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