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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.

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.

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 go to A&E, do not drive yourself. Get someone else to drive you or call for an ambulance.

Take the dihydrocodeine box or leaflet inside the packet plus any remaining medicine with you.

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:

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 happen in less than 1 in 100 people.

Call a doctor or contact 111 straight away if you:

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

Go to 111.nhs.uk or call 111.

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

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

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.

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.

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

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.

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165 public posts

Medication question

I have been on Dihydrocodeine for a long time. They have been effective at helping with pain, but I am starting to struggle on the dose I am on. It just isn't enough to control the pain. Is anyone on Pregabalin or Gabapentin? Do you find them effective at getting rid of it for a few hours?
I have been on Dihydrocodeine for a long time. They have been effective at helping with pain, but I am starting to struggle on the dose I am on. It just isn't enough to control the pain. Is anyone on Pregabalin or Gabapentin? Do you find them effective at getting rid of it for a few hours?
Tuscany profile image
Tuscany
in Fibromyalgia Action UK
1 month ago

confused

I was doing this for just over a week when my sisster said she thought the GP was wrong as the max daily dose for dihydrocodeine is 180mg a day (up to 6 tablets), and I had been taking 8 tablets a day ( 240mg)??
I was doing this for just over a week when my sisster said she thought the GP was wrong as the max daily dose for dihydrocodeine is 180mg a day (up to 6 tablets), and I had been taking 8 tablets a day ( 240mg)??
momander profile image
momander
in Pain Concern
5 months ago

Had surgery three weeks ago

I was on Liquid Morphine, Dihydrocodeine slow release , baclofen, naproxen, buscopan, cyclizine, lansoprazole, the list goes on about 14 different medications during that wait. I am trying to wind down my pain medication gradually to see what effect the surgery has had.
I was on Liquid Morphine, Dihydrocodeine slow release , baclofen, naproxen, buscopan, cyclizine, lansoprazole, the list goes on about 14 different medications during that wait. I am trying to wind down my pain medication gradually to see what effect the surgery has had.
chameleonkeeper profile image
chameleonkeeper
in Endometriosis UK
3 months ago
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Prescibed Pramipexole for RLS - nausea and vomiting side effects

I’m on dihydrocodeine for chronic joint and muscle pain which takes edge off the RLS symptoms but I can’t take these after 3ish as give me insomnia. Took the Pramipexole as prescribed for first time last Saturday- felt some relief from symptoms but then nausea and spent most of night vomiting.
I’m on dihydrocodeine for chronic joint and muscle pain which takes edge off the RLS symptoms but I can’t take these after 3ish as give me insomnia. Took the Pramipexole as prescribed for first time last Saturday- felt some relief from symptoms but then nausea and spent most of night vomiting.
NotSleeping247 profile image
NotSleeping247
in Restless Legs Syndrome
5 months ago

Light headed and warm legs

I was encouraged to come off a daily 30mg dihydrocodeine when I could and have halved the dose with a view to ending soon.
I was encouraged to come off a daily 30mg dihydrocodeine when I could and have halved the dose with a view to ending soon.
Mog06 profile image
Mog06
in British Heart Foundation
9 months ago

unsure of what to do next

In 42, not wanting any more children , currently take naproxen and dihydrocodeine and paracetamol to manage pain. Sorry again for the long post .
In 42, not wanting any more children , currently take naproxen and dihydrocodeine and paracetamol to manage pain. Sorry again for the long post .
Yupithurts profile image
Yupithurts
in Endometriosis UK
1 month ago

RLS codeine

I have never experienced such a dramatic sensation in my body but I do keep RLS at bay with dihydrocodeine before bedtime and one in the night if I start kicking and screaming. The two natural things I find helpful is magnesium and a magnet wrapped in cloth near my legs.
I have never experienced such a dramatic sensation in my body but I do keep RLS at bay with dihydrocodeine before bedtime and one in the night if I start kicking and screaming. The two natural things I find helpful is magnesium and a magnet wrapped in cloth near my legs.
Daisy2408 profile image
Daisy2408
in Restless Legs Syndrome
10 months ago

Still suffering many years later

I have been put on modified release Dihydrocodeine to help with the pain. Most days I can only eat one meal. I am now struggling with work. I feel so depressed due to the pain, I just don’t know what to do anymore.
I have been put on modified release Dihydrocodeine to help with the pain. Most days I can only eat one meal. I am now struggling with work. I feel so depressed due to the pain, I just don’t know what to do anymore.
Lilendowarrior profile image
Lilendowarrior
in Endometriosis UK
9 months ago

Thoracic fractures and osteoarthritis

I am prescribed lidocaine patches plus dihydrocodeine.... which I use sparingly. But I would love to go for a walk and enjoy pain free. Also every bra I buy becomes uncomfortable very quickly.
I am prescribed lidocaine patches plus dihydrocodeine.... which I use sparingly. But I would love to go for a walk and enjoy pain free. Also every bra I buy becomes uncomfortable very quickly.
Etblue profile image
Etblue
in British Heart Foundation
11 months ago

Aspirin intolerance

I also take Dihydrocodeine for nerve pain, due to diabetes. Thanks as ever, Judi
I also take Dihydrocodeine for nerve pain, due to diabetes. Thanks as ever, Judi
Heyjude31 profile image
Heyjude31
in British Heart Foundation
1 year ago

