Dihydrocodeine
- Drugs List
- Therapeutic Indications
- Dosage
- Administration
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Modified release tablet containing 60mg dihydrocodeine tartrate
Modified release tablet containing 90mg dihydrocodeine tartrate
Modified release tablet containing 120mg dihydrocodeine tartrate
Drugs List
Therapeutic Indications
Uses
Relief of severe pain in cancer and other chronic conditions
Dosage
Adults
60mg to 120mg every 12 hours
Elderly
Use a reduced dose in elderly patients
Children
Under 12 years of age
Contraindicated in children under 12 years of age
12 years and over
60mg to 120mg every 12 hours
Patients with Renal Impairment
Reduce dose in patients with renal impairment. Analgesia may be increase and prolonged, and there may be increased cerebral sensitivity.
Patients with Hepatic Impairment
Reduce dose in patients with chronic hepatic disease. May precipitate coma.
Administration
For oral administration.
Tablets should be swallowed whole and not crushed, chewed or broken, failure to do this may lead to rapid release and potential overdose.
Contraindications
Acute respiratory depression.
Chronic obstructive airways disease.
Acute asthma.
Raised intracranial pressure.
Acute alcohol intoxication.
Paralytic ileus.
Risk of paralytic ileus.
Head trauma.
Coma.
Children under 12 years of age.
Galactosaemia.
Pregnancy.
Breastfeeding.
Hypoxia.
Precautions and Warnings
Elderly or debilitated, reduce dose.
Hypothyroidism, reduce dose.
Adrenal insufficiency, reduce dose.
Chronic hepatic disease, reduce dose.
Renal impairment, reduce dose.
Prostatic hypertrophy.
History of opioid dependence.
Biliary tract disorder.
Pancreatitis.
Respiratory impairment.
Within 2 weeks of discontinuing treatment with an MAOI.
Myasthenia gravis.
Obstructive bowel disorder or constipation, monitor for constipation and give appropriate laxatives as required.
Asthma, as dihydrocodeine may cause histamine release.
Cardiac failure secondary to pulmonary disorder (Cor pulmonale).
Hypotension.
History of seizures.
There is the potential for drug abuse as with other opioids. Use with caution in patients with a history of drug dependence or alcohol or drug abuse.
Potential for tolerance and dependence to occur. Patients may require progressively higher doses to maintain pain control. Prolonged use may lead to physical dependence, and abrupt withdrawal should be avoided in order to prevent withdrawal syndrome. Monitor at regular intervals as withdrawal symptoms and dependence may occur.
Dihydrocodeine may cause drowsiness, and so patients should be advised not to drive or operate machinery if affected. Alcohol should be avoided as this will worsen the effects of drowsiness.
Contains lactose, avoid or use with caution in patients with glucose-galactose malabsorption syndrome or lactose intolerance.
All patients require careful monitoring for signs of abuse and addiction.
Adrenal insufficiency has been reported with opioid use, as opioid may influence the gonadal or the hypothalamic-pituitary-adrenal axes. Changes in serum prolactin, plasma cortisol and testosterone levels have been shown with the use of opioids. If adrenal insufficiency is suspected, gradually wean patient off opioid treatment until adrenal function is recovered. Continue with corticosteroid treatment until adrenal function has recovered and opioid treatment can commence.
Neonate exposure in labour, risk of respiratory depression.
Neonate exposed in utero, monitor for neonatal withdrawal syndrome.
Central sleep apnoea and sleep-related hypoxemia has been reported with opioid use in a dose-dependent fashion. Consider dose reduction in patients presenting with central sleep apnoea.
Advise that effects are potentiated by CNS depressants (including alcohol).
Pregnancy and Lactation
Pregnancy
Dihydrocodeine is contraindicated during pregnancy.
The manufacturer recommends that dihydrocodeine should only be used during pregnancy and labour the potential benefits outweighs the potential risks of neonatal respiratory depression.
At the time of writing there is limited published information regarding the use of dihydrocodeine during pregnancy. Potential risks are unknown, however, there is a risk of neonatal respiratory depression following use of dihydrocodeine during pregnancy and labour. Use of dihydrocodeine during pregnancy may also result in neonatal withdrawal syndrome in the infant.
Lactation
Dihydrocodeine is contraindicated during breastfeeding.
The manufacturer does not recommend the use of dihydrocodeine during breastfeeding due to the risk of respiratory depression in the infant.
The presence of dihydrocodeine in human breast milk is unknown but due to dihydrocodeine's low molecular weight, it is expected that dihydrocodeine is excreted into breast milk (Briggs, 2015).
Effects on Ability to Drive and Operate Machinery
This class of medicine is in the list of drugs included in regulations under 5a of the Road Traffic Act 1988 (England and Wales). When prescribing this medicine: Advise patient the medicine can affect cognitive function and is likely to affect ability to drive. Advise patient not to drive until they know how the medicine affects them.
Counselling
Tablets should be swallowed whole and not crushed, chewed or broken.
Dihydrocodeine may cause drowsiness, and so patients should be advised not to drive or operate machinery if affected. Alcohol should be avoided as this will worsen the effects of drowsiness.
May cause opiate induced constipation requiring treatment with a suitable laxative.
Side Effects
Constipation
Nausea
Vomiting
Headache
Somnolence
Pruritus
Rash
Urinary retention
Ureteric spasm
Biliary spasm
Dry mouth
Mood changes
Blurred vision
Sweating
Reduced libido
Flushing
Abdominal pain
Hypotension
Paraesthesia
Confusion
Dizziness
Hallucinations
Urticaria
Paralytic ileus
Respiratory depression
Tolerance
Dependence
Muscle rigidity
Vertigo
Bradycardia
Tachycardia
Palpitations
Postural hypotension
Hypothermia
Dysphoria
Miosis
Angioedema
Convulsions
Dyspnoea
Diarrhoea
Increased hepatic enzymes
Asthenia
Withdrawal syndrome
Oedema
Euphoria
Drowsiness
Sleep disturbances
Sexual dysfunction
Micturition difficulties
Sleep apnoea
Effects on Laboratory Tests
Opioids may interfere with gastric emptying studies as they delay gastric emptying. Hepatobiliary imaging using technetium Tc 99m disofenin may also be affected as opioid treatment may cause constriction of the sphincter of Oddi and increase biliary tract pressure.
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Shelf Life and Storage
Store at or below 25 degrees C
Further Information
Last Full Review Date: September 2011
Reference Sources
Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.
Gov.uk. Government departments. Department for Transport. Publications. Drug driving and medicine: advice for healthcare professionals. Drug driving: Guidance for healthcare professionals on drug driving. Available at: https://www.gov.uk Last accessed: 6 January 2015
New drug driving offence implications for medicines packaging. Medicines Regulatory News. 10 December 2013. Available at: https://www.mhra.gov.uk Last accessed: 6 January 2015
NICE Evidence Services Available at: www.nice.org.uk Last accessed: 16 February 2021
Summary of Product Characteristics: DHC Continus. Napp Pharmaceuticals Ltd. Revised October 2020.
Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
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