BMA Concise Guide to Medicine & Drugs

Dihydrocodeine

Brand names DF118 Forte, DHC Continus

Used in the following combined preparations Co-dydramol, Paramol, Remedeine

QUICK REFERENCE

Drug group Opioid analgesic

Overdose danger rating High

Dependence rating Medium

Prescription needed Yes (most preparations)

Available as generic Yes

GENERAL INFORMATION

Dihydrocodeine is an opioid analgesic related to codeine and of similar potency. It is used mainly for the relief of moderately severe pain but has also been used as a cough suppressant. As with codeine, side effects limit the dose that can be taken; dihydrocodeine causes constipation, nausea, and vomiting. The drug is also used in combination with paracetamol; in this way, a lower dose of the opioid can be used to give pain relief with fewer side effects. A combined preparation containing dihydrocodeine and paracetamol is available under the generic name of co-dydramol.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Tablets, SR tablets, liquid, injection.

Frequency and timing of doses 2–6 x daily.

Adult dosage range 120–240mg daily.

Onset of effect 30–60 minutes (tablets, liquid); 3–4 hours (SR tablets).

Duration of action 4–6 hours (tablets, liquid); 12 hours (SR tablets).

Diet advice None.

Storage Keep in original container at room temperature out of the reach of children.

Missed dose Take as soon as you remember if needed for relief of symptoms. If not needed, do not take the missed dose, and return to your normal dosage schedule when necessary.

Stopping the drug Can be safely stopped as soon as you no longer need it.

OVERDOSE ACTION

Seek immediate medical advice in all cases. Take emergency action if slow or irregular breathing, severe drowsiness, or loss of consciousness occur.

POSSIBLE ADVERSE EFFECTS

The most common adverse effects are constipation, nausea, vomiting, drowsiness, dizziness, headache, and vertigo. More rarely, the drug may cause abdominal pain. If any of these symptoms are severe, discuss with your doctor. If rash, itching, confusion, hallucinations, or breathing difficulties occur, seek medical advice promptly; you should also stop taking the drug if you have breathing difficulties. Tolerance and dependence may occur with long-term use of dihydrocodeine.

INTERACTIONS

Sedatives All drugs that have a sedative effect on the central nervous system increase dihydrocodeine’s sedative properties. They include other opioid analgesics, sleeping drugs, antihistamines, antipsychotics, and antidepressants.

Monoamine oxidase inhibitors (MAOIs) may cause a dangerous rise in blood pressure. Avoid using together and for 14 days after stopping MAOI treatment.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have liver or kidney problems.

· You have a phaeochromocytoma.

· You have a lung disorder such as asthma or bronchitis.

· You have a problem with alcohol abuse.

· You have an enlarged prostate.

· You have low blood pressure.

· You have an underactive thyroid.

· You are taking other medicines.

Pregnancy Safety in pregnancy not established. The drug may affect the baby’s breathing in labour.

Breast-feeding Safety not established. Discuss with your doctor.

Infants and children Not recommended for children under 4 years. In children over 4 years a reduced dose is necessary.

Over 60 Reduced dose necessary.

Driving and hazardous work Avoid such activities until you have learned how dihydrocodeine affects you because the drug may cause drowsiness, dizziness, and confusion.

Alcohol Avoid. Alcohol may increase the sedative effects of the drug.

PROLONGED USE

Dihydrocodeine is generally only used in the short term since it can be habit forming if used long term.