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Solpadol 30mg/500mg Caplets


Active Constituents
Codeine Phosphate Hemihydrate


For excipients see 6.1.


Solpadol Caplets are white capsule shaped tablets, marked SOLPADOL on
one side.




Therapeutic indications
For the relief of severe pain.
Indicated in patients older than 12 years of age for the treatment of acute
moderate pain which is not considered to be relieved by other analgesics such
as paracetamol or ibuprofen (alone).


Posology and method of administration
Two tablets not more frequently than every 4 hours, up to a maximum of 8
tablets in any 24 hour period.

As adults, however a reduced dose may be required. See warnings.
Children aged 16 to 18 years:
One to two tablets every 6 hours when necessary to a maximum of 8 tablets in
24 hours.
Children aged 12 to 15 years:
One tablet every 6 hours when necessary to a maximum of 4 tablets in 24
Children under 12:
Not recommended for children under 12 years of age. This is because of
codeine risk of opioid toxicity due to the variable and unpredictable
metabolism of codeine to morphine (see sections 4.3 and 4.4).
The duration of treatment should be limited to 3 days and if no effective pain
relief is achieved the patients/carers should be advised to seek the views of a
Solpadol Caplets are for oral administration.


Hypersensitivity to paracetamol or codeine which is rare.
Hypersensitivity to any of the other constituents.
Conditions where morphine and opioids are contraindicated e.g:
• Acute asthma
• Respiratory depression
• Acute alcoholism
• Head injuries
• Raised intra-cranial pressure
• Following biliary tract surgery
• Breast-feeding (see Section 4.6)
Monoamine oxidase inhibitor therapy, concurrent or within 14 days.
In all paediatric patients (0-18 years of age) who undergo tonsillectomy and/or
adenoidectomy for obstructive sleep apnoea syndrome due to an increased risk
of developing serious and life-threatening adverse reactions (see section 4.4).
In patients for whom it is known that they are CYP2D6 ultra-rapid


Special warnings and precautions for use
CYP2D6 metabolism

Codeine is partially metabolised by CYP2D6. If a patient has a deficiency or is
completely lacking this enzyme they will not obtain adequate analgesic
effects. Estimates indicate that up to 7% of the Caucasian population may have
this deficiency. However, if the patient is an extensive or ultra-rapid
metaboliser there is an increased risk of developing side effects of opioid
toxicity even at commonly prescribed doses. These patients convert codeine
into morphine rapidly resulting in higher than expected serum morphine
General symptoms of opioid toxicity include nausea, vomiting, constipation,
lack of appetite, somnolence, shallow breathing, small pupils and confusion. In
severe cases this may include symptoms of circulatory and respiratory
depression, which may be life-threatening and very rarely fatal. Estimates of
prevalence of ultra-rapid metabolisers in different populations are summarized
African American
Northern European

Prevalence %
3.4% to 6.5%
1.2% to 2%
3.6% to 6.5%

The leaflet will state in the “pregnancy and breast-feeding” subsection of
the section 2 “Before taking your medicine”:
Solpadol is contraindicated in breast-feeding
Post-operative use in children
There have been reports in the published literature that codeine given postoperatively in children after tonsillectomy and/or adenoidectomy for
obstructive sleep apnoea, led to rare, but life-threatening adverse events
including death (see also section 4.3). All children received doses of codeine
that were within the appropriate dose range; however there was evidence that
these children were either ultra-rapid or extensive metabolisers in their ability
to metabolise codeine to morphine.
Children with compromised respiratory function
Codeine is not recommended for use in children in whom respiratory function
might be compromised including neuromuscular disorders, severe cardiac or
respiratory conditions, upper respiratory or lung infections, multiple trauma or
extensive surgical procedures. These factors may worsen symptoms of
morphine toxicity.
Care should be observed in administering the product to any patient whose
condition may be exacerbated by opioids, particularly the elderly, who may be
sensitive to their central and gastro-intestinal effects, those on concurrent CNS
depressant drugs, those with prostatic hypertrophy and those with
inflammatory or obstructive bowel disorders. Care should also be observed if
prolonged therapy is contemplated.

Care is advised in the administration of paracetamol to patients with severe
renal or severe hepatic impairment. The hazards of overdose are greater in
those with alcoholic liver disease.
Patients should be advised not to exceed the recommended dose and not take
other paracetamol containing products concurrently. Keep the product out of
the reach and sight of children.
Caution is advised in patients with underlying sensitivity to aspirin and/or to
non-steroidal anti-inflammatory drugs (NSAIDs).
The risk-benefit of continued use should be assessed regularly by the
The leaflet will state in a prominent position in the ‘before taking’ section:
Do not take for longer than directed by your prescriber.
Taking codeine regularly for a long time can lead to addiction, which might
cause you to feel restless and irritable when you stop the tablets.
Taking a pain killer for headaches too often or for too long can make them
The label will state (To be displayed prominently on outer pack (not
boxed) :
Do not take for longer than directed by your prescriber as taking codeine
regularly for a long time can lead to addiction.


