Dihydrocodeine

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Dihydrocodeine is an opiate painkiller. It is prescribed for pain management of moderate to severe pain (Wotherspoon et al (1991)) or pain that has not responded to other pain relief such as paracetamol or ibuprofen. You may be prescribed dihydrocodeine following a serious injury or after an operation (for postoperative pain). It can also be used to treat longer-term chronic pain if other weaker painkillers haven't worked (NHS, 2022).

We also have other prescription opioid-based pain relief available

  • Belongs to the opioid category of painkiller
  • Treats moderate to severe pain
  • Effective relief
  • Genuine medication
  • Shipped from EU Pharmacies
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Type of drugNarcotic analgesics (pain medicine)
Health conditions prescribed forModerate to severe pain (e.g. following surgery or a serious injury)
Active Ingredient(s)Dihydrocodeine tartrate
Brand namesDF118 Forte, DHC Continus
Available strengths30mg, 60mg, 90mg or 120mg
Available astablet, oral solution
Possible side effectsVomiting, nausea, abdominal pain, dizziness, sleepiness, constipation, mood swings, headaches, dry mouth
Patient Information LeafletFor more information about this pain killer medication, see the Dihydrocodeine patient information leaflet.

Dihydrocodeine - Key Information

Dihydrocodeine UK

  • Dihydrocodeine is an opiate painkiller and a Class B controlled drug (BNF, 2023). It is a controlled substance currently controlled under the misuse of drugs legislation including both the Misuse of Drugs Act 1971 and the Misuse of Drugs Regulations 2001, in the United Kingdom (GOV.UK, 2022).
  • Dihydrocodeine can be mixed with paracetamol in certain preparations such as co-dydramol
  • Dihydrocodeine is an opiate that can be used to treat acute moderate pain to severe pain including: migraines, headaches, joint pain and muscle pain, toothache and period pain (NHS, 2023).
  • Both short acting and sustained release dihydrocodeine is available
  • Dihydrocodeine is a opioid medicine that is sometimes known by its trade names DHC Continus and DF118 Forte
  • Dihydrocodeine tablets are an oral morphine derivative of moderate potency (Flecknell, P.; 2016)
  • It is important to read the patient leaflet for a full list of adverse effects and cautions.

Google Web Story - A-Z Guide to Dihydrocodeine

EU Meds have put together a Google Web Story called an ‘A-Z Guide to Dihydrocodeine’ to breakdown all terminology related to the opioid painkiller medication. You can view it below:

Dihydrocodeine is a semi-synthetic form of opioid pain relief. It works by blocking the pain signals from the central nervous system and the brain that are sent from the area of pain, by binding to opioid receptors (Buckle, J., 2015). This means that your sensation of the pain is either reduced or eliminated (NHS, 2022).

Dihydrocodeine use does not treat the cause of the pain, but it may help you to feel more comfortable whilst recovering from an injury or operation.

Minimising pain is helpful for recovery. If you are mobile then your risk of a post-operative blood clot will be reduced. You may also be able to cough more comfortably to prevent a chest infection after an operation.

Dihydrocodeine Tablets

Dihydrocodeine is available as a tablet or liquid. The tablets should be swallowed with water.

It is advisable to take dihydrocodeine with a meal or snack, as this may reduce the risk of side effects including nausea or vomiting and headache.

Every patient needing pain relief treatment has different symptoms and a unique individual experience when taking Dihydrocodeine as a medication.

To see what people have to say about their experiences with the medication, take a look at the Dihydrocodeine user reviews available at iwantgreatcare.org and patientslikeme.com.

You must speak to a doctor or your healthcare provider before taking Dihydrocodeine. They will assess your suitability for the medication and whether your health condition requires an alternative treatment.

For more additional important information on the pain relief medication please refer to the Dihydrocodeine patient information leaflet, which is usually found in the prescription drugs' box.

