Panadol Extra (paracetamol and caffeine) for pain

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1 Panadol Extra (paracetamol and caffeine) for pain This Medicine Update is for people who are taking, or thinking about taking, Panadol Extra. Summary Panadol Extra is a pain reliever available from pharmacies. It contains two active ingredients paracetamol and caffeine. Compared with paracetamol alone, Panadol Extra improves pain relief for some people. The caffeine in Panadol Extra can cause anxiety and sleeplessness, but this is very rare when Panadol Extra is used correctly. However, you may be more likely to get these side effects if you consume caffeine-containing food and drinks when taking Panadol Extra. Make sure that you don t take more than eight Panadol Extra caplets in 24 hours (equivalent to four grams of paracetamol). Many different brands of pain relievers and cold and flu remedies contain paracetamol. Check the label or packaging of all the medicines you take to make sure that you don t take too much paracetamol by accident. Independent, not-for-profit and evidence based, NPS enables better decisions about medicines and medical tests. We are funded by the Australian Government Department of Health and Ageing.

2 Contents section What Panadol Extra is...1 What Panadol Extra is for... 2 Who can take Panadol Extra... 3 How to take Panadol Extra... 4 What does Panadol Extra do?... 5 Important side effects to consider... 6 What else you should know about Panadol Extra... 7 Other medicines available for pain... 8 How to decide between Panadol Extra and other pain relievers... 9 Panadol Extra availability...10 Other ways to relieve pain...11 Where to find more information...back page Asking the right questions about new medicines What is Medicine Update? Medicine Update provides independent information about new medicines and new listings on the PBS. It tells you about the possible benefits and harms of new medicines, who can and can't use them, and some of the other treatment options available. How to use Medicine Update Medicine Update is a tool to help you understand your treatment choices and to discuss them with your doctor. Medicine Update doesn t describe all possible side effects, precautions, or interactions with other medicines so you should always read the consumer medicine information on the packaging. Who is it for? Medicine Update is for anyone who is starting this medicine or thinking of starting it, and their carers. Where does Medicine Update come from? Medicine Update is written by NPS: Better choices, Better health in consultation with consumers and health professionals. NPS is an independent, not-for-profit, government-funded organisation. NPS takes reasonable care to ensure this information is accurate and up-to-date at the time of creation. It is for your information only and is not medical advice. NPS does not warrant its completeness and excludes liability where permitted by law. We recommend you seek advice from a health professional about your medical condition. 2

3 1. What Panadol Extra is Panadol Extra is a capsule-shaped tablet (caplet) to help relieve pain. Each caplet contains two active ingredients paracetamol and caffeine. The Extra in Panadol Extra refers to the addition of caffeine. The active ingredient is the chemical in the medicine that makes the medicine work. Many medicines are known by their brand names as well as by the name of the active ingredient. Some medicines are available under several different brand names. 2. What Panadol Extra is for Panadol Extra is taken to help relieve pain. It can be used to relieve pain that is short-term, like the pain you might feel after having a tooth removed. Other types of short-term pain that Panadol Extra can be used to treat include: headache and migraine cold and flu symptoms (paracetamol also reduces fever) muscle aches sore throat period pain. Panadol Extra can also be used to treat joint pain caused by arthritis (inflammation of the joints). Arthritis pain can last for a long time and may need regular treatment. You should talk to your doctor about the best way to use paracetamolcontaining medicines like Panadol Extra to treat your joint pain. 3. Who can take Panadol Extra Panadol Extra can be taken by adults and children over the age of 12 to relieve pain. Panadol Extra is a pharmacy medicine. This means that it is available without a prescription, but only from a pharmacy. You should speak to your pharmacist before buying Panadol Extra if you: are pregnant or breastfeeding have kidney or liver problems are taking other medicines. If your pain has not improved within a few days, talk to your doctor or pharmacist. You may need to have your condition or your medicines reviewed. Panadol Extra, and other medicines containing paracetamol, should only be used for longer periods of time under your doctor s supervision. Talk with your doctor or pharmacist about all the treatment options for your pain. 3

