Experiences with
Dihydrocodeine

Dihydrocodeine is an opioid painkiller. It's used to treat moderate to severe pain, such as after an operation or a serious injury.

It's also used for long-term pain if weaker painkillers, such as paracetamol, ibuprofen and aspirin, have not worked.

It works by blocking pain signals from the central nervous system and the brain.

Dihydrocodeine is only available on prescription.

It comes as standard tablets, slow-release tablets and as a liquid that you swallow. It can also be given by an injection into the muscle or under the skin. This is usually done in hospital.

Co-dydramol, Paramol, Remedeine and Remedeine Forte are brand names that contain dihydrocodeine and paracetamol.

Who can take dihydrocodeine

Most adults can take dihydrocodeine. Although it can be given to children from the age of 1 year, it is usually only given to children aged 4 and over.

Who may not be able to take dihydrocodeine

Dihydrocodeine is not suitable for some people. To make sure it's safe for you, tell a pharmacist or doctor before taking the medicine if you:

have ever had an allergic reaction to dihydrocodeine or any other medicine
have any stomach problems, such as irritable bowel syndrome (IBS) or Crohn's disease, or if you're taking medicines for these conditions
have lung problems, asthma, breathing difficulties or allergies
have a head injury or a condition that causes seizures or fits
have an underactive thyroid gland (hypothyroidism)
have an addiction to alcohol
have liver or kidney problems
have myasthenia gravis, a rare illness that causes muscle weakness
are trying to become pregnant, are already pregnant or are breastfeeding
are under 18 years and have had your tonsils or adenoids taken out to treat obstructive sleep apnoea
have a rare condition causing problems with galactose intolerance

Dosage and strength

You'll usually start on a low dose of standard dihydrocodeine. Your doctor may increase this gradually until your pain is well controlled.

Standard tablets

Dihydrocodeine standard tablets come in different strengths. They contain 30mg or 40mg of dihydrocodeine.

The usual dose for adults and children aged 12 years and over is:

30mg tablet – take 1 tablet every 4 to 6 hours. The maximum dose in 24 hours is 6 tablets (180mg)
40mg tablet – take 1 or 2 tablets up to 3 times in 24 hours. The maximum dose in 24 hours is 6 tablets (240mg)

Slow-release tablets

Dihydrocodeine slow-release tablets contain 60mg, 90mg or 120mg of dihydrocodeine.

The usual dose for adults and children aged 12 years and over is:

60mg, 90mg or 120mg tablets – take 1 tablet taken every 12 hours

Liquid

The usual dose of dihydrocodeine liquid is one to three, 5ml spoonfuls taken every 4 to 6 hours. One 5ml spoonful or syringe measure has 10mg of dihydrocodeine in it.

Dose for children under 12

For children aged between 1 and 11 years, their dose is based on weight.

The usual dose is between 0.5mg and 1mg per kg of body weight. They can be given a maximum dose of up to 30mg every 4 to 6 hours.

How to take it

Swallow the tablets whole with a drink of water. It's best to take them with or soon after a meal or snack.

If you're taking dihydrocodeine as a liquid, it will come with a plastic medicine spoon or syringe to help you measure the correct amount. Ask a pharmacist for one if you do not have it.

Do not measure the liquid with a kitchen teaspoon because it will not give the right amount.

How long to take it for

This will depend on why you're taking dihydrocodeine.

If you're taking it for pain after an operation you may only need to take if for a short time.

You may need to take it for longer if you have a long-term pain or illness such as cancer.

Always check with a doctor if you want to stop taking dihydrocodeine.

It's possible that you could become dependent on dihydrocodeine and have withdrawal symptoms if you stop suddenly. These can include:

yawning
sneezing
muscle twitching
sweating
feeling worried or anxious
poor sleep
pain, including stomach pain
feeling or being sick
feeling restless

If these happen to you, speak to a doctor. It may be possible to reduce your dose slowly to stop these from happening.

If you have been taking dihydrocodeine for more than a few weeks do not stop taking it without speaking to your doctor first.

If you forget to take a dose, check the information leaflet inside the packet or ask a pharmacist or doctor for advice on what to do.

Never take 2 doses at the same time to make up for a forgotten one.

If you often forget doses, it may help to set an alarm to remind you. You could also ask a pharmacist for advice on other ways to remember to take your medicine.

If you take too much

If you take too much dihydrocodeine you may:

feel very sleepy, sick or dizzy
find it difficult to breathe
become unconscious

you take too much dihydrocodeine

Go to 111.nhs.uk or call 111 . If you need advice for a child under the age of 5 years, call 111.

find it difficult to breath
become unconscious

If you need to go to A&E, do not drive. Ask someone to drive you or call 999 and ask for an ambulance.

Bring the dihydrocodeine packet or leaflet inside it, any remaining medicine, and any other medicines you take.

If you have been prescribed dihydrocodeine, it's really important that you:

store it properly and safely at home
keep it out of the sight and reach of children
do not give your medicine to anyone else
return any unused dihydrocodeine to a pharmacy so they can throw it away in the right way

Common side effects

These common side effects of dihydrocodeine happen in more than 1 in 100 people. There are things you can do to help cope with them:

Dihydrocodeine slows down your digestion and this can cause constipation. If you become constipated, try to include more high-fibre foods in your diet such as fruits, vegetables and cereals. Try to drink several glasses of water each day. If you can, it may also help to do some gentle exercise.

