This medicine is an opioid painkiller. There is a serious risk of addiction when taking this medicine, especially if used long-term. The Medicines and Healthcare products Regulatory Agency (MHRA) has issued new guidance for people prescribed an opioid painkiller. If you have any questions or concerns about taking opioids safely please speak with your doctor or a pharmacist.
Dihydrocodeine is prescribed for moderate-to-severe types of pain.
The most common side-effects are feeling sick (nausea), constipation, feeling dizzy or sleepy, and a dry mouth.
Dihydrocodeine is likely to affect your reactions and ability to drive. It may be an offence to drive while affected. Do not drive until you know how you react, especially when you first start treatment.
|Type of medicine||An opioid painkiller (analgesic)|
|Used for||Pain relief|
|Also called||DHC Continus®;|
Co-dydramol (dihydrocodeine with paracetamol): Remedeine®; Paramol®
|Available as||Tablets, prolonged-release tablets, oral liquid medicine and injection|
Dihydrocodeine is an opioid medicine (sometimes called an opiate). It is used to treat moderate-to-severe types of pain. It works by binding to certain tiny areas, called opioid receptors, in your central nervous system (brain and spinal cord). This leads to a decrease in the way you feel pain and your reaction to pain. Dihydrocodeine is available on a prescription from a doctor.
Dihydrocodeine is sometimes prescribed in combination with the painkiller paracetamol in a medicine called co-dydramol. Co-dydramol is available on prescription and also from pharmacies on the advice of