Yes. Plain dihydrocodeine can generally be taken with paracetamol when both medicines are being used as directed. NHS guidance on taking dihydrocodeine with other medicines specifically lists paracetamol among the painkillers that can be taken with dihydrocodeine.
However, there is an important safety check to make first: find out whether your dihydrocodeine medicine already contains paracetamol.
Medicines such as co-dydramol and Paramol contain both ingredients. Taking additional paracetamol with one of these products could mean taking paracetamol twice without realising it.
The safest rule is therefore simple: check the active ingredients, not just the medicine or brand name.
Dihydrocodeine is available on its own, but it is also included in combination painkillers.
This creates two different situations.
If you have plain dihydrocodeine, it does not contain paracetamol. NHS guidance states that it can be taken with paracetamol when the medicines are used correctly.
If you have co-dydramol, Paramol or another dihydrocodeine-paracetamol combination, paracetamol is already included.
For example, NHS information about co-dydramol confirms that it contains two active ingredients:
Different strengths of co-dydramol contain different amounts of dihydrocodeine alongside paracetamol.
Before adding another painkiller, look at the active ingredients on the packet, dispensing label or patient information leaflet. If you are unsure what your medicine contains, ask a pharmacist.
For more background on the opioid itself, read our guide to what dihydrocodeine is, how it works and its common side effects.
Paracetamol and dihydrocodeine are different types of painkiller.
Dihydrocodeine is an opioid painkiller used to treat certain types of moderate to severe pain.
Paracetamol is a non-opioid painkiller.
The fact that the two ingredients can be used together is also reflected in licensed combination medicines such as co-dydramol.
This does not mean that taking more of either medicine will provide better pain relief. The appropriate treatment depends on factors such as the cause of the pain, other medicines being taken, individual health circumstances and the treatment recommended by a healthcare professional.
One of the most important issues when combining painkillers is accidentally taking the same active ingredient from two different products.
Someone may, for example, take co-dydramol and then take ordinary paracetamol without realising that the co-dydramol already contains paracetamol.
The same problem can occur with other combination medicines.
This matters because taking too much paracetamol can be dangerous and can cause liver damage.
Paracetamol can also be found in other medicines, including some products used for colds and flu. It is therefore worth checking every medicine being taken rather than assuming that products with different brand names contain different ingredients.
If you cannot tell whether two medicines contain the same ingredient, check with a pharmacist before combining them.
Yes. Co-dydramol contains both dihydrocodeine and paracetamol in a single medicine.
It is available in different strengths. The numbers shown on a co-dydramol packet indicate the amount of dihydrocodeine followed by the amount of paracetamol in each tablet.
For example, according to the official co-dydramol 10mg/500mg Summary of Product Characteristics, each tablet contains 10mg of dihydrocodeine tartrate and 500mg of paracetamol.
This is important because someone prescribed plain dihydrocodeine should not assume that a particular strength of co-dydramol is an interchangeable alternative.
Do not switch between plain dihydrocodeine, separate paracetamol and combination products or alter the amount you take without appropriate advice.
Follow the dispensing label and the instructions provided with the exact medicine you have been given.
Paramol is another example of why checking active ingredients matters.
The official Paramol product information confirms that its active ingredients include both paracetamol and dihydrocodeine.
Someone taking Paramol is therefore already taking both medicines in the same product.
Taking additional paracetamol without checking the ingredients could duplicate the paracetamol component.
Brand names can change or be unfamiliar, so the active ingredient list is a more reliable safety check than recognising a particular brand.
Do not take co-codamol with dihydrocodeine unless a healthcare professional has specifically told you to.
Co-codamol contains codeine and paracetamol.
The concern here is different from simply combining plain paracetamol with dihydrocodeine. Codeine and dihydrocodeine are both opioid painkillers.
NHS dihydrocodeine interaction guidance advises against taking dihydrocodeine with painkillers containing codeine because doing so increases the chance of side effects.
This is another reason to check all the active ingredients when using more than one pain medicine.
Even when two medicines can normally be used together, individual circumstances can change what is appropriate.
Speak to a doctor or pharmacist if you are uncertain about combining medicines, particularly if you:
NHS guidance on who can take dihydrocodeine highlights several circumstances in which additional medical advice may be needed.
A pharmacist can also review the active ingredients in your medicines and help identify accidental duplication or potential interactions.
Do not respond to uncontrolled pain by simply adding more painkillers or increasing the amount you take.
Pain that remains severe, changes or becomes worse may need reassessment.
A doctor or pharmacist can review whether the medicines are being used correctly and whether further assessment or a different approach is appropriate.
This is particularly important with opioid medicines. Taking more than directed can increase the risk of harmful effects without addressing why the pain is continuing.
Get urgent medical advice if you think you may have taken too much paracetamol or dihydrocodeine.
Too much paracetamol can cause serious liver damage, and symptoms may not always be obvious straight away.
Taking too much dihydrocodeine can cause symptoms such as severe drowsiness, dizziness, nausea or breathing problems. NHS guidance on taking too much dihydrocodeine explains when to contact NHS 111 and when emergency help is required.
Contact NHS 111 for urgent medical advice if you think too much medicine may have been taken.
Call 999 or go to A&E if someone has severe difficulty breathing, becomes unconscious or cannot be properly awakened.
Take the medicine packet, leaflet or dispensing information with you if possible. This can help healthcare professionals identify exactly what was taken.
Plain dihydrocodeine and paracetamol can generally be taken together when they are being used correctly.
The important step is checking what is already in your medicine.
Co-dydramol and Paramol already contain both dihydrocodeine and paracetamol. Co-codamol contains paracetamol plus codeine, another opioid that should not normally be combined with dihydrocodeine unless specifically advised.
Instead of relying on the brand name, check the active ingredients whenever more than one pain medicine is being used.
If anything is unclear, ask a pharmacist or prescriber before combining the medicines.
