat smaller meals, eat and drink slowly, and exercise regularly if you can. There are pharmacy medicines that can also help, such as simethicone.
8. Pregnancy and breastfeeding
Ibuprofen and codeine during pregnancy
While a short course of combined ibuprofen and codeine could be taken up to 28 weeks of pregnancy, other painkillers are likely to be more suitable.
Ibuprofen can affect your baby's circulation and amniotic fluid if you take it after 28 weeks, or for more than a few days at a time.
Codeine can affect your baby, especially towards the end of pregnancy. Your baby may get used to having codeine and may have withdrawal symptoms when they're born. There is a slightly higher risk of your baby having breathing problems. These are usually temporary, but your baby may need to stay in hospital for extra monitoring.
As a result, combined ibuprofen is not recommended during pregnancy. Other medicines are more suitable. Ask your doctor or pharmacist for advice.
Ibuprofen and codeine while breastfeeding
It is not recommended that women take combined ibuprofen and codeine while breastfeeding.
Small amounts of the codeine may get into breast milk and can cause breathing problems in your baby.
However, ibuprofen alone is safe to take while breastfeeding.
Non-urgent advice: Tell your doctor if you're:
- trying to get pregnant
- pregnant
- breastfeeding
9. Cautions with other medicines
Ibuprofen and codeine do not mix well with some medicines.
Tell your doctor if you're taking these medicines before you start taking combined ibuprofen and codeine:
- anticoagulants, such as warfarin
- other anti-inflammatory painkillers, such as aspirin (including a daily low dose of 75mg), diclofenac, mefenamic acid and naproxen
- medicines for high blood pressure
- steroids that you swallow, such as prednisolone
- antidepressants, such as citalopram, fluoxetine, fluvoxamine, paroxetine, sertraline or venlafaxine
- other antidepressants called monoamine oxidase inhibitors (MAOIs)
- methotrexate (a medicine for psoriasis and rheumatoid arthritis)
- lithium (a medicine for mental health problems)
- other medicines that can make you sleepy, such as sleeping pills or tranquillisers
Mixing ibuprofen and codeine with herbal remedies and supplements
There's not enough research to know whether complementary medicines and herbal remedies are safe to take with combined ibuprofen and codeine. They are not tested in the same way as other medicines.
Important: Medicine safety
Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements.
10. Common questions about ibuprofen and codeine
How does combined ibuprofen and codeine work?
Ibuprofen belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs). It works by reducing hormones that cause pain and swelling in the body.
Codeine is from a group of medicines called opiates, or narcotics. It works in the central nervous system and the brain to block pain signals to the rest of the body. It also reduces the anxiety and stress caused by pain.
When codeine blocks the pain, there are other unwanted effects, including slow or shallow breathing. It also slows down digestion, which is why codeine can cause constipation.
How long does combined ibuprofen and codeine take to work?
Combined ibuprofen and codeine works in 30 to 60 minutes and keeps on working for about 4 to 6 hours.
How long can I take ibuprofen and codeine tablets for?
If you have bought combined ibuprofen and codeine from a pharmacy, do not use it for more than 3 days. If your pain has not gone away within 3 days, talk to your pharmacist or doctor.
Are there any long-term side effects?
The ibuprofen in this medicine can cause ulcers in your stomach or gut, especially if you take it for a long time or in big doses. However, if you take it correctly, with food, for short periods of time, the risk is very low.
If you buy combined ibuprofen and codeine from a pharmacy, do not use it for more than 3 days. If your pain has not gone away, talk to a pharmacist or doctor.
If you need to take combined ibuprofen and codeine for a long time, your body can get used to (known as tolerance) codeine. That means you need higher doses to control your pain over time.
Some people can become more sensitive to pain (hyperalgesia). If this happens, your doctor will reduce your dose gradually to help these symptoms.
It's possible to become addicted to the codeine in this medicine. For this reason, your dose will be reviewed to make sure you’re only taking the amount you need to control your pain.
Your treatment plan may include details of how and when to stop taking combined ibuprofen and codeine.
If you're having treatment for cancer pain or other severe pain, your pain control will be carefully monitored. Speak to your doctor if you're worried about tolerance, hyperalgesia or becoming addicted.
Always follow the instructions that come with your medicine.
If you need to take it for a long time your doctor may also prescribe a medicine to help protect your stomach.
Can I become addicted to combined ibuprofen and codeine?
If you take combined ibuprofen and codeine regularly for a long time, you can become addicted to the codeine in it.