Dosage

A common oral administration dose of standard release dihydrocodeine tablet is 30 mg tablets taken every 4 to 6 hours. The maximum dose across 24 hours is 180mg. Standard dihydrocodeine takes around two hours to begin working fully (NHS, 2022).

A slow release tablet is also available. The dose of dihydrocodeine begins working more slowly, but has a long term pain-relieving effect. This means the tablets can be taken less frequently. The usual dose of slow release dihydrocodeine is 60 mg to 120 mg tablet taken twice a day (NHS, 2022).

Side Effects

Like all medications, dihydrocodeine can have some side effects.

Dihydrocodeine Side Effects

The most common side effects include:

  • Constipation
  • Nausea or vomiting (feeling sick or being sick)
  • Headaches
  • Feeling sleepy
  • Confusion
  • Feeling dizzy
  • Dry mouth.

If these side effects don’t settle or are troublesome, speak to a healthcare professional for advice.

Rarely, serious side effects can occur when taking dihydrocodeine. These include:

  • Feeling dizzy or tired due to low blood pressure
  • Stiff muscles.

You should speak to a doctor or pharmacist if these side effects occur.

You should call 999 if you have a seizure or fit, or if you have difficulty breathing when taking dihydrocodeine.

If you have a severe allergic reaction (anaphylaxis) including breathlessness, lip or tongue swelling, call 999 immediately.

Warnings

Dihydrocodeine may not be suitable for everyone. You should tell your doctor or pharmacist if you have:

  • Inflammatory bowel disease such as Crohn’s disease or ulcerative colitis
  • Irritable bowel syndrome
  • Lung disease including asthma
  • Liver or kidney disease
  • A head injury
  • Seizures or fits
  • Thyroid disease
  • Myasthenia gravis
  • Galactose intolerance
  • Obstructive sleep apnoea
  • Alcohol or drug addiction

Dihydrocodeine may not be suitable during pregnancy, if you are trying to conceive, or breastfeeding. Always consult your doctor prior to starting treatment to ensure it's safety.

Some prescription medications can interact with dihydrocodeine. You may be advised that dihydrocodeine will not suit you if you already take:

  • A painkiller that contains codeine
  • Sleeping tablets
  • Anti-sickness medications
  • Allergy medications
  • Anxiety medications.

You should also tell your prescriber about any herbal remedies or supplements you take. This will allow your prescriber to check that dihydrocodeine will not interact with them.

It is important that your doctor checks that dihydrocodeine will suit you. Your doctor should complete a thorough health questionnaire and review your current medications before prescribing this medication.

Dihydrocodeine FAQs

No, it is not safe to take Dihydrocodeine at the same time as benzodiazepine medications. The side effects can be severe, for example, combined use of both types of medication could result in respiratory depression, sedation, coma and/or death (Electronic Medicines Compendium, 2020). This emphasises the importance of speaking to a doctor or healthcare professional for medical advice prior to starting treatment with dihydrocodeine, any other opioid medication and/or benzodiazepine medications to ensure that they are safe and suitable for your requirements. This is further supported by Zamparutti et al (2011) who concluded that opiate/opioid misusers should be educated about risks of polydrug misuse.

Whilst it is not a widely reported direct side effect of dihydrocodeine usage on it's own, a 2002 study by Goldmeier & Lamba reported two cases where dihydrocodeine and sildenafil interacted with each other, resulting in prolonged erections for the patients.

No, according to BMJ (2013), The BNF does not recommend the use of dihydrocodeine (and opioid analgesics) as they are relatively ineffective at treating dental pain and can have adverse effects. You should always consult your doctor for advice on pain relief treatments to ensure that the medication is the most appropriate treatment for your requirements.

Are withdrawal symptoms possible if you stop taking dihydrocodeine?

