DIHYDROCODEINE (IN THE FORM OF DIHYDROCODEINE TARTRATE) WARNINGS
Dihydrocodeine should be used with caution in:
- Children, over 12 years of age (prolonged release tablets)
- Children over 4 years (tablets)
- Pregnant women
- Women breastfeeding
- People with any breathing difficulties e.g. asthma, bronchitis
- People with decreased function of thyroid gland (hypothyroidism)
- People with decreased kidney function
- People with decreased liver function
- People with a drug addiction or a history of drug abuse, especially opioids
- People with enlargement of the prostate gland (prostatic hypertrophy)
- People with inflammation of the pancreas (pancreatitis)
- People with a heart problem resulting from long-term lung disease known as cor pulmonale, if severe
- People with obstructive bowel disorders
- People with constipation
- People with inflammatory bowel disease, such as Crohn's disease and ulcerative colitis
- People with decreased function of the adrenal gland (adrenocortical insufficiency)
- People with low blood pressure (hypotension)
- People with difficulties passing urine
- People with gall-bladder or other biliary problems
- People who are taking or have taken monoamine oxidise inhibitors (MAOIs) which are used to treat depression such as moclobemide, isocarboxazid, phenelzine
- People who are taking alcohol or other medicines which have an effect on breathing rate and sleepiness including sleeping pills and some drugs used to treat mental problems.
It should not be used in:
- People with an allergy to dihydrocodeine, or any of the ingredients in the medicine
- People with severe breathing difficulties
- People with head injuries
- People with increased intracranial pressure (increased pressure in the brain)
- People who drink alcohol to excess (acute alcoholism)
- People with paralytic ileus (inactivity of the intestine which results delayed emptying and movement through the gut)
- People during an attack of bronchial asthma
- People with a lung condition known as chronic obstructive pulmonary disease (COPD)
- People with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption (tablets, as they contain lactose)
- Children under 12 years of age (prolonged release tablets)
- Children under 4 years (tablets)
Also see list of precautions and interactions
Do not store above 25°C in a dry place. Store in the original package to protect from light.
DIHYDROCODEINE (IN THE FORM OF DIHYDROCODEINE TARTRATE) USES
What is it used for?
- Dihydrocodeine is used to relieve pain.
- It is an opioid painkiller, sometimes known as an opioid analgesic.
- It is used to control and reduce moderate to severe pain. Dihydrocodeine acts on opioid receptors in the brain and blocks the feeling of pain.
- In general this drug is used to treat moderate to severe pain after an operation or injury or resulting from an illness, such as cancer.
- Benefits of being on this drug can include feeling less or no pain (analgesic effect).
Listed below are the typical uses of dihydrocodeine.
- Relief of moderate to severe pain
- Relief of severe pain resulting from long-term illnesses
On occasion your doctor may prescribe this medicine to treat a condition not on the above list.
HOW TO USE/TAKE
- Dihydrocodeine is available as tablets, prolonged release tablets, oral solution and injection.
- The tablets should be taken orally usually every four to six hours, after food. The medication should be swallowed whole with water. Dihydrocodeine prolonged release tablets are designed to release dihydrocodeine more slowly into your body and do not need to be taken as often. The prolonged release tablets are usually taken every twelve hours. It is very important that prolonged release tablets are not crushed or chewed and are swallowed whole.
- This medication can also been taken as deep subcutaneous or intra-muscular injections, usually every four to six hours.
- This medication is also commonly used in combination with paracetamol e.g. co-dydramol.
- Use this medication for duration of the prescription in order to get the most benefit from it.
- Remember to use it at the same time each day - unless specifically told otherwise by your doctor.
- It may take up to 30 minutes before the full benefit of this drug takes effect.
- Certain medical conditions may require different dosage instructions as directed by your doctor.
- Dosage is based on your age, gender, medical condition, response to therapy, and use of certain interacting medicines.
Do I need to avoid anything?
- This medication may cause drowsiness or dizziness. If you are affected you should avoid driving or operating machinery. Consult your doctor or pharmacist for more details. Consult your doctor or pharmacist for more details.
When can I stop?
- It is important to continue taking this medication even if you feel well, unless your doctor tells you to stop. Abruptly stopping your medication may result in your symptoms worsening and you may experience withdrawal symptoms such as fever, muscle weakness, restlessness and sweating. If your medication is stopped, your doctor will gradually decrease the medication over a period of time so that you don't have withdrawal symptoms.
DIHYDROCODEINE (IN THE FORM OF DIHYDROCODEINE TARTRATE) SIDE EFFECTS
- Nausea and vomiting
- Skin rash
- Problems urinating
- Biliary spasms or spasms in ureter (abdominal pain is usually a symptom)
- Dry mouth
- Mood changes
- Blurred vision and vision changes
- Decreased libido
- Facial flushing
- Abdominal pain
- Low blood pressure
- Tingling in fingers and toes
- Hallucinations and abnormal thoughts
- Decrease in intestinal movement
- Slow breathing (respiratory depression)
If any of these persist or you consider them severe then inform doctor or pharmacist
Tell your doctor immediately if you develop any of the following symptoms:
- Tolerance or dependence on medication
Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
A serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction include: rash, itching/swelling (especially of the face/tongue/throat), dizziness, trouble breathing.