Medication changes

Hello, just wondering if anyone can let me know what treatments/medications changed or added when they had taken co-codamol full dose, gabapentin full dose and amitriptilyne 25mg with a change of dihydrocodeine at night instead of codeine and they have been getting extra pain at night (sacro-iliac/periformis
Hello, just wondering if anyone can let me know what treatments/medications changed or added when they had taken co-codamol full dose, gabapentin full dose and amitriptilyne 25mg with a change of dihydrocodeine at night instead of codeine and they have been getting extra pain at night (sacro-iliac/periformis
greekqueen profile image
greekqueen
in Pain Concern
1 year ago

Tablet's

Hi everyone, I have been suffering with widespread pain and load's of other symptoms for 13yrs I have got an appointment with the pain clinic in February, I take Dihydrocodeine, Pregabbilin, and the Dr's have just taken me off my Citalopran and changed them to Trazadone due to my depression ,8 month's
Hi everyone, I have been suffering with widespread pain and load's of other symptoms for 13yrs I have got an appointment with the pain clinic in February, I take Dihydrocodeine, Pregabbilin, and the Dr's have just taken me off my Citalopran and changed them to Trazadone due to my depression ,8 month's
Star1dog profile image
Star1dog
in Fibromyalgia Action UK
1 year ago

Endometriosis

I have tried Fybogel, contraceptive pill, ibuprofen, paracetamol and I am currently on Dihydrocodeine as well. Any advice would be hugely appreciated as this is taking its toll on my relationship, work, family, friends and my mental health now too. Thank you for taking the time to read this.
I have tried Fybogel, contraceptive pill, ibuprofen, paracetamol and I am currently on Dihydrocodeine as well. Any advice would be hugely appreciated as this is taking its toll on my relationship, work, family, friends and my mental health now too. Thank you for taking the time to read this.
Leadtheway profile image
Leadtheway
in Endometriosis UK
1 year ago

Please say help gets better

Im taking Dihydrocodeine 2 tablets twice a day and pregabalin 1 tablet twice a day. They were easing the pain but due to taking them for so long they dont have the same effect and they wont give me anything stronger because of my anti depressants.
Im taking Dihydrocodeine 2 tablets twice a day and pregabalin 1 tablet twice a day. They were easing the pain but due to taking them for so long they dont have the same effect and they wont give me anything stronger because of my anti depressants.
TBards profile image
TBards
in Fibromyalgia Action UK
1 year ago

excessive blood loss

I'm currently on 600mg pregabalin and 15mg/ph butrans patches 30mg dihydrocodeine as well as paracetamol n cbd oil as well as smoking cannabis. Has anyone got any coping mechanisms that may work?
I'm currently on 600mg pregabalin and 15mg/ph butrans patches 30mg dihydrocodeine as well as paracetamol n cbd oil as well as smoking cannabis. Has anyone got any coping mechanisms that may work?
dodgeviperdiva profile image
dodgeviperdiva
in Endometriosis UK
1 year ago

Surgery fears

. - I'm currently on Dihydrocodeine - but this takes like 2 hours to have some effect and makes me even more nauseous sometimes.
. - I'm currently on Dihydrocodeine - but this takes like 2 hours to have some effect and makes me even more nauseous sometimes.
Loverretro profile image
Loverretro
in Endometriosis UK
1 year ago

Pain clinic ,is this who actually diagnose fibro

with the same problem,back ache,leg and hip ache,stiff neck that lasts for month's ,numbness at the tips of my finger's ,basically pain everywhere,i have had numerous blood test x rays and nothing comes back,now my dr's are sending me to a pain clinic,will they be able to diagnose my problem,been on dihydrocodeine
with the same problem,back ache,leg and hip ache,stiff neck that lasts for month's ,numbness at the tips of my finger's ,basically pain everywhere,i have had numerous blood test x rays and nothing comes back,now my dr's are sending me to a pain clinic,will they be able to diagnose my problem,been on dihydrocodeine
Star1dog profile image
Star1dog
in Fibromyalgia Action UK
2 years ago

need some advice… and to have a rant

imagine i look completely normal to everyone else, even if it feels like someone is setting me on fire on the inside. the past two days have been excruciating… i can still walk and talk (unfortunately), but every movement just makes me want to die. i take naproxen, diazepam, co-codamol and sometimes dihydrocodeine
imagine i look completely normal to everyone else, even if it feels like someone is setting me on fire on the inside. the past two days have been excruciating… i can still walk and talk (unfortunately), but every movement just makes me want to die. i take naproxen, diazepam, co-codamol and sometimes dihydrocodeine
avavs777 profile image
avavs777
in Pain Concern
1 year ago

need help

the pain has been excruciating and i’m really concerned as i haven’t had a period in months and i’m not supposed to be having one (or any of the symptoms). i’m still feeling very faint and weak but i’m having to take dihydrocodeine that i have left over from surgery every few hours to keep the pain away
the pain has been excruciating and i’m really concerned as i haven’t had a period in months and i’m not supposed to be having one (or any of the symptoms). i’m still feeling very faint and weak but i’m having to take dihydrocodeine that i have left over from surgery every few hours to keep the pain away
avavs777 profile image
avavs777
in Endometriosis UK
2 years ago

Should I be concerned?

I'm also on Sertraline 150mg a day, Naproxin 30mg, Dihydrocodeine, 30mg x4 per day. Little concerned reading about the Duloxotine and Sertraline making too much serotonin and getting very ill. I'm on the lookout for symptoms. Anyone else have those two combinations? Many thanks x
I'm also on Sertraline 150mg a day, Naproxin 30mg, Dihydrocodeine, 30mg x4 per day. Little concerned reading about the Duloxotine and Sertraline making too much serotonin and getting very ill. I'm on the lookout for symptoms. Anyone else have those two combinations? Many thanks x
lrsco profile image
lrsco
in Fibromyalgia Action UK
2 years ago
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