4 4. How to take Panadol Extra You can take two Panadol Extra caplets every four to six hours. But don t take more than eight caplets in 24 hours. Medicines that contain paracetamol should be taken according to the information on the packaging or label, not in response to your level of pain. You can take Panadol Extra with or without food. Swallow the caplets with a glass of water. 5. What does Panadol Extra do? Panadol Extra provides relief from pain and reduces fever, but it doesn t reduce inflammation (swelling). It contains two active ingredients. The paracetamol in Panadol Extra is a pain reliever that works on the body s nervous system. It is thought to reduce the sensation of pain by preventing the production of chemicals called prostaglandins. The caffeine in Panadol Extra is included to supplement the pain relieving effect of paracetamol. 6. Important side effects to consider When you take a combination medicine, you need to consider the side effects of both active ingredients. The paracetamol and caffeine in Panadol Extra can cause side effects, but they are very rare when it s used correctly. Paracetamol can cause a skin rash, and caffeine can make you anxious or restless. This can lead to difficulty sleeping. Paracetamol can cause serious liver damage if you accidentally take too much. Be aware of possible caffeine side effects You should avoid consuming too much caffeine when taking Panadol Extra. Caffeine may cause anxiety, or sleeplessness if it is taken before going to bed. Ask your pharmacist about the possible side effects of this medicine before you take it. Always tell your doctor about any changes to your condition if you are taking a new medicine. You can also discuss side effects with a pharmacist, by calling the Adverse Medicines Event (AME) Line on (Mon Fri, 9am 5pm). As a guide, one dose of Panadol Extra (2 caplets) contains 130 mg of caffeine this is equivalent to the caffeine content of two cups of instant coffee. Talk to your doctor or pharmacist about other pain relief options if you are pregnant. Consuming too much caffeine can slow your baby s growth and increase the risk of an early birth. Caffeine can pass into breast milk, and then to your baby if you breastfeed. This doesn t appear to cause any long-term problems for your baby, but it may make them jittery or restless if you consume a lot of caffeine each day. You can find out more about caffeine from Food Standards Australia New Zealand ( factsheets/factsheets2010/caffeinejune2010.cfm). 4

5 7. What else you should know about Panadol Extra Panadol Extra is a new medicine in Australia, so there are some important things you should know before using it. Paracetamol can interact with other medicines Some medicines (certain antidepressants, opioid pain relievers and medicines used to relieve cramps and nausea) can affect the rate at which paracetamol is absorbed into your system. This could change the way the paracetamol works. If you take paracetamol regularly, and you also take a blood-thinning medicine called warfarin, your doctor might need to adjust your warfarin dose. An interaction occurs when something affects how a medicine works. The interaction may be with a food, or another medicine, or a herbal remedy, or food supplement. You should tell your doctor or pharmacist about all the medicines you take including medicines from pharmacies, supermarkets or health food stores before you take Panadol Extra. Paracetamol is present in many different medicines Many pain, cough, cold and flu medicines contain paracetamol. You should check the active ingredients of any medicines you buy without a prescription before taking them at the same time as Panadol Extra. Ask your pharmacist if you re not sure. It s important that you don t take more than eight Panadol Extra caplets a day (equivalent to four grams of paracetamol). Accidentally taking too much paracetamol can cause serious liver damage. The risk of liver damage is increased if you have been drinking alcohol. Check the label or packaging of all your pain relievers and cold and flu remedies to make sure you are not taking too much paracetamol. Medication overuse headache Taking pain relievers like paracetamol too often, or for too long, can cause headaches or make them worse. This is called medication overuse headache. Pain relievers that contain more than one active ingredient are thought to be more likely to cause medication overuse headache. 5

6 8. Other medicines available for pain The other types of medicines for pain available from your pharmacy are: paracetamol alone non-steroidal anti-inflammatory drugs (NSAIDs), and combination pain relievers that contain more than one active ingredient. Paracetamol Paracetamol (for example Dymadon, Panadol and Panamax) relieves mild-to-moderate pain and reduces fever. In general, it is a safe medicine when taken at the recommended dose. But taking more than recommended can cause serious liver damage. Non-steroidal anti-inflammatory drugs (NSAIDs) The most commonly used NSAIDs are aspirin (Aspro, Disprin), ibuprofen (Advil, Nurofen) and diclofenac (Fenac, Voltaren). Like paracetamol, they provide temporary relief from pain, but they can also reduce inflammation. Common side effects include nausea, heartburn and indigestion. You should use the lowest dose of NSAID that controls your pain, and use it only when needed. This is because NSAIDs can cause serious side effects like kidney problems or bleeding from the stomach. Combination pain relievers Combination pain relievers contain more than one active ingredient. Panadol Extra is a combination pain reliever containing paracetamol and caffeine. Others include a combination of: an NSAID and codeine, or paracetamol and codeine. Combination pain relievers containing codeine are only available after talking with your pharmacist, who can provide enough for up to 5 days of treatment. Some combination pain relievers containing higher codeine doses require a prescription. Combination pain relievers containing codeine can cause constipation, nausea, vomiting and drowsiness. Older people may be more susceptible to these side effects. 9. How to decide between Panadol Extra and other pain relievers To ensure you get the safest and most effective pain relief, talk to your doctor or pharmacist before choosing a pain reliever. Remember that risks and benefits differ between medicines and from person to person. Paracetamol Paracetamol is the most appropriate pain reliever for many people. It relieves pain with few side effects when used at the right dose. If you can manage your pain with paracetamol alone, there is no need to try other pain relievers. If taking paracetamol does not control your pain, speak to your doctor or pharmacist. 6

