BRAND NAMES
- Australia: Rikodeine PI
- Austria: Codidol retard, Paracodin
- France: Dicodin
- Switzerland: Codicontin
- UK: DF 118, DHC Continus
 MECHANISM OF ACTION
Dihydrocodeine is an opioid analgesic. It is related to codeine and has similar analgesic activity.
Dihydrocodeine is used also as an antitussive, and the recommended dose is lower than the usual recommended dose for analgesia. The antitussive effects of dihydrocodeine are mediated through direct action on receptors in the cough centre of the medulla.
Dihydrocodeine is used to relieve moderate to severe pain.
Dihydrocodeine is also used as a cough suppressant.
For analgesia 30 mg after food every 4 to 6 hours; up to 240mg daily may be given for severe pain.
Children over 4 years of age may be given 0.5 to 1 mg/kg every 4 to 6 hours.
As a cough suppressant 10 to 30 mg up to three times daily.
- Known hypersensitivity to dihydrocodeine or to other opioids
- Pre-existing respiratory depression
- Obstructive airways disease
- Acute asthma attack
- Acute alcoholism
- Convulsive disorders
- Paralytic ileus
- Head injuries or conditions in which intracranial pressure is raised
- Comatose patients
 WARNINGS AND PRECAUTIONS
CNS: Dihydrocodeine (like other opioids) may cause CNS depression, it should be given with caution to patients with CNS depression.
Dihydrocodeine may impair the ability of the patient to drive or operate machinery.
Patients treated with dihydrocodeine should be cautioned that their ability might be reduced.
Renal: Caution is advised in patients with severe renal impairment as dose accumulation may occur. In the elderly with lower renal clearance, there is marked variability in the pharmacokinetics so small doses may be needed initially.
Lung: As dihydrocodeine may cause the release of histamine, it should be given with caution in asthmatics, in patients with decreased respiratory reserve (eg. emphysema), cor pulmonale or chronic obstructive respiratory disease.
Gastrointestinal: Opioids should be given with caution or in reduced doses to patients with inflammatory or obstructive bowel disorders, biliary tract disorders or inflammation of the pancreas.
Others: Dosage of dihydrocodeine should be reduced in hypothyroidism and chronic hepatic disease. Opioids should be given with caution or in reduced doses to patients with adrenocortical insufficiency, prostatic hyperplasia, hypotension, shock, or myasthenia gravis.
As with many other opiates, abuse of dihydrocodeine has been reported.
Dosage should be reduced in elderly or debilitated patients.
Dihydrocodeine may enhance the effects of CNS depressants. These include alcohol, and medications such as antiemetics, antihistamines, hypnotics and sedatives, and tranquillisers.
Consideration should also be given to potential interactions with other medications, which occur with other opioids:
- Medications with anticholinergic effects such as antihistamines with anticholinergic effects, or tricyclic antidepressants, which may increase constipation and/or urinary retention.
- Antihypertensive medications (possible additive hypotensive effects);
- Antiperistaltic antidiarrhoeals (may increase risk of severe constipation);
- Monoamine oxidase (MAO) inhibitors (may lead to anxiety, confusion, severe respiratory depression);
- Neuromuscular blockers (may lead to additive respiratory depressant effects);
- Opioid agonists (eg. codeine, morphine, pethidine, etc) may increase the toxic effects of dihydrocodeine;
- Opioid antagonists (eg naloxone)
 PREGNANCY AND LACTATION
 SIDE EFFECTS
Adverse effects of opioid analgesics are nausea, vomiting, constipation, drowsiness, and confusion; tolerance to these (except constipation) generally develops with long term use. Dry mouth, dizziness, sweating, facial flushing, headache, vertigo, bradycardia, tachycardia, palpitations, orthostatic hypotension, hypothermia, restlessness, changes of mood, decreased libido potency, hallucinations, and miosis also occur. Raised intracranial pressure occurs in some patients. Larger doses of opioids produce respiratory depression and hypotension, with circulatory failure and deepening coma.
 RELATED LINKS
|Antitussives / Cough|
|Cough suppressants||Benzonatate • Butamirate • Codeine • Dextromethorphan • Dihydrocodeine • Dropropizine • Levocloperastine • Levodropropizine • Nepinalone • Oxolamine|
|Mucolytics||Acetylcysteine • Ambroxol (Oral) • Bromhexine • Carbocisteine • Erdosteine • Guaifenesin • Neltenexine|