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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: Dihydrocodeine tablets are indicated for the relief of moderate to severe pain.
Verbatim from this product's MHRA label. Tap a section to expand.
For oral administration The analgesic effect is not materially enhanced by increasing the dose above that recommended below; in severe cases the interval between doses should be reduced to obtain the requisite analgesic cover. Dihydrocodeine tablets are best taken with or after food.
Adults and children over 12 years: 1 tablet every four to six hours or at the discretion of the practitioner. Maximum dose in 24 hours 180mg (6 tablets).
Elderly:
A reduced adult dose is recommended, at the advice of the physician. 5 to 1 mg/kg body weight, every 4 to 6 hours. 4).
The information below lists reported adverse reactions, using the following frequency classification: Very common (≥1/10); common (≥1/100 to <1/10); uncommon (≥1/1,000 to <1/100); rare (≥1/10,000 to <1/1,000); very rare (<1/10,000), not known (cannot be estimated from the available data).
Skin disorders: rash, urticaria, pruritus, sweating. Central and peripheral nervous system disorders: paraesthesia, dizziness, headache, vertigo, respiratory depression. Muscle rigidity has been reported after high doses. Vision disorders: visual disturbances, miosis.
4). Gastro-intestinal system disorders: dry mouth, nausea, vomiting, abdominal pain, constipation. Liver and biliary system disorders: biliary spasm which may be associated with alterations in liver enzyme values. Cardiovascular disorders general: hypotension, syncope Heart rate and rhythm disorders: bradycardia, tachycardia, palpitations.
Vascular (extracardiac) disorders: facial flushing.
Urinary systems disorders:
Micturition may be difficult and there may be ureteric spasm. General disorders and administration site conditions: uncommon: drug withdrawal syndrome Body as a whole, general: oedema. Regular prolonged use of DHC is known to lead to addiction and tolerance.
Symptoms of restlessness and irritability may result when treatment is then stopped. Prolonged use of a painkiller for headaches can make them worse. Reporting of suspected 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 given in reduced doses or with caution to patients with asthma and decreased respiratory reserve. Avoid use during an acute asthma attack. Dihydrocodeine should be avoided, or the dose reduced in patients with hepatic or renal impairment.
Dihydrocodeine should be given in reduced doses or with caution to; debilitated patients, adrenocortical insufficiency, prostatic hyperplasia, urethral stricture, hypotension, shock, inflammatory or obstructive bowel disorders, hypothyroidism or convulsive disorders.
However, these conditions should not necessarily be a deterrent to use in palliative care. Use in caution in those with a history of drug abuse. Alcohol should be avoided whilst under treatment with these tablets. Risk from concomitant use of sedative medicines such as benzodiazepines or related drugs: 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. If a decision is made to prescribe Dihydrocodeine concomitantly with sedative medicines, the lowest effective dose should be used, and the duration of treatment should be as short as possible.
The patients should be followed closely for signs and symptoms of respiratory depression and sedation. 5). Contains lactose monohydrate. Patients with rare hereditary problems of galactose intolerance, the Lapp lactose deficiency or glucose-galactose malabsorption should not take this medicine.
The risk-benefit of continued use should be assessed regularly by the prescriber. 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.
• Hypersensitivity to dihydrocodeine or any of the excipients • Respiratory depression • Obstructive airways disease • Acute alcoholism • Risk of paralytic ileus • Head injuries or conditions in which intracranial pressure is raised.
Not medical advice. Always read the patient information leaflet and follow your prescriber or pharmacist.
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, 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.
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 or 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. The leaflet will state in a prominent position in the ‘before taking’ section: • Do not take for longer than directed by your prescriber • Taking dihydrocodeine (DHC) regularly for a long time can lead to addiction, which might cause you to feel restless and irritable when you stop the tablets • Taking a painkiller for headaches too often or for too long can make them worse.
The label will state (to be displayed prominently on outer pack – not boxed): • Do not take for longer than directed by your prescriber as taking DHC regularly for a long time can lead to addiction