Kapake

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How does it work?

Kapake tablets, capsules and effervescent tablets contain two active ingredients, paracetamol and codeine phosphate. This combination of medicines is often referred to as co-codamol. (NB. Co-codamol is also available without a brand name, ie as the generic medicine.)

Paracetamol is a simple painkilling medicine used to relieve mild to moderate pain. Despite its widespread use for over 100 years, we still don't fully understand how paracetamol works to relieve pain. However, it is now thought that it works by reducing the production of prostaglandins in the brain and spinal cord.

The body produces prostaglandins in response to injury and certain diseases. One of the effects of prostaglandins is to sensitise nerve endings, causing pain (presumably to prevent us from causing further harm to the area). As paracetamol reduces the production of these nerve sensitising prostaglandins it is thought it may increase our pain threshold, so that although the cause of the pain remains, we can feel it less.

Codeine is a stronger painkiller known as an opioid. Opioid painkillers work by mimicking the action of naturally occurring pain-reducing chemicals called endorphins. Endorphins are found in the brain and spinal cord and reduce pain by combining with opioid receptors.

Codeine mimicks the action of natural endorphins by combining with the opioid receptors in the brain and spinal cord. This blocks the transmission of pain signals sent by the nerves to the brain. Therefore, even though the cause of the pain may remain, less pain is actually felt.

Kapake tablets, capsules and effervescent tablets contain 30mg of codeine, which in combination with the paracetamol, is effective at relieving severe pain.

What is it used for?

- Severe pain.

Warning!

- This medication may cause drowsiness. If affected do not drive or operate machinery. Avoid alcoholic drink.
- Do not take this medicine with any other products that contain paracetamol. Many over-the-counter painkillers and cold and flu remedies contain paracetamol. It is important to check the ingredients of any medicines you buy without a prescription before taking them in combination with this medicine. Seek further advice from your pharmacist.
- An overdose of paracetamol is dangerous and capable of causing serious damage to the liver and kidneys. You should never exceed the dose stated in the information leaflet supplied with this medicine. Immediate medical advice should be sought in the event of an overdose with this medicine, even if you feel well, because of the risk of delayed, serious liver damage.
- Alcohol increases the risk of liver damage that can occur if an overdose of paracetamol is taken. The hazards of paracetamol overdose are greater in persistant heavy drinkers and in people with alcoholic liver disease.

- If this medicine is taken regularly for long periods of time, the body can become tolerant to it and it may become less effective at relieving pain. With prolonged use, the body may also become dependent on the codeine. As a result, withdrawal symptoms such as restlessness and irritability may occur if the medicine is then stopped suddenly. If you find you need to use this medicine all the time you should consult your doctor for advice.
- Consult your doctor if your symptoms persist despite taking this medicine.
- Taking a painkiller for headaches too often or for too long can make them worse.
- Kapake effervescent tablets contain sodium. They should be avoided in people with kidney problems and those on a low sodium diet.

Use with caution in

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- Elderly people
- Weak or debilitated people
- Decreased kidney function
- Decreased liver function
- Asthma
- Chronic obstructive pulmonary disease
- Epilepsy
- Underactive thyroid gland (hypothyroidism)
- Low blood pressure (hypotension)
- Narrowing of the urethra, causing difficulty passing urine
- Enlarged prostate gland
- People at risk of bowel obstruction, eg due to constipation
- Inflammatory bowel disease such as ulcerative colitis or Crohn's disease
- Biliary tract disorders, eg recent surgery on the biliary tract
- Underproduction of natural steroid hormones by the adrenal glands (Addison's disease)
- Myasthenia gravis.

Not to be used in

- Children under 12 years of age
- Slow, shallow breathing (respiratory depression)
- People having an asthma attack
- Alcohol intoxication (acute alcoholism)
- People with a head injury or raised pressure inside the skull (raised intracranial pressure)
- Paralysis or inactivity in the intestines that prevents material moving through the gut (paralytic ileus).

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

- Paracetamol is not known to be harmful when used during pregnancy. However, the safety of codeine has not been established. If codeine is used in the third trimester it may cause withdrawal symptoms in the baby after birth. As a result, this medicine should be used with caution during pregnancy, and only if the expected benefit to the mother outweighs any potential risk to the infant.

Seek medical advice from your doctor.
- Paracetamol and codeine may pass into breast milk in amounts that are probably too small to be harmful in most people. However, as with all medicines, you should always seek medical advice from your doctor or pharmacist before taking this medicine if you are breastfeeding.

Label warnings

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- Do not take more than 2 at any one time. Do not take more than 8 in 24 hours.
- Do not take this medication with any other products containing paracetamol.
- This medication may cause drowsiness. If affected do not drive or operate machinery. Avoid alcoholic drink.

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