Zapain (Co-codamol)

The opioid medication Zapain is commonly prescribed for moderate to severe pain.

Zapain contains two key ingredients, Paracetamol and Codeine phosphate– which make co-codamol. 

What is Zapain used for?

Zapain is the brand name for this prescription-strength co-codamol.

It comprises two components: Codeine and Paracetamol. Together, these two medications make “Co-codamol“.

Available in tablet or capsule form, Zapain has various strengths and dosages.

The most potent form of this combination is 500mg Paracetamol and 30 mg Codeine. Some lower-strength versions can contain 500mg of Paracetamol and either 8mg, 15mg or 30mg of Codeine.

Zapain is commonly prescribed for severe pain, such as post-operative pain, or moderate pain that does not respond to other non-opioid analgesics.

How long does Zapain take to work?

Zapain (Co-codamol) can take up to an hour before its full effects are felt. The painkilling effects last approximately 4 to 6 hours.

How long does Zapain stay in your system?

As your liver metabolises Codeine, the time it takes depends on your physiology. 

Typically, it is in your urine for 12 to 48 hours.

A saliva test will show it in your system for around 20-24 hours, and hair tests may show Codeine for several months. A blood test will only show results for approximately 4-5 hours.

Regardless of your prescribed dosage, it is essential not to take more than 8 Zapain tablets over 24 hours.

If you do take more, there is a risk of overdosing and liver damage. Paracetamol overdose is life-threatening and can occur if you take more than the prescribed safe amount.

Zapain directions

Swallow one to two tablets with water (do not crush or chew) every four hours.

Never take more than eight pills in 24 hours.

Do not take Zapain tablets if you:

• Take other paracetamol-containing products.
• Are under 12 years old
• Know that you are allergic to paracetamol or codeine
• Suffer from severe kidney or liver disease.
• Suffer from asthma or any other breathing problems, for example, chronic bronchitis or emphysema.
• Have just had a head injury or suffer from increased pressure on the brain.
• Drink a lot of alcohol or have done it in the past.
• Have you recently had an operation on your gallbladder.
• Have diarrhoea.
• Are taking monoamine oxidase inhibitors (MAOIs), or have you been taking them within the last two weeks. MAOIs such as phenelzine, moclobemide or isocarboxazid are medicines used to treat depression.

Use in children and adolescents

The recommended dose for children aged 16-18 is one to two capsules every 6 hours when necessary and up to 8 capsules in 24 hours.

The recommended dose for children aged 12-15 is one capsule every 6 hours when necessary and up to a maximum of 4 capsules in 24 hours.

Zapain Capsules should not be taken by children below the age of 12 due to the risk of severe
breathing problems

Instructions for storing Zapain Capsules

• Ensure that children cannot access or see Zapain Capsules.
• Avoid using Zapain Capsules after the expiration date indicated on the carton after the “EXP” label.
• Store this medication in a dry location.
• Do not store above 25°C.
• Shield from exposure to light.
• Do not dispose of any medications through wastewater or household waste. Consult your pharmacist for proper disposal methods for unused medicines. These precautions will aid in protecting the environment.

Zapain side effects

Zapain is associated with many potential side effects, including:

• constipation
• drowsiness
• Allergic reactions (rare)
• vision problems may occur in some people

Strategies to reduce the severity of these side effects are available and should be discussed with your healthcare professional.

It should be noted that side effects are widespread in those who take opioid treatment. Clinical trials suggest that 50% and 80% of all patients experience at least one problematic side effect when taking Zapain or a similar opioid.

Side effects are likely even higher in someone who takes opioids daily or for an extended period. 

Common side effects of Zapain include:

Codeine allergy

Some people may be allergic to the codeine phosphate in Zapain, paracetamol or either of the following ingredients that are in Zapain:

• maize starch
• sodium lauryl sulphate
• talc
• magnesium stearate
• croscarmellose sodium
• gelatin, titanium dioxide E171
• erythrosine E127
• red iron oxide E172. 

An allergic reaction will include symptoms of:

• anaphylaxis
• shortness of breath
• tightness in the chest and throat
• swelling of the face, tongue, lips, and throat
• a skin rash that can result in blistering

If you experience any side effects that are troublesome or worrying after taking Zapain, stop the medication and speak to your doctor as soon as possible.

