- Drugs List
- Therapeutic Indications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
Solution for injection containing 50mg/ml of dihydrocodeine tartrate
Relief of severe pain
Dihydrocodeine should be given parenterally when oral administration is not appropriate.
Up to 50mg by intramuscular or deep subcutaneous injection.
A reduced dose should be administered to elderly patients (See Dosage; Adult)
Children aged 4 years 18 years
0.5mg/kg to 1mg/kg every 4 to 6 hours.
The following alternative dosing schedule may be suitable:
Children aged 12 to 18 years
30mg every 4 to 6 hours (up to a maximum of 50mg).
Children aged 4 to 11 years
0.5mg/kg to 1mg/kg every 4 to 6 hours (up to 30mg per dose).
Children aged 1 to 4 years (unlicensed)
500 micrograms/kg every 4 to 6 hours.
Patients with Renal Impairment
Reduce dose in renal impairment
Patients with Hepatic Impairment
Reduce dose in chronic hepatic disease.
For administration by intramuscular or deep subcutaneous injection.
Obstructive airways disease
Raised intracranial pressure
Phaeochromocytoma (risk of pressor response to histamine release)
Risk of paralytic ileus
Children under 1 year
Within 2 weeks of discontinuing MAOIs
Precautions and Warnings
Reduce the dose patients with the following:
Chronic hepatic disease
Use with caution in patients with the following conditions:
Asthma (dihydrocodeine may cause histamine release)
Obstructive or inflammatory bowel disease
Biliary tract disorders
Pregnancy (see Pregnancy )
Lactation (see Lactation )
Children aged 1 to 4 years (see Dosage - Children ).
Alcohol should be avoided whilst receiving dihydrocodeine.
Dihydrocodeine may cause drowsiness, and so patients should be advised not to drive or operate machinery if affected.
Pregnancy and Lactation
Use with caution in pregnancy.
There is inadequate evidence of safety in human pregnancy, however dihydrocodeine has been used for many years without apparent ill effects.
Opioids are known to depress neonatal respiration, and withdrawal effects have been seen in infants of dependant mothers.
If administered during labour, gastric stasis and inhalational pneumonia may occur in the mother.
The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Use with caution in lactation.
It is not known whether dihydrocodeine or its metabolites are excreted in breast milk.
Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1
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.
Advise patients to avoid alcohol whilst receiving dihydrocodeine.
Advise patients that dihydrocodeine may cause drowsiness, and they should not to drive or operate machinery if affected.
Difficulty in micturition
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 ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Shelf Life and Storage
Protect from light.
Last Full Review Date: September 2012
Summary of Product Characteristics: Dihydrocodeine injection. Martindale Pharmaceuticals Ltd. Revised June 2003
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: 17 August 2017
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Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
FDB Disclaimer : FDB Multilex is intended for the use of healthcare professionals and is provided on the basis that the healthcare professionals will retain FULL and SOLE responsibility for deciding what treatment to prescribe or dispense for any particular patient or circumstance.