You're unlikely to become addicted if you follow your doctor's advice carefully about how long to take it for.
If you buy combined ibuprofen and codeine at a pharmacy, follow the instructions that come with the medicine and only take it for up to 3 days at a time. If your pain is not better after 3 days, it's important to ask your doctor for advice about ongoing pain relief.
How will I know if I'm addicted?
If you're addicted to the codeine in combined ibuprofen and codeine, you may find it difficult to stop taking it or feel you need to take it more often than necessary.
If you stop taking codeine suddenly, you may get withdrawal symptoms.
These can include:
- feeling agitated or anxious
- panic attacks
- feeling your heart beat (palpitations)
- difficulty sleeping
- shaking
- sweating
- body aches
- feeling restless
Talk to your doctor if you:
- are worried about addiction
- need help with addiction
- want to stop taking codeine
Can it cause stomach ulcers?
The ibuprofen in this medicine can cause ulcers in your stomach or gut, especially if you take it for a long time or in big doses.
However, if you take it correctly, with food, for short periods of time, the risk is very low. Always follow the instructions that come with your medicine.
How does combined ibuprofen and codeine compare with other painkillers?
Some painkillers work better than others for certain pains. For example, the best painkiller to ease your headache may not be the best one for your backache.
The ibuprofen in combined ibuprofen and codeine means it can be particularly effective for period pain, back pain, strains and sprains.
Before taking combined ibuprofen and codeine, try taking paracetamol to see if that helps your pain. Paracetamol can help relieve most types of pain.
Combined ibuprofen and codeine is meant to be taken for short periods only, of up to 3 days.
This means it may not be suitable for treating longer term conditions unless your doctor prescribes it.
If you need pain relief for a long-term condition or ongoing pain, your doctor will be able to discuss the best treatment options with you.
Will recreational drugs affect it?
If you take recreational drugs, such as cannabis, cocaine and heroin, while you're taking combined ibuprofen and codeine, you're more likely to get the serious side effects of the codeine.
These include breathing difficulties, heart problems, seizures or fits, and even going into a coma.
Some recreational drugs, such as cannabis, also increase common side effects that you can get with codeine such as sleepiness and dizziness.
Taking heroin while you're taking ibuprofen and codeine is especially dangerous. You're more likely to get all the side effects of the codeine, including addiction.
Speak to your doctor if you think you might take recreational drugs while taking ibuprofen and codeine.
Can I drink alcohol with it?
Drinking alcohol while you're taking combined ibuprofen and codeine can make you feel more sleepy or increase the risk of serious side effects.
It's best to stop drinking alcohol while taking combined ibuprofen and codeine.
If you do choose to drink and you feel sleepy, stop drinking alcohol until you finish taking this medicine.
Is there any food or drink I need to avoid?
Apart from avoiding alcohol, you can eat and drink normally while taking combined ibuprofen and codeine.
In fact it's best to take ibuprofen and codeine with, or just after, a meal so it does not upset your stomach. Do not take it on an empty stomach.
Will combined ibuprofen and codeine affect my contraception?
Combined ibuprofen and codeine does not affect any contraceptives, including the combined pill and emergency contraception.
Will it affect my fertility?
There is no clear evidence that taking combined ibuprofen and codeine for a maximum of 3 days will affect your fertility.
However, taking ibuprofen tablets in large doses or for a long time can affect ovulation in women. That might make it more difficult for you to get pregnant. This is usually reversible when you stop taking ibuprofen.
Taking codeine can temporarily reduce fertility in men and women. If you take high doses of codeine for a long time, it can cause a health problem called hypogonadism.
Hypogonadism is where the body does not make enough sex hormones. This can make it more difficult for you to conceive.
If you're worried about taking combined ibuprofen and codeine for longer than 3 days and how this may affect your fertility, talk to your doctor.
Can I drive or ride a bike?
Combined ibuprofen and codeine can make you feel sleepy or dizzy. If this happens to you, do not drive or ride a bike, or operate tools or machinery, until you feel better.
It's an offence to drive a car if your ability to drive safely is affected. It's your responsibility to decide if it's safe to drive. If you're in any doubt, do not drive.
Even if your ability to drive is not affected, the police have the right to request a saliva sample to check how much combined ibuprofen and codeine is in your body. GOV.UK has more information on the law on drugs and driving.
Talk to your doctor or pharmacist if you're unsure whether it's safe for you to drive while taking codeine.