GPs told not to initiate patients on co-codamol tablets amid national shortage

GPs have been told not to initiate patients on co-codamol 30mg/500mg tablets tablets until a national shortage of the painkiller has resolved.

The Department of Health and Social Care has said prescribers should not start treating new patients with the drug, and advised on alternatives to prescribing the tablets.

The limited supply of co-codamol 30mg/500mg tablets, began this month and will last until June at the earliest, according to a DHSC medicine supply notification.

The Scottish Government confirmed the shortage earlier this week, stating the tablets would be in limited supply until June.

The Government banned all exports and hoarding of the drug, a combination of paracetamol and codeine, on 28 January.

The DHSC notification said: ‘Healthcare professionals should not initiate new patients on co-codamol 30mg/500mg tablets until the supply issues have resolved.’

For patients already taking co-codamol tablets, and whose supply is insufficient to last until the re-supply date, it advised prescribers to ‘review pain control to determine if treatment is still required’, and if the decision is made to stop treatment, ‘avoid abrupt cessation of therapy’.

The supply notification outlined alternatives to prescribing the tablets, including:

Paracetamol 500mg tablets ‘remain available and can support a full uplift in demand’;

Codeine 30mg tablets ‘remain available and can support a partial uplift in demand’;

Co-codamol 30mg/500mg capsules ‘remain available and can support a partial uplift in demand from mid-April 2026’;

Co-codamol 30mg/500mg effervescent tablets ‘remain available but cannot support an uplift in demand’.

However, ‘no single suitable alternative’ could ‘fully absorb’ the additional demand on them created by the shortage of co-codamol tablets, and changing prescriptions from tablets to other formulations risks worsening supply pressures, according to the Specialist Pharmacy Service.

Lancashire and South Cumbria ICB, which claimed it was the ‘highest prescriber of opioids in England’, said the drug in all forms made up 31% of all opioid prescribing.

It described the shortage as ‘enormously disruptive’ but said it could be ‘an opportunity to reduce the overall opioid burden’.

A House of Lords report has recently warned medicines shortages in the UK are a national security issue that should be given more priority. It recommended that shortages to be better communicated to GPs to enable them to support patients.

Actions for prescribers

Do not initiate new patients on co-codamol 30mg/500mg tablets until the supply issues have resolved.
Where insufficient supply to last until the re-supply date, prescribers should determine if treatment is still required, and if the decision is made to stop treatment, avoid abrupt cessation of therapy.
Where pain control is still required, prescribers should establish:
- if the minimum dose of co-codamol 30mg/500mg tablets is to maintain pain control
- if the codeine component is still required and
- appropriateness of switching to separate components (paracetamol 500mg and codeine 30mg tablets) and consideration of the increase in tablet load (if applicable)
Where the above options are not considered appropriate, consider switching patients to an alternative analgesic preparation.
Where the above options are not appropriate and the patient requires a co-codamol 30mg/500mg combination product, consider reserving co-codamol 30mg/500mg capsules for these patients ensuring the gelatin content is acceptable and there is not an intolerance to any of the excipients.
Ensure the patient is counselled on any changes in dosing and formulation.

Source: North Central London ICB