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DIHYDROCODEINE is a brand name for Dihydrocodeine. The medicine, its uses, side effects and dosage are the same regardless of brand.
Used for: For the relief of severe pain in cancer and other chronic conditions. Dihydrocodeine 120mg tablets are indicated for use in adults and children over 12 years of age.
Verbatim from this product's MHRA label. Tap a section to expand.
Posology Adults and children over 12 years:
The usual dose is one tablet 12-hourly.
Elderly:
Dosage should be reduced. 4).
Paediatric population Children 12 years or under:
Not recommended. Method of administration Oral.
The adverse experiences listed below are classified by body system according to their incidence (common or uncommon). Common adverse drug experiences have an incidence of ≥ 1% and uncommon adverse drug experiences have an incidence of < 1%.
4) Nervous system disorders Somnolence Convulsions Dizziness Headache Paraesthesia Sedation Sleep apnoea syndrome Eye disorders Blurred vision Ear and labyrinth disorders Vertigo Vascular disorders Hypotension Flushing Respiratory, Dyspnoea thoracic and mediastinal disorders Respiratory depression Gastrointestinal disorders Abdominal pain Constipation Dry mouth Nausea Vomiting Diarrhoea Paralytic ileus Hepato-biliary disorders Biliary colic Hepatic enzymes increased Skin and subcutaneous tissue disorders Hyperhidrosis Pruritus Rash Urticaria Renal and urinary disorders Urinary retention Uretic spasm Reproductive system and breast disorders Decreased libido General disorders and administration site conditions Asthenia Fatigue Malaise Drug withdrawal syndrome Drug tolerance Drug withdrawal syndrome neonatal Prolonged use of a painkiller for headaches can make them worse.
6). Reporting of adverse reactions Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.
Dihydrocodeine should be administered with caution to the elderly or patients with: • a history of opioid abuse or dependence • raised intracranial pressure, intracranial lesions or head injury • reduced level of consciousness of uncertain origin • biliary tract disorders • prostatic hypertrophy • pancreatitis • impairment of hepatic function • severe renal dysfunction • constipation • an obstructive bowel disorder • respiratory depression with hypoxia • chronic obstructive pulmonary disease • cor pulmonale • bronchial asthma • hypothyroidism • sleep apnoea The primary risk of opioid excess is respiratory depression.
Opioids may cause sleep-related breathing disorders including central sleep apnoea (CSA) and sleep-related hypoxemia. Opioid use may increase the risk of CSA in a dose-dependent manner in some patients. 8). In patients who present with CSA, consider decreasing the total opioid dosage.
Dihydrocodeine should be used with caution in patients taking monoamine oxidase inhibitors or within two weeks of such therapy. Concomitant use of dihydrocodeine and sedative medicines such as benzodiazepines or related drugs may result in sedation, respiratory depression, coma and death.
Because of these risks, concomitant prescribing with these sedative medicines should be reserved for patients for whom alternative treatment options are not possible. 2). The patients should be followed closely for signs and symptoms of respiratory depression and sedation.
5). Do not use for acute post-operative pain owing to the increased risk of persistent post-operative opioid use (PPOU) and opioid-induced ventilatory impairment (OIVI). Drug dependence, tolerance and potential for abuse For all patients, prolonged use of this product may lead to drug dependence (addiction), even at therapeutic doses.
, major depression). Additional support and monitoring may be necessary when prescribing for patients at risk of opioid misuse. A comprehensive patient history should be taken to document concomitant medications, including over-the-counter medicines and medicines obtained on- line, and past and present medical and psychiatric conditions.
1; severe respiratory depression with hypoxia; severe chronic obstructive lung disease; severe cor pulmonale; severe bronchial asthma; paralytic ileus; acute alcoholism. As dihydrocodeine may cause the release of histamine, it should not be given during an asthma attack.
Patients with rare hereditary problems of galactose intolerance, total lactase deficiency or glucose-galactose malabsorption should not take this medicine.
Not medical advice. Always read the patient information leaflet and follow your prescriber or pharmacist.
Other brands of Dihydrocodeine in United Kingdom.
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Patients may find that treatment is less effective with chronic use and express a need to increase the dose to obtain the same level of pain control as initially experienced. Patients may also supplement their treatment with additional pain relievers.
These could be signs that the patient is developing tolerance. The risks of developing tolerance should be explained to the patient. Overuse and misuse may result in overdose and/or death. It is important that patients only use medicines that are prescribed for them at the dose they have been prescribed and do not give this medicine to anyone else.
Patients should be closely monitored for signs of misuse, abuse or addiction. The clinical need for analgesic treatment should be reviewed regularly. Drug withdrawal syndrome Prior to starting treatment with any opioids, a discussion should be held with patients to put in place a withdrawal strategy for ending treatment with dihydrocodeine.
Drug withdrawal syndrome may occur upon abrupt cessation of therapy or dose reduction. When a patient no longer requires therapy, it is advisable to taper the dose gradually to minimise symptoms of withdrawal. Tapering from a high dose may take weeks to months.
The opioid drug withdrawal syndrome is characterised by some or all of the following: restlessness, lacrimation, rhinorrhoea, yawning, perspiration, chills myalgia, mydriasis and palpitations. Other symptoms may also develop including irritability, agitation, anxiety, hyperkinesia, tremor, weakness, insomnia, anorexia, abdominal cramps, nausea, vomiting, diarrhoea, increased blood pressure, increased respiratory rate or heart rate.
If women take this drug during pregnancy, there is a risk that their newborn infants will experience neonatal withdrawal syndrome. Hyperalgesia Hyperalgesia may be diagnosed if the patient on long-term opioid therapy presents with increased pain.
This might be qualitatively and anatomically distinct from pain related to disease progression or to breakthrough pain resulting from development of opioid tolerance. Pain associated with hyperalgesia tends to be more diffuse than the pre-existing pain and less defined in quality.
Symptoms of hyperalgesia may resolve with a reduction of opioid dose. Abuse of oral dosage forms by parenteral administration can be expected to result in serious adverse events, which may be fatal. Dihydrocodeine tablets must be swallowed whole, and not broken, chewed or crushed.
9). Opioids, such as dihydrocodeine, may influence the hypothalamic-pituitary- adrenal or –gonadal axes. Some changes that can be seen include an increase in serum prolactin, and decrease in plasma cortisol and testosterone. Clinical symptoms may manifest from these hormonal changes.