Do not take Syndol if

• you are allergic to codeine, paracetamol, doxylamine succinate, caffeine or any of the ingredients of this medicine (listed in section 6). Signs of an allergic reaction include a rash and breathing problems. There can also be swelling of the legs, arms, face, throat or tongue
• you are having an asthma attack or have severe breathing problems
• you have recently had a head injury
• you have been told by your doctor that you have increased pressure in your head. Signs of this include headaches, being sick (vomiting) and blurred eyesight
• you have recently had an operation on your liver, gall bladder or bile duct (biliary tract)
• you are at risk of blocked intestine (paralytic ileus)
• you are taking other medicines containing codeine or any other paracetamol-containing products
• you are taking a medicine of the class known as Monoamine Oxidase Inhibitors (MAOIs, e.g. selegiline, moclobemide), which are used as antidepressants, or if you had taken any medicine of this group in the past 14 days.
• you are an alcoholic
• the person going to take the tablets is under 12 years of age
• you are under 18 years of age and have had your tonsils or adenoids removed due to Obstructive Sleep Apnoea Syndrome
• you know that you metabolise very rapidly codeine into morphine
• you are breast-feeding or planning to breastfeed

Do not take Syndol if any of the above apply to you.

Warnings and precautions

Talk to your doctor or pharmacist before taking Syndol if:

• You have liver, kidney, thyroid or heart problems and/or are elderly or of a weakened state;
• You have high blood pressure, problems with the prostate gland, obstructive bowel problems, acute abdominal conditions (e.g. peptic ulcer), hormonal problems, problems passing urine or have had recent gastrointestinal surgery;
• You are in shock, have gallstones, glaucoma, or a disease called myasthenia gravis (a condition which weakens muscles) or a history of fits;
• You have a history of mood swings, alcohol or drug abuse or are under psychiatric treatment;
• You are taking a benzodiazepine (used for treatment of anxiety or sleep disorders ), e.g. diazepam, clobazam, lorazepam, chlordiazepoxide, oxazepam, temazepam, nitrazepam, loprazolam, lormetazepam or clonazepam

Codeine is transformed to morphine in the liver by an enzyme. Morphine is the substance that produces pain relief. Some people have a variation of this enzyme and this can affect people in different ways. In some people, morphine is not produced or produced in very small quantities, and it will not provide enough pain relief. Other people are more likely to get serious side effects because a very high amount of morphine is produced. If you notice any of the following side effects, you must stop taking this medicine and seek immediate medical advice: slow or shallow breathing, confusion, sleepiness, small pupils, feeling or being sick, constipation, lack of appetite.

If you are not sure if any of the above apply to you, talk to your doctor or pharmacist before taking this medicine.

Other medicines and Syndol

Tell your doctor or pharmacist if you are taking or have recently taken any other medicines. This includes medicines obtained without a prescription, including herbal medicines. This is because Syndol can affect the way some other medicines work. Also, some other medicines can affect the way Syndol works.

While taking Syndol you should not take any other medicines which contain paracetamol.

This includes some painkillers, cough and cold remedies. It also includes a wide range of medicines available from your doctor and more widely in shops.

Do not take this medicine and tell your doctor or pharmacist if you are taking

• Medicines to treat depression called MAOIs (monoamine oxidase inhibitors) or have recently taken them in the last two weeks. MAOIs are medicines such as moclobemide, phenelzine, tranylcypromine.

Tell your doctor or pharmacist if you are taking or have recently taken any of the following medicines:

• Medicines which make you drowsy or sleepy (CNS depressants) (e.g. barbiturates, anaesthetics, hypnotics, other opioid analgesics, anxiolytic sedatives, antipsychotics, tricyclic antidepressants and phenothiazines) or a benzodiazepine used to treat anxiety or sleep disorders
• Medicines for the treatment of high blood pressure (diuretics and antihypertensives)
• Medicines to treat or prevent clinical depression (antidepressants)
• Medicines used to treat mental distress or disorder (antipsychotics)
• Any of the group called antimuscarinics (e.g. atropine, hyoscine)
• Any of the group called neuromuscular blockers (e.g. tubocurarine)
• Medicines used to thin the blood such as warfarin (or other coumarins)
• Metoclopramide or domperidone – used to stop you feeling sick (nausea) or being sick (vomiting)
• Colestyramine – for lowering blood cholesterol levels
• Hydroxyzine – to treat anxiety and tension
• Mexiletine – to treat irregular heartbeat
• Kaolin or loperamide – for the treatment of diarrhoea
• Naloxone – to treat a narcotic overdose
• Naltrexone – used as part of a treatment program for drug or alcohol dependence
• Cimetidine – to treat stomach ulcers
• Cisapride – to treat gastro-oesophageal reflux disease
• Quinidine – to treat irregular heart rate
• The oral contraceptive pill

If you are not sure if any of the above apply to you, talk to your doctor or pharmacist before taking Syndol.

Concomitant use of opioids and benzodiazepines increases the risk of drowsiness, difficulties in breathing (respiratory depression), coma and may be life-threatening. Because of this, you should only take these together if prescribed by a doctor. Please follow your doctor’s dosage recommendation closely. It could be helpful to inform friends or relatives to be aware of signs and symptoms stated above. Contact your doctor when experiencing such symptoms.

Taking Syndol with food and drink

Avoid alcohol whilst taking Syndol.