Yes. Patients who suddenly stop taking dihydrocodeine could be at an increased risk of suffering from withdrawal symptoms, particularly if the are addicted (NHS, 2022). These withdrawal symptoms can include:

  • Gastrointestinal disorders such as nausea and vomiting
  • Panic attacks
  • Involuntary shaking
  • Sweating
  • Anxiety
  • Heart palpitations
  • Trouble sleeping

The BNF (2020) advise that to reduce the risks of dependence, addiction and withdrawal symptoms, dihydrocodeine dose reduction should be tapered slowly at the end of treatment to avoid opioid misuse - tapering a high dose of dihydrocodeine safely can take a longer period of time, ranging from weeks to months. Your doctor or healthcare professional will be able to advise you on how to safely taper dosage of dihydrocodeine to suit your individual situation, depending on if you are taking higher doses or a lower dose.

If you are concerned about withdrawal symptoms or dihydrocodeine addiction to dihydrocodeine, you should consult your doctor or trusted healthcare professional prior to starting treatment with the medication. They will be able to advise you on appropriate usage and if the medication is suitable for you.

According to a study by Leppert (2010), Dihydrocodiene (DHC) has an analgesic effect that is slightly stronger than codeine (a natural opioid analgesic) when it is taken orally and it can be twice as potent as codeine for the parenteral route (intravenous administration).

Research by Mayo Clinic Laboratories (2023) indicates that dihydrocodeine is typically detectable for up to three days in a patient's urine.

According to NHS (2021), in relation to palliative care, when a patient's pain cannot be managed by paracetamol usage, the World Health Organization (WHO) suggest that an opioid medication could be a potential solution for healthcare professionals to prescribe to patients. These opioids come in various forms, dosages and release characteristics. Examples of alternative opioids to dihydrocodeine, for the management of mild to moderate pain, include:

  • Dihydrocodeine
  • Codeine
  • Buprenorphine patches
  • Tramadol

Research has suggested that dihydrocodiene intake reduced breathlessness by 20% in the following 45 minutes, whilst also increasing exercise tolerance by 18% and a reduction in oxygen consumption and ventilation when work loads were at a submaximal level, although there were no changes to the spirometric volumes (Woodcock et al, 1981). However, this study is dated and also recommends that further evaluation is needed into the long-term benefits and safety of usage. In combination with aspirin and caffeine, dihydrocodeine has risk of causing sleep-related breathing problems such as sleep apnea (Mayo Clinic, 2023). You should always consult your doctor or healthcare professional prior to using dihydrocodeine to ensure that it is appropriate for you.

The CQC have set out guidelines for how care homes can work with their relevant community pharmacy to dispose of control drugs including advice on storing them appropriately and keeping appropriate records of the medications (Care Quality Commission, 2022).

Yes. Dihydrocodeine is an active ingredient in Paramol tablets, along with paracetamol.

No. Dihydrocodeine does not affect any type of contraception, including emergency contraception or the combined pill (NHS, 2022).

Buy Dihydrocodeine Online

Buying Dihydrocodeine Online in the UK

Are you looking for a safe, trusted online clinic where you can buy Dihydrocodeine? EU Meds is an online clinic. If you have a prescription, we can fill it for you and ship it to you within 48 hours (most days of the week).

Buy Dihydrocodeine

If you don't currently have a prescription for Dihydrocodeine, our online consultation with a pharmacist independent prescriber may be able to assist you. The online consultation will ensure that Dihydrocodeine is the right prescription medication for your medical condition. If approved, you can continue to order Dihydrocodeine with your electronic prescription, just as you would at an online pharmacy. For a repeat prescription, the same process will apply, to ensure your safety and suitability for the prescription medicine.

Medical Reviewer

Medical Reviewer

Irfan Siddique

Deputy Medical Superintendent (DMS) • MBBS

Dr. Irfan Siddique is a Medical Doctor with a license to practice in the United Kingdom, awarded by the General Medical Council. He graduated in 2017 from the University of Health Sciences, Lahore.

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