7 9. How to decide between Panadol Extra and other pain relievers...continued Non-steroidal anti-inflammatory drugs (NSAIDs) NSAIDs are more likely than paracetamol to cause side effects. So most people should only use an NSAID if regular doses of paracetamol have not relieved the pain. Serious side effects of NSAIDs include stomach bleeding, kidney damage and an increased risk of heart conditions. Some of these problems may be more likely if you: are over 65 years of age are taking two types of NSAID at the same time are taking medicines to thin your blood, medicines called corticosteroids, or some combinations of blood pressure lowering medicines have, or have had, a stomach ulcer, stomach bleeding or kidney damage drink alcohol on a regular basis take more than the recommended dose take the NSAID for more than a few days at a time. For people with any of these risk factors, paracetamol is usually the preferred pain reliever. Combination pain relievers Many combination pain relievers contain an NSAID and codeine, or paracetamol and codeine. However, it s thought that the majority of these combination products do not provide any additional pain relief. For most people, paracetamol alone is likely to be as effective as paracetamol combined with low-doses of codeine. But by avoiding the codeine content, you can avoid side effects such as constipation and drowsiness. Panadol Extra In clinical trials, about 7 out of every 10 people (65 %) who took paracetamol and caffeine (Panadol Extra) felt that their pain had been significantly relieved. But so did 6 out of every 10 people (57 %) who took paracetamol alone. These results suggest that the effect or benefit of adding caffeine to paracetamol is small. A clinical trial is a research study conducted with patients, which compares one treatment with one or more other treatments, or with no other treatment, to assess its effectiveness and safety. If you decide to take Panadol Extra, you will have to consider the possible side effects of caffeine as well as those of paracetamol (see section 6). 10. Panadol Extra availability Panadol Extra is not covered by the Pharmaceutical Benefits Scheme (PBS). It is a pharmacy medicine. This means that it is available without a prescription, but only from a pharmacy. The full price of Panadol Extra may vary from one pharmacy to another, but it is likely to be more expensive than pain relievers that contain paracetamol alone. 7

8 11. Other ways to relieve pain Panadol Extra (paracetamol and caffeine) for pain Medicines are not the only way to help you relieve pain, there are other ways. Understanding the cause of your pain will help you to choose the best approach. Recognising the difference between short-term and long-term pain Short-term pain might be caused by something like a sprained ankle or having a tooth removed at the dentist. You might take a medicine to relieve the pain, but it usually settles down after a day or two. Long-term pain is different. It can last for months and might be caused by a chronic condition like osteoarthritis (a type of joint pain caused by breakdown of cartilage). If you have pain like this, or any pain that lasts for more than a few days, you should speak to your doctor. Relieving pain in other ways Whether your pain is short-term or long-term, there are other things you can do to help ease it. For example, in short-term pain, resting the affected part and putting an ice pack on it can often help. Others may find that applying heat soothes the pain. If your pain is long-term, you should speak to your doctor about non-medicine options. These will vary depending on the cause of your pain. With osteoarthritis, it s important to stay active. Exercise can help to decrease pain, maintain joint flexibility and increase muscle strength. You should choose a combination of activities that strengthen or stretch your muscles, and increase your heart rate. These might include walking, hydrotherapy, tai chi and yoga. Ask your doctor or physiotherapist for advice about suitable activities for you. Whatever type of pain you have, it s important that you try to look after it yourself you will know, more than anyone, what helps and what doesn t. 8

9 Where to find out more information Read the label on the Panadol Extra packaging It will tell you: who should not use the medicine how to take the medicine most of the possible side effects the ingredients. Information over the phone NPS works with healthdirect Australia to provide consumers with information on medicines. To get information about Panadol Extra call 1300 MEDICINE ( ) from anywhere in Australia for the cost of a local call (excluding mobiles). Service is available Monday Friday, 9am 5pm EST except NSW public holidays. To report a side effect with Panadol Extra Call the Adverse Medicines Event (AME) Line on (Mon Fri, 9am 5pm EST). The AME Line lets you report and discuss side effects that might be related to your medicine. The side effects of your medicine but not your personal details are reported to the Australian medicines regulatory agency (the Therapeutic Goods Administration or TGA for short). The information helps to improve the safe use of medicines. For more information about the AME Line visit More about taking medicines For more information on how new medicines are tested and approved in Australia see the NPS factsheet New medicines: are they always better? at More information on understanding side effects is available from Date published: December 2010 Visit the NPS website to find out about our free activities and resources for consumers Independent, not-for-profit and evidence based, NPS enables better decisions about medicines and medical tests. We are funded by the Australian Government Department of Health and Ageing National Prescribing Service Limited. This work is copyright. You may download, display print and reproduce this work in unaltered form only (retaining this notice) for non-commercial use either personally or within your organisation. Apart from any such use or otherwise as permitted under the Copyright Act 1968, all rights are reserved. Queries concerning reproduction and rights should be sent to copyright@nps.org.au. ABN l Level 7/418A Elizabeth Street Surry Hills NSW 2010 l PO Box 1147 Strawberry Hills NSW 2012 Phone: l Fax: l info@nps.org.au l web: