Formulary
For relief of mild to moderate pain
| Co-codamol |
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Formulary
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Tablets 30/500 (codeine 30mg/paracetamol 500mg), Compound analgesic preparations (containing opioids) should not be used routinely. Patients should be given the individual components where possible to allow titration of dose. Where these preparations are used, they should be for short term use only, for relief of moderate pain. There will be a long-term supply shortage of co-codamol 30/500mg tablets, which is expected from February 2026 until June 2026.
Prescribing in acute pain
• Only issue up to 28 days' supply to reduce/avoid stockpiling by patients
• Consider prescribing as separate paracetamol and codeine (30mg or 15mg strengths if appropriate)
• Bulk/routine switching to other opioids (tramadol, higher dose opioids), or other co-codamol compound analgesic preparations (8/500mg, 15/500mg, soluble formulations, branded generics etc) is not recommended.
Prescribing for chronic (long-term) pain
• Identify prn/infrequent collections and take these off repeat
• Contact community pharmacies and stop all repeat dispensing of co-codamol 30/500mg tablets
• Consider moving all pain medication from repeat to acute supply and review and reduce quantities where possible
• Review patients, provide guidance to consider paracetamol alone and/or rationalising if multiple opioids are prescribed
• Outline risks of codeine prescribing but may need to be an option for some people.
• Review all weekly prescriptions
• Consider comms to care homes re; ordering and not wasting prn stock monthly (use care home team ordering resources)
Prescribing following discharge/outpatient appointments
• To reduce risk of inappropriate or unintended further prescribing do not routinely add acute medicines to the prescribing record (e.g. analgesics, laxatives, PPIs etc) unless these are expected to be continued
• If adding for information purposes use the ‘Hospital Only’ section.
More information is in the linked documents, below.
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 LSCMMG: Over the Counter Items that Should not be Routinely Prescribed in Primary Care Policy MHRA: Codeine for analgesia: restricted use in children because of reports of morphine toxicity MHRA: Paracetamol and pregnancy - reminder that taking paracetamol during pregnancy remains safe |
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| Paracetamol |
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Formulary
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Tablets 500mg Suppositories Consider OTC purchase Some patients may be at increased risk of experiencing toxicity at therapeutic doses, particularly those with a body-weight under 50 kg and those with risk factors for hepatotoxicity. Clinical judgement should be used to adjust the dose of oral and intravenous paracetamol in these patients. |
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LSCMMG Paracetamol – prescribing weight-adjusted paracetamol in adults in the community LSCMMG: Over the Counter Items that Should not be Routinely Prescribed in Primary Care Policy MHRA: Paracetamol and pregnancy - reminder that taking paracetamol during pregnancy remains safe |
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| Paracetamol |
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Formulary
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Intravenous infusion 1g/100mL For short term treatment of moderate pain or fever when the oral route is not available. Some patients may be at increased risk of experiencing toxicity at therapeutic doses, particularly those with a body-weight under 50 kg and those with risk factors for hepatotoxicity. Clinical judgement should be used to adjust the dose of oral and intravenous paracetamol in these patients. |
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MHRA: Paracetamol and pregnancy - reminder that taking paracetamol during pregnancy remains safe |
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| Nefopam |
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Formulary
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Tablets 30mg
For the relief of persistent pain unresponsive to other non-opioid analgesics.
Prescribers should carefully consider whether the potential benefits outweigh the risks of adverse effects in individual patients. Prescribers should be cautious of the anticholinergic burden of nefopam, particularly in the elderly.
Treatment should be reviewed regularly and stopped if benefits are not seen in the short term. |
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LSCMMG: Nefopam NMR |
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Links
Breastfeeding and paracetamol. (UKMI Q+A)- Cochrane review:nefopam for acute post- op pain
- LSCMMG Paracetamol – prescribing weight-adjusted paracetamol in adults in the community
- LSCMMG Paracetamol – prescribing weight-adjusted paracetamol in adults in the community
- LSCMMG Paracetamol – prescribing weight-adjusted paracetamol in adults in the community
- LSCMMG: ADHD combined adult and child shared care guideline
- LSCMMG: Chronic Pain Patient Resources: Managing Opioid Medication
- LSCMMG: Chronic Pain Prescriber Resources
- LSCMMG: Headache Management Guideline For Adults
- LSCMMG: Nefopam NMR
- LSCMMG: Neuropathic Pain: Primary Care Management
- LSCMMG: Opioid reduction: best interests opioid reduction position statement
- LSCMMG: Opioid treatment: patient-prescriber opioid treatment agreement
- LSCMMG: Over the Counter Items that Should not be Routinely Prescribed in Primary Care Policy
- LSCMMG: Over the Counter Items that Should not be Routinely Prescribed in Primary Care Policy
- LSCMMG: Restless Legs Syndrome in Adults in Primary Care
- MHRA safety information on use of IV paracetamol in children
- MHRA safety warning: Co-proxamol
- MHRA: Codeine for analgesia: restricted use in children because of reports of morphine toxicity
- MHRA: Paracetamol and pregnancy - reminder that taking paracetamol during pregnancy remains safe
- MHRA: Paracetamol and pregnancy - reminder that taking paracetamol during pregnancy remains safe
- MHRA: Paracetamol and pregnancy - reminder that taking paracetamol during pregnancy remains safe
- NICE CG150: Headaches in over 12s: diagnosis and management
- NICE CG173: Neuropathic pain in adults: pharmacological management in non-specialist settings
- NICE CG59: Low back pain and sciatica in over 16s: assessment and management
- NICE NG180: Perioperative care in adults
- NICE NG193: Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain