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Updated 2 Feb 2023 | Opioid analgesics


Modified release tablet containing 60mg dihydrocodeine tartrate
Modified release tablet containing 90mg dihydrocodeine tartrate
Modified release tablet containing 120mg dihydrocodeine tartrate

Drugs List

  • DHC CONTINUS 120mg tablets
  • DHC CONTINUS 60mg tablets
  • DHC CONTINUS 90mg tablets
  • dihydrocodeine 120mg modified release tablet
  • dihydrocodeine 60mg modified release tablet
  • dihydrocodeine 90mg modified release tablet
  • Therapeutic Indications


    Relief of severe pain in cancer and other chronic conditions



    60mg to 120mg every 12 hours


    Use a reduced dose in elderly patients


    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.


    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.


    Acute respiratory depression.

    Chronic obstructive airways disease.

    Acute asthma.

    Raised intracranial pressure.

    Acute alcohol intoxication.

    Paralytic ileus.

    Risk of paralytic ileus.

    Head trauma.


    Children under 12 years of age.





    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.


    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).


    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


    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.


    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.


    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

    Urinary retention
    Ureteric spasm
    Biliary spasm
    Dry mouth
    Mood changes
    Blurred vision
    Reduced libido
    Abdominal pain
    Paralytic ileus
    Respiratory depression
    Muscle rigidity
    Postural hypotension
    Increased hepatic enzymes
    Withdrawal syndrome
    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.


    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 ( ) or if this is unavailable at the backup site ( ).

    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. 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: Last accessed: 6 January 2015
    New drug driving offence implications for medicines packaging. Medicines Regulatory News. 10 December 2013. Available at: Last accessed: 6 January 2015

    NICE Evidence Services Available at: Last accessed: 16 February 2021

    Summary of Product Characteristics: DHC Continus. Napp Pharmaceuticals Ltd. Revised October 2020.

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