Ask your doctor about medicine to help prevent or treat constipation caused by dihydrocodeine.

Take dihydrocodeine with or just after a meal or snack to ease feelings of sickness. If you're being sick, try small frequent sips of water.

This side effect should wear off after a few days. Talk to a doctor about taking an anti-sickness medicine if it carries on for longer.

If you take the combined contraceptive pill or the progestogen-only pill and you're being sick your contraception may not protect you from pregnancy. Check the contraceptive pill packet for advice.

This side effect should wear off within a week or two as your body gets used to dihydrocodeine. Talk to a doctor if it carries on for longer.

If dihydrocodeine makes you feel dizzy when you stand up, try getting up very slowly or stay sitting down until you feel better. If you begin to feel dizzy, lie down so that you do not faint or fall, then sit until you feel better.

This side effect should wear off within a few days as your body gets used to dihydrocodeine. Talk to a doctor if it carries on for longer.

Try chewing sugar-free gum or sucking sugar-free sweets. You can also buy or a doctor may prescribe an artificial saliva substitute to keep your mouth moist. This comes as a spray, gel or lozenge and can be bought from a pharmacy.

Make sure you rest and drink plenty of fluids. It may be best not to drink alcohol while taking dihydrocodeine as this can make headaches worse. It's safe to take a painkiller such as paracetamol or ibuprofen.

Talk to a doctor if headaches last longer than a week or are severe.

Speak to a doctor or pharmacist if the advice on how to cope does not help and a side effect is still bothering you or does not go away.

Serious side effects

Serious side effects happen in less than 1 in 100 people.

Call a doctor or call 111 now if you:

get muscle stiffness
feel dizzy, tired and have low energy – this could be a sign of low blood pressure (hypotension)

you have had a seizure or fit
you have difficulty breathing or short shallow breathing

A&E safety messaging (for 999 only)

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to dihydrocodeine.

Meds New IA (H4) - serious allergic reaction

Some people with conditions that need long-term pain relief may need to take dihydrocodeine for a long time.

If you need to take it for a long time your body can become used to it (known as tolerance). That means you need higher doses to control your pain over time.

Some people can become more sensitive to pain (hyperalgesia). If this happens, your doctor will reduce your dose gradually to help these symptoms.

It's possible to become addicted to dihydrocodeine. For this reason, your dose will be reviewed to make sure you're only having the amount you need to control your pain.

Your treatment plan may include details of how and when you'll stop dihydrocodeine.

If you're having treatment for cancer pain or other severe pain, your pain control will be carefully monitored. Speak to your doctor if you're worried about tolerance, hyperalgesia or becoming addicted.

Other side effects

These are not all the side effects of dihydrocodeine. For a full list, see the leaflet inside your medicine packet.

Dihydrocodeine and pregnancy

Dihydrocodeine can be taken during pregnancy. However, other medicines such as paracetamol may be better and it's best to try them first.

If you take dihydrocodeine towards the end of pregnancy, your baby might have withdrawal symptoms after they're born. If this happens, your baby may need extra time in hospital for observation.

It is important to treat pain in pregnancy. If you have severe pain, dihydrocodeine might sometimes be the best option. Your doctor can help you decide what's right for you and your baby.

Dihydrocodeine and breastfeeding

If your doctor or health visitor says your baby is healthy, you can take dihydrocodeine while breastfeeding. There may be other painkillers that are better to use while breastfeeding, but your doctor will help you decide.

It is not known how much dihydrocodeine gets into breast milk, but it is likely to be a small amount. It is better to take low doses and to only use it for a short time. This reduces the risk of your baby getting side effects.

Talk to your doctor, pharmacist, health visitor or midwife as soon as possible if you have any concerns about your baby, including if your baby:

is not feeding as well as usual
has constipation

seems unusually sleepy
is having difficulty breathing

There's no evidence to suggest that dihydrocodeine reduces fertility in men or women.

However, speak to a doctor if you are trying to get pregnant.

Meds New IA (H2) - Pregnancy non-urgent care card

Cautions with other medicines

Some medicines can affect dihydrocodeine.

Tell a doctor if you're taking any of these medicines before you start taking dihydrocodeine:

sleeping pills or tranquillisers
medicines for depression or other mental health conditions
medicines to stop you feeling sick or vomiting, such as domperidone or metoclopramide
antihistamines or hay fever tablets
medicines to treat anxiety
mexiletine to control your heart rhythm

Taking dihydrocodeine with other painkillers

It's safe to take dihydrocodeine with paracetamol, ibuprofen or aspirin (do not give aspirin to children under 16 years of age).

However, if you're prescribed co-dydramol, Paramol, Remedeine or Remedeine Forte, do not take paracetamol as these brands already contain paracetamol and dihydrocodeine.

Do not take dihydrocodeine with painkillers that contain codeine. You'll be more likely to get side effects. These include:

co-codamol (codeine and paracetamol)
Nurofen Plus (codeine and ibuprofen)
co-codaprin (codeine and aspirin)
Solpadeine (codeine, paracetamol, ibuprofen and caffeine)

Always follow the instructions that come with your medicine.

Mixing dihydrocodeine with herbal remedies and supplements

There's not enough information to say whether dihydrocodeine is safe to take with herbal remedies and supplements. They're not tested in the same way as pharmacy and prescription medicines. They're generally not tested for the effect they have on other medicines.

Meds New IA (H2) - Cautions with other medicines alert