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
The Yellow Card Scheme allows you to report suspected side effects from any type of medicine (which includes vaccines, herbals and over the counter medicines) that you are taking. It is run by the medicines safety watchdog called the Medicines and Healthcare products Regulatory agency (MHRA). Please report any suspected side effect on the Yellow Card Scheme website
DIHYDROCODEINE (IN THE FORM OF DIHYDROCODEINE TARTRATE) PRECAUTIONS
Before taking dihydrocodeine, tell your doctor or pharmacist if you are allergic to it; or to other opioid painkillers; or if you have any other allergies.
This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have:
- Allergy to dihydrocodeine, or any of the ingredients in the medicine
- Severe breathing difficulties
- Head injuries
- Increased intracranial pressure (increased pressure in the brain)
- Acute alcoholism (drink alcohol to excess)
- Paralytic ileus (inactivity of intestine which results delayed emptying and movement through the gut)
- Bronchial asthma, as it should not be used during an asthma attack
- Obstructive airways disease
- Rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption
Before using this medication, tell your doctor or pharmacist your medical history, especially any of the following
- Breathing difficulties e.g. asthma, bronchitis
- Decreased function of thyroid gland (hypothyroidism)
- Decreased kidney function
- Decreased liver function
- Drug addiction or a history of drug abuse, especially opioids
- Enlargement of the prostate gland (prostatic hypertrophy)
- Inflammation of the pancreas (pancreatitis)
- Heart problem resulting from long-term lung disease known as cor pulmonale, if severe
- Obstructive bowel disorders
- Inflammatory bowel disease, such as Crohn's disease and ulcerative colitis
- Decreased function of the adrenal gland (adrenocortical insufficiency)
- Low blood pressure (Hypotension)
- Difficulties passing urine
- Gall-bladder or other biliary problems
Before having surgery, tell your doctor or dentist that you are taking this medication.
Does alcohol intake affect this drug?
- It is not recommended to consume alcohol while on this medication, as it may increase the sedative effects of the drug and make you feel very drowsy.
The elderly: dihydrocodeine should be used with caution in the elderly as it may result in more side effects of the medication and dose adjustment may be required.
Pregnancy and breastfeeding - please ensure you read the detailed information below
The safety of dihydrocodeine has not been established during pregnancy. Ask your doctor or pharmacist if you have any doubts or questions about this.
It is sensible to limit use of medication during pregnancy whenever possible. However, your doctor may decide that the benefits outweigh the risks in individual circumstances and after a careful assessment of your specific health situation.
If you have any doubts or concerns you are advised to discuss the medicine with your doctor or pharmacist.
It is not known whether dihydrocodeine passes into breast milk. The manufacturer therefore states that it should not be taken if you are breastfeeding.
It is sensible to limit use of medication during breastfeeding whenever possible. However, your doctor may decide that the benefits outweigh the risks in individual circumstances and after a careful assessment of your specific health situation.
If you have any doubts or concerns you are advised to discuss the medicine with your doctor or pharmacist.
DIHYDROCODEINE (IN THE FORM OF DIHYDROCODEINE TARTRATE) INTERACTIONS
Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with them first.
This drug should not be used with the following medications because very serious, possibly fatal interactions may occur:
- Sodium oxybate
If you are currently using any of these medications, tell your doctor or pharmacist before starting dihydrocodeine.
Before using this medication, tell your doctor or pharmacist of all prescription and non-prescription/herbal products you may use, especially of:
- Monoamine oxidase inhibitors (MAOIs) used to treat depression such as moclobemide, isocarboxazid, phenelzine - taking or stopped taking in the past 2 weeks
- Mexiletine or quinidine (used to control heart rhythm)
- Domperidone or metoclopramide (used to treat nausea and vomiting)
- Medications such as loperamide, kaolin (used to treat diarrhoea)
- Painkillers for headaches (if used too often or for too long your tolerance and dependence upon dihydrocodeine can be increased)
- Tricyclic antidepressants (for depression, e.g. amitriptyline, dosulepin)
- Tranquilisers, sedatives, hypnotics, anxiolytics (for sleeping troubles and anxiety, e.g. diazepam, temazepam)
- Antipsychotics (for psychosis e.g. haloperidol)
- Alcohol or other medicines which have an effect on breathing rate and sleepiness including sleeping pills and some drugs used to treat mental health problems.
This information does not contain all possible interactions. Therefore, before using dihydrocodeine, tell your doctor or pharmacist of all the products you use.
DIHYDROCODEINE (IN THE FORM OF DIHYDROCODEINE TARTRATE) OVERDOSE
Signs of overdose may include sleepiness and drowsiness which can progress to a stupor and coma, slow breathing, pin-point pupils, low blood pressure, muscle weakness, cold and clammy skin and slow heart beat. Failure to pump blood around the body and deepening coma may occur in more severe cases. Convulsions (fits) may occur in infants and children.
Crushing of dihydrocodeine prolonged release tablets and ingestion of this medication could result in immediate medication release around the body which could result in a fatal overdose.
If you think you, or someone you care for, might have accidentally taken more than the recommended dose of dihydrocodeine or intentional overdose is suspected, contact your local hospital, GP or if in England call 111 or NHS Direct. In Scotland call NHS 24. In Wales, call NHS Direct Wales. In the case of medical emergencies, always dial 999.
If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.