Interaction with other medicinal products and other forms of interaction
Paracetamol may increase the elimination half-life of chloramphenicol. Oral
contraceptives may increase its rate of clearance. The speed of absorption of
paracetamol may be increased by metoclopramide or domperidone and absorption
reduced by colestyramine.
The anticoagulant effect of warfarin and other coumarins may be enhanced by
prolonged regular use of paracetamol with increased risk of bleeding; occasional
doses have no significant effect.
The effects of CNS depressants (including alcohol) may be potentiated by codeine.


Fertility, pregnancy and lactation

Careful consideration should be given before prescribing the product for
pregnant patients. Opioid analgesics may depress neonatal respiration and
cause withdrawal effects in neonates of dependent mothers.
A large amount of data on pregnant women indicate neither malformative, nor
feto/neonatal toxicity. Paracetamol can be used during pregnancy if clinically
needed however it should be used at the lowest effective dose for the shortest
possible time and at the lowest possible frequency.
As a precautionary measure, use of Solpadol should be avoided during the
third trimester of pregnancy and during labor.
Paracetamol is excreted in breast milk but not in a clinically significant
Codeine should not be used during breastfeeding (see section 4.3).
At normal therapeutic doses codeine and its active metabolites may be present
in breast milk at very low doses and is unlikely to adversely affect the breast
fed infant. However, if the patient is an ultra-rapid metaboliser of CYP2D6,
higher levels of the active metabolite, morphine, may be present in breast milk
and on very rare occasions may result in symptoms of opioid toxicity in the
infant, which may be fatal.

Effects on ability to drive and use machines
This medicine can impair cognitive function and can affect a patient’s ability to drive
safely. This class of medicine is in the list of drugs included in regulations under 5a of
the Road Traffic Act 1988. When prescribing this medicine, patients should be told:
• The medicine is likely to affect your ability to drive
• Do not drive until you know how the medicine affects you
• It is an offence to drive while under the influence of this medicine
• However, you would not be committing an offence (called ‘statutory defence’) if:
- The medicine has been prescribed to treat a medical or dental problem and
- You have taken it according to the instructions given by the prescriber and in
the information provided with the medicine and
- It was not affecting your ability to drive safely


Undesirable effects
Codeine can produce typical opioid effects including constipation, nausea,
vomiting, dizziness, light-headedness, confusion, drowsiness and urinary
retention. The frequency and severity are determined by dosage, duration of
treatment and individual sensitivity. Tolerance and dependence can occur,
especially with prolonged high dosage of codeine.
• Regular prolonged use of codeine is known to lead to addiction and
tolerance. Symptoms of restlessness and irritability may result when
treatment is then stopped.
• Prolonged use of a painkiller for headaches can make them worse.

Adverse effects of paracetamol are rare:
Blood and lymphatic system disorders
Very rare: thrombocytopenia, neutropenia, leucopenia
Not known: agranulocytosis
Immune system disorders
- Hypersensitivity including skin rash may occur.
- Not known: Anaphylactic shock, angioedema.
Respiratory, thoracic and mediastinal disorders
Not known: bronchospasm (see section 4.4)
Skin and subcutaneous disorders
Very rare cases of serious skin reactions have been reported.
Very rare occurrence of pancreatitis.
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal
product is important. It allows continued monitoring of the benefit/risk balance
of the medicinal product. Healthcare professionals are asked to report any


The effects of Codeine over-dosage will be potentiated by simultaneous
ingestion of alcohol and psychotropic drugs.
Central nervous system depression, including respiratory depression, may
develop but is unlikely to be severe unless other sedative agents have been coingested, including alcohol, or the overdose is very large. The pupils may be
pin-point in size; nausea and vomiting are common. Hypotension and
tachycardia are possible but unlikely.
Management should include general symptomatic and supportive measures
including a clear airway and monitoring of vital signs until stable. Consider
activated charcoal if an adult presents within one hour of ingestion of more
than 350 mg or a child more than 5 mg/kg.
Give naloxone if coma or respiratory depression is present. Naloxone is a

competitive antagonist and has a short half-life so large and repeated doses
may be required in a seriously poisoned patient. Observe for at least 4 hours
after ingestion, or 8 hours if a sustained release preparation has been taken.
Liver damage is possible in adults who have taken 10g or more of paracetamol.
Ingestion of 5g or more of paracetamol may lead to liver damage if the patient
has risk factors (see below).
Risk factors
If the patient
a. Is on long term treatment with carbamazepine, phenobarbitone, phenytoin,
primidone, rifampicin, St John’s Wort or other drugs that induce liver enzymes.
b. Regularly consumes ethanol in excess of recommended amounts.
c. Is likely to be glutathione deplete e.g. eating disorders, cystic fibrosis, HIV
infection, starvation, cachexia.
Symptoms of paracetamol over-dosage in the first 24 hours are pallor, nausea,
vomiting, anorexia and abdominal pain. Liver damage may become apparent 12
to 48 hours after ingestion. Increased levels of hepatic transaminases, lactate
dehydrogenase and bilirubin may occur and the INR may increase.
Abnormalities of glucose metabolism and metabolic acidosis may occur. In
severe poisoning, hepatic failure may progress to encephalopathy, haemorrhage,
hypoglycaemia, cerebral oedema, gastrointestinal bleeding and death. Acute
renal failure with acute tubular necrosis, strongly suggested by loin pain,
haematuria and proteinuria, may develop even in the absence of severe liver
damage. Cardiac arrhythmias, pancreatitis and pancytopenia have been reported.
Immediate treatment is essential in the management of paracetamol overdose.
Despite a lack of significant early symptoms, patients should be referred to
hospital urgently for immediate medical attention. Symptoms may be limited
to nausea or vomiting and may not reflect the severity of overdose or the risk of
organ damage. Management should be in accordance with established treatment
guidelines, see BNF overdose section.
Treatment with activated charcoal should be considered if the overdose has been
taken within 1 hour. Plasma paracetamol concentration should be measured at 4
hours or later after ingestion (earlier concentrations are unreliable). Treatment
with N-acetylcysteine may be used up to 24 hours after ingestion of paracetamol;
however, the maximum protective effect is obtained up to 8 hours post-ingestion.
The effectiveness of the antidote declines sharply after this time. If required the
patient should be given intravenous N-acetylcysteine, in line with the established
dosage schedule. If vomiting is not a problem, oral methionine may be a suitable
alternative for remote areas, outside hospital. Management of patients who
present with serious hepatic dysfunction beyond 24h from ingestion should be

discussed with the NPIS or a liver unit.




Pharmacodynamic properties
Pharmacotherapeutic group: Anilides, Paracetamol combinations
ATC Code: NO2B E51

Paracetamol is an analgesic which acts peripherally, probably by blocking
impulse generation at the bradykinin sensitive chemo-receptors which evoke
pain. Although it is a prostaglandin synthetase inhibitor, the synthetase system in
the CNS rather than the periphery appears to be more sensitive to it. This may
explain paracetamol's lack of appreciable anti-inflammatory activity.
Paracetamol also exhibits antipyretic activity.
Codeine is a centrally acting weak analgesic. Codeine exerts its effect through µ
opioid receptors, although codeine has low affinity for these receptors, and its
analgesic effect is due to its conversion to morphine. Codeine, particularly in
combination with other analgesics such as paracetamol, has been shown to be
effective in acute nociceptive pain.


Pharmacokinetic properties
Following oral administration of two tablets (ie, a dose of paracetamol 1000mg
and codeine 60mg) the mean maximum plasma concentrations of paracetamol
and codeine were 15.96g/ml and 212.4ng/ml respectively. The mean times to
maximum plasma concentrations were 0.88 hours for paracetamol and 1.05
hours for codeine.
The mean AUC for the 9 hours following administration was 49.05g/ml per hour
for paracetamol and 885.0ng/ml per hour for codeine.
The bioavailabilities of paracetamol and codeine when given as the combination
are similar to those when they are given separately.
Codeine is mainly metabolized by glucuronidation to codeine-6-glucuronide.
Minor routes of metabolism include O- demethylation leading to morphine, Ndemethylation to norcodeine and after both O- and N-demethylation formation of
normorphine. Morphine and norcodeine are further transformed in
glucuroconjugates. Unchanged codeine and its metabolites are mainly excreted
by urinary route within 48h (84.4±15.9%).

The O-demethylation of codeine to morphine is catalyzed by the cytochrome
P450 isozyme 2D6 (CYP2D6) which shows genetic polymorphism that may
affect the efficacy and toxicity of codeine.
Genetic polymorphism in CYP2D6 leads to ultra-rapid, extensive and poor
metaboliser phenotypes.


Preclinical safety data
There are no preclinical data of relevance which are additional to that already
included in other sections of the SPC.




List of excipients
Pregelatinised starch, maize starch, povidone, potassium sorbate, microcrystalline
cellulose, stearic acid, talc, magnesium stearate, croscarmellose sodium (type A).


None known.


Shelf life
3 years.


Special precautions for storage
Store in the original package. Do not store above 25°C.


Nature and contents of container
Child resistant PVC/aluminium foil (250μm) / PVC (15μm) blister packs or
child resistant PVC/aluminium foil (250 µm/9 µm /Glassine paper (35 gsm).
Pack sizes: 4, 10, 24, 30, 60 and 100 tablets.


Special precautions for disposal
No special requirements.


Aventis Pharma Limited
One Onslow Street
or trading as:
Sanofi-aventis or Sanofi
One Onslow Street


PL 04425/0637


10/03/1997 / 30/09/2004



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Source: Medicines and Healthcare Products Regulatory Agency

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