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Dihydrocodeine

1. About dihydrocodeine

Dihydrocodeine is a opiate 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-standing pain when weaker painkillers, such as paracetamol, ibuprofen and aspirin, have not worked.

Dihydrocodeine is only available on prescription. It also comes mixed with paracetamol, this is called co-dydramol.

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.

Dihydrocodeine is also known by the brand names DHC Continus and DF118 Forte.

2. Key facts

  • Dihydrocodeine works by stopping pain signals travelling along the nerves to the brain.
  • Standard dihydrocodeine tablets take 1.5 to 2 hours to work fully.
  • It's possible to become addicted to dihydrocodeine, but this is rare if you're taking it to relieve pain and you're taking it as a doctor has prescribed.
  • Dihydrocodeine can cause withdrawal problems. Do not stop taking the medicine suddenly.
  • The most common side effects are feeling or being sick, feeling drowsy or constipation.

3. Who can and cannot take it

Adults and children aged 4 years and over can take dihydrocodeine.

Dihydrocodeine is not suitable for some people. Tell a 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 or breathing difficulties
  • have a head injury or a condition that causes seizures or fits
  • have an underactive thyroid gland (hypothyroidism)
  • have an addiction to alcohol
  • take any other painkillers (including those you buy from a pharmacy or supermarket)
  • 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

4. How and when to take it

It's important to take dihydrocodeine as your doctor has asked you to.

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

How much will I take?

Dihydrocodeine tablets come in 5 different strengths. The tablets contain 30mg, 40mg, 60mg, 90mg or 120mg of dihydrocodeine.

How often you take your tablets will depend on the strength:

  • 30mg tablet – 2 tablets up to 4 times in 24 hours
  • 40mg tablet – 1 or 2 tablets up to 3 times in 24 hours
  • 60mg, 90mg and 120mg tablets – up to 2 tablets in 24 hours, leaving 12 hours between doses

For children aged 4 to 12 years the usual dose is 0.5mg (1mg per kg of body weight) usually up to 4 times in 24 hours.

Slow-release dihydrocodeine tablets come in 3 different strengths. The tablets contain 60mg, 90mg or 120mg of dihydrocodeine. The usual dose is between 60mg and 120mg, taken twice a day.

The usual dose of dihydrocodeine liquid is one to three 5ml spoonfuls up to 4 times in 24 hours. One 5ml spoonful has 10mg of dihydrocodeine in it (3 spoonfuls contains 30mg).

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.

Will my dose go up or down?

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

What if I forget to take it?

This will vary depending on which type of dihydrocodeine you're taking.

If you forget to take a dose, check the patient 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.

What if I take too much?

Urgent advice: Call 111 now if:

  • you take too much dihydrocodeine.

If you take too much dihydrocodeine you may feel:

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

Go to 111.nhs.uk or call 111

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.

Where to store dihydrocodeine

If you're 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

5. 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).

Do not take dihydrocodeine with painkillers that contain codeine. You will be more likely to get side effects.

Painkillers that contain codeine include co-codamol (codeine and paracetamol), Nurofen Plus (codeine and ibuprofen), co-codaprin (codeine and aspirin) and Solpadeine (codeine, paracetamol, ibuprofen and caffeine).

6. Side effects

Like all medicines, dihydrocodeine can cause side effects in some people, but many people have no side effects or only minor ones.

You're more likely to have side effects if you take the higher strengths of dihydrocodeine.

Common side effects

Common side effects happen in more than 1 in 100 people. Talk to a doctor or pharmacist if the side effects bother you or do not go away:

Serious side effects

Serious side effects happen in less than 1 in 100 people. Call a doctor straight away if you get any of the following:

Immediate action required: Call 999 if:

  • you have had a seizure or fit (where your body jerks and shakes)
  • you have difficulty breathing or short shallow breathing

Serious allergic reaction

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

Immediate action required: Call 999 or go to A&E now if:

  • you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
  • you're wheezing
  • you get tightness in the chest or throat
  • you have trouble breathing or talking
  • your mouth, face, lips, tongue or throat start swelling

You could be having a serious allergic reaction and may need immediate treatment in hospital.

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

Information:

You can report any suspected side effect to the UK safety scheme.

7. How to cope with side effects

What to do about:

  • feeling or being sick – 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.
  • feeling sleepy – this side effect should go away within a few days as your body gets used to dihydrocodeine. Talk to a doctor if it carries on for longer.
  • confusion, feeling dizzy and vertigo – 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, 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.
  • dry mouth – try chewing sugar-free gum or sucking sugar-free sweets. A doctor can also prescribe an artificial saliva substitute to keep your mouth moist. This comes as a spray, gel or lozenge.
  • headaches – 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.

8. Pregnancy and breastfeeding

Dihydrocodeine is generally not recommended during pregnancy or breastfeeding. There may be safer medicines that you can take – ask a doctor or pharmacist for advice.

In early pregnancy, it's been linked to some problems for your baby. If you take dihydrocodeine at the end of pregnancy there's a risk that your baby may get withdrawal symptoms or be addicted to dihydrocodeine when they're born.

However, it's important to treat pain in pregnancy. For some pregnant women with severe pain, dihydrocodeine might be the right option. Your doctor is the best person to help you decide what's right for you and your baby.

Dihydrocodeine and breastfeeding

Dihydrocodeine is not usually recommended if you're breastfeeding.

Small amounts of dihydrocodeine pass into breast milk and can cause breathing problems in your baby.

Speak to a doctor as they may be able to recommend a different painkiller.

Non-urgent advice: Tell a doctor if you're:

  • trying to get pregnant
  • pregnant
  • breastfeeding

9. Cautions with other medicines

Some medicines interfere with the way dihydrocodeine works.

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

  • sleeping pills or tranquillisers
  • medicines for depression or other mental health problems
  • medicines to stop you feeling sick or vomiting, such as domperidone or metoclopramide
  • antihistamines or hay fever tablets
  • medicines to treat anxiety

Mixing dihydrocodeine with herbal remedies and supplements

It's not possible to say that dihydrocodeine is safe to take with herbal remedies and supplements. They're not tested for the effect they have on other medicines in the same way pharmacy and prescription medicines are.

Important

Tell a doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.

10. Common questions

How does dihydrocodeine work?

Dihydrocodeine belongs to a group of medicines called opiates. It works in the central nervous system and the brain to block pain signals.

As well as blocking pain signals, dihydrocodeine can have negative effects. Your breathing may become slow and shallow. It may also slow down your digestion, which is why dihydrocodeine can cause constipation.

How long does it take to work?

This depends on the type of dihydrocodeine you take – fast-acting, standard or slow-acting.

Dihydrocodeine liquid is fast-acting and takes around 30 to 60 minutes to work.

Standard tablets take between 1.5 and 2 hours to work fully.

Slow-acting tablets may take a little longer to work, but will last longer.

How long will I take it for?

This will depend on why you are taking dihydrocodeine.

If you are 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 illness such as cancer.

Can I become addicted to dihydrocodeine?

It is possible to become addicted to dihydrocodeine, but this if you are taking this medicine as prescribed.

The dose you take will be reviewed to make sure you are only taking the amount you need to control your pain.

If you're taking dihydrocodeine to relieve pain (rather than using it as a recreational drug) it's unlikely you will become addicted to it because you're not taking it to get a "high".

How will I know if I'm addicted?

If you're addicted to dihydrocodeine, you may find it difficult to stop taking it or feel you need to take it more often than necessary.

If you stop taking it suddenly you may suffer from withdrawal symptoms. These include:

  • feeling agitated, anxious or nervous
  • panic attacks
  • difficulty sleeping
  • shaking
  • pins and needles
  • ringing in the ears
  • sweating

Talk to a doctor if you're worried about addiction or if you want to know more about how to prevent withdrawal symptoms.

Is it safe to take for a long time?

It is safe to take dihydrocodeine for long-term conditions, but your body can get used to it, which means it stops working as well at reducing pain.

Do not increase the dose if this happens. Talk to a doctor, who might prescribe you a different strength or a different painkiller.

What will happen if I stop taking it?

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.

Symptoms of withdrawal include:

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

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

How is it different to other opiates?

Dihydrocodeine works in the same way as a lot of other opiates but may cause fewer breathing difficulties as a side effect.

It's not better than other opiates for treating specific conditions or pain, but may be more suitable for you, depending on other conditions you have or other painkillers you have tried.

Can I drink alcohol with it?

Drinking alcohol while you're taking dihydrocodeine can make you feel more sleepy. It can also increase the risk of serious side effects.

It's best to stop drinking alcohol during the first few days of treatment, or if a doctor increases your dose, until you see how dihydrocodeine affects you.

If you feel sleepy while taking dihydrocodeine, do not drink alcohol while you're taking it.

Is there any food or drink I need to avoid?

You can eat and drink normally while taking dihydrocodeine.

Will it affect my contraception?

Dihydrocodeine does not affect any type of contraception, including the contraceptive pill or emergency contraception.

Will it affect my fertility?

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

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

Can I drive or ride a bike?

Do not drive a car, ride a bike or operate machinery if dihydrocodeine causes you to have blurred vision, makes you feel dizzy, sleepy, clumsy or unable to concentrate.

These side effects may be more likely when you first start taking dihydrocodeine but could happen at any time. For example, when starting another medicine or if a doctor increases your dose.

It's an offence to drive a car if your ability to drive safely is affected. It's your responsibility to decide if it's safe to drive. If you're in any doubt, do not drive.

GOV.UK has more information about the law on drugs and driving

Talk to a doctor or pharmacist if you're unsure whether it's safe for you to drive while taking dihydrocodeine.

Will recreational drugs affect it?

If you take recreational drugs, such as cannabis, cocaine and heroin, while you're taking dihydrocodeine, you're more likely to get the serious side effects of dihydrocodeine including breathing difficulties, muscle stiffness, low blood pressure and seizures or fits.

Some recreational drugs, such as cannabis, will also increase dihydrocodeine side effects and make you feel sleepy and dizzy.

Taking heroin while you're taking prescribed dihydrocodeine is especially dangerous. You're more likely to get all the side effects of dihydrocodeine, including addiction.

Tell a doctor if you take recreational drugs while you're taking dihydrocodeine.