Your health questions answered

'I wasn't warned about addiction'
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Q. Last summer, I took the painkiller co-codamol for back pain. I started with the lowest dose of codeine (8mg), but then took the 30mg tablets for two months. Coming off it gave me the experience of "cold turkey"; I felt very strange and agitated, and sleep proved difficult. With advice from NHS addictive drug agencies, I managed to get off them. My question is: how common is such an experience and should I have been warned? There is no reference to addiction in the patient information leaflet.

Co-codamol is a combination of paracetamol and codeine. It comes in the two strengths of codeine you mention. The combination of paracetamol and codeine is more effective than either drug on its own. Most people don't realise that natural codeine is extracted from opium. (It can also be made synthetically from morphine.) It is a narcotic which, like heroin and morphine, can cause physical addiction. The higher dose of codeine, a Class B drug, is regulated by the Misuse of Drugs Act 1971.

You should have been warned that addiction to codeine can be a problem, particularly if taken for prolonged periods in high doses. Some versions of theinformation leaflet mention addiction, but others do not. One leaflet I have seen says: "Taking co-codamol regularly for a long time can lead to addiction, which might cause you to feel restless and irritable when you stop taking the medicine. If you are concerned about this, discuss the problem with your doctor or pharmacist." But another version of the leaflet that was authorised by the Medicines and Healthcare products Regulatory Agency (MHRA) in February 2006 makes no mention of addiction. The MHRA should look into this.


Q. I consulted my GP about my vision blurring and general tiredness. An optician's eye examination had shown no eye defect. Blood tests came back normal except for an excess red cell count. This is the second time in two years this has been picked up. Could this cause my symptoms?

When the red blood cell count is too high, the blood becomes thicker. This can lead to small blockages in tiny blood vessels, and this may well explain episodes of blurring of vision. Smokers and people with chronic chest problems sometimes have high red cell counts, but there are other causes that can only be discovered by specialised investigations. Occasionally, the problem can be caused by kidney disease. If your red cell count is persistently high, you need to find out what is going on. Ask for a referral to a consultant haematologist.

Please send your questions and suggestions to A Question of Health, 'The Independent', Independent House, 191 Marsh Wall, London E14 9RS; fax 020-7005 2182; or e-mail Dr Kavalier regrets that he is unable to respond personally to questions.