If you fear being allergic to co-codamol, you must seek emergency medical help immediately.

Zapain and pregnancy

If you are currently expecting a child or nursing, suspect that you may be pregnant, or have plans to conceive, it is advisable to consult your doctor or pharmacist before consuming this medication.

Pregnancy: Unless you have discussed the matter with your prescriber and it is determined that the benefits of treatment outweigh the potential harm to the baby, avoid taking Zapain Capsules if you are pregnant or suspect that you may be.

If you do use Zapain Capsules during pregnancy, it is possible for your baby to develop a dependency and experience withdrawal symptoms after birth, which may require medical intervention.

Breastfeeding

Refrain from taking Zapain Capsules while breastfeeding, as the codeine contained in the medication can pass into breast milk and have an impact on your baby.

Zapain strength

Zapain is the stronger of the brand medications that combine Paracetamol and Codeine.

Co-codamol is the generic name for 8mg/15mg Codeine 500mg, and Zapain is the brand name for 30mg Codeine 500mg Paracetamol.

Because of the strength of the dosage, you can get co-codamol 8m/500mg over the counter in pharmacies, but 15mg/500 co-codamol and Zapain need a prescription. 

This medication treats pain where weaker forms such as Paracetamol and Ibuprphen have not been enough. It is typically used to treat level 3-moderate occasional pain.

This is above regular co-codamol but not as strong as Morphine, which is given for severe pain. 

Co-codamol overdose

If taking Zapain causes you to become excessively tired or confused to the point that you cannot remember when you took your last dose, it is essential to let your doctor know. Experiencing these side effects could cause you to take more than you are prescribed accidentally.

Deliberate misuse of this medication can lead to a co-codamol overdose, resulting in respiratory arrest, organ failure, coma and death. Combining Zapain with other depressant drugs such as sleeping pills, benzodiazepines, opioids or alcohol also vastly increases your risk of overdose.

Symptoms of Cocodamol overdose:

• Bluish lips and fingernails
• Breathlessness
• Cold, clammy skin
• Shallow breathing
• Losing consciousness
• Unresponsive or difficult to wake
• Pinpoint pupils
• Extreme muscle weakness
• Coma
• Weak pulse
• Low blood pressure
• Slow heart rate
• Respiratory arrest 

If you or someone you love has taken too many pills and shows overdose symptoms, please seek emergency medical help.

Additionally, anyone taking more than 7.5g of Paracetamol within a 4-hour timeframe risks acute liver damage and should immediately attend a hospital for treatment. The sooner a paracetamol overdose is treated, the better the outcome for the patient.

Zapain and alcohol

Zapain and alcohol should never be taken together. This medication comes with a warning on the packaging to avoid alcohol.

Codeine is a central nervous system depressant, and drinking alcohol with it will increase the depressant effects of both substances.

Those who abuse drugs may not give a second thought to combining Zapain and alcohol; however, this can easily lead to overdose. Frequently combining it with alcohol increases your risk of dual dependence and addiction.

Consuming alcohol while taking a course of Zapain will likely make you initially euphoric and highly drowsy. Some people who abuse alcohol and Zapain may take them together to initiate sleep.

Drinking alcohol to the point of losing consciousness whilst taking Zapain could mean you never wake up. The risk of stopping breathing whilst asleep is genuine for those who abuse this drug.

Is Zapain the same as Tramadol?

The two are opiate medications, which are often used in combination with Paracetamol.

Tramadol is synthetic, whereas Zapain is a natural opioid.

They are slightly different in effectiveness, with Tramadol offering somewhat more pain relief and Zapain causing fewer cardiovascular complications and other side effects such as vomiting.

Tramadol can be problematic for people with seizures as it can lower the threshold for having a seizure as an unwanted side effect.

Is Zapain Addictive?

Prolonged use of Codeine can lead to drug dependence, even at therapeutic doses. Drug dependence can happen to anyone who takes addictive substances or medications regularly. This is easily remedied with a tapering-off regime planned and monitored by your doctor.

Addiction occurs when a person develops a psychological dependence on a substance. More often than not, this is accompanied by physical dependence. Addiction is a recognised chronic medical condition far more complex to treat than dependence alone and is considered life-threatening.

When a drug addiction develops, lasting changes occur in the brain’s reward circuits. These changes make it virtually impossible to stop substance use without professional treatment and help. 

The risks of developing an addiction to Zapain are increased in those with a current or past history of a substance use disorder, including alcohol. Those with a family history of addiction or who suffer from a mental health disorder such as depression, PTSD or generalised anxiety disorder are also at a greater risk of developing an addiction. 

If you have previously had an addiction to opioids, prescribed or otherwise, it is wise to let your doctor know. Where no other suitable alternatives are available, your doctor will prescribe for as short as possible and should offer additional support and monitoring.

Tolerance and dependence on opioid painkillers

When a person takes an opioid such as this for over 3 to 5 consecutive days, they risk developing physical dependence. The longer they take the drug and the higher the dosage, the more severe the dependence and withdrawal symptoms become.

Over time and with repeated use, a dosage of an opioid drug will lose its effects and painkilling properties. When this happens, your pain will likely return and feel unmanaged as you have developed tolerance to the dosage. Once a tolerance to a dosage has occurred, you may be tempted to return to your doctor to advise that your pain has worsened.

The reality is that your pain levels may not have changed and have only returned due to tolerance developing. Whilst your doctor may well suggest an increased dosage to manage your pain, other pain management options are worth discussing, especially if your condition is chronic. Long-term pain can be controlled in ways other than with addictive pain relief.

Be cautious when taking an increased dosage for an extended period, as this will only result in tolerance once more. This can develop into a vicious circle of ever-increasing opioid pain relief until you reach a point where your pain can no longer be managed by medication. Increasing the frequency and dosage often leads to drug dependence and puts you at higher risk of Zapain addiction.

Zapain addiction

Codeine dependence can occur even when you follow a prescription. This is due to the addictive properties of opioid drugs. Even over-the-counter strength codeine will cause drug dependence when taken for more than 3 to 5 days consecutively. Therefore, you must only take Zapain when you need to and for as short a time as possible.

Unfortunately, due to the uncareful prescribing of Zapain, many people take this drug for extended periods, even years after suffering an initial injury or the onset of chronic pain. There is nothing to suggest clinically that it is helpful to take opioid painkillers for longer than three months in cases of non-cancer-related chronic pain.

Data collected from prospective cohort studies suggest that opioids delay returning to work after injury and may prolong functional recovery or worsen physical functioning.

A Danish cross-sectional study also indicates that opioid users are associated with poorer quality of life, employment status, increased healthcare use, and worse pain than non-opioid users.

Long-term use of these pills can also cause chronic constipation and depression. Also, due to developing tolerance, a person may turn to illicit Class A opioids.

Zapain addiction and treatment

Whilst most people under medical care can take the tablet safely, a minority will be predisposed to developing an addiction.

Addiction is likely to occur when a person takes a drug other than exactly as prescribed (including not spacing out the dosages properly) or when a person purposely abuses it.

Forms of Zapain abuse include:

• Buying prescription-strength co-codamol from the internet without a prescription
• Doctor shopping (Seeking out different doctors for more prescriptions)
• Taking co-codamol with alcohol or other drugs to increase its effects
• Taking it more frequently
• Taking the medication to get high
• Taking medication prescribed for someone else

Addiction is an illness and not a moral failing. No one chooses to become addicted. If you or someone you love have become addicted to Codeine, professional help and treatment are available.

Signs of Zapain addiction include

• Taking higher doses than what has been prescribed
• Frequent intoxication
• Regular abuse of the drug
• Suffering opioid withdrawal symptoms
• Suffering negative consequences to mental and physical health, occupation or education and social and personal relationships 
• Getting co-codamol from sources other than your pharmacy
• Frequently losing control over the amount consumed
• Experiencing intense cravings 
• Unable to follow a reduction regime due to loss of control and cravings

Someone suffering from Zapain addiction is unwell with a substance use disorder and requires professional medical and therapeutic treatment to recover.

Our inpatient rehab programmes for Zapain addiction treatment offer:

• A safe, recovery-focused space, free from temptation
• A complete medical detox
• A comprehensive doctor assessment
• Comprehensive treatment for dual diagnosis and any additional addictions or dependencies
• Evidence-based addiction treatment therapies delivered by a multi-disciplinary team of professionals
• A comprehensive discharge plan
• Free aftercare and ongoing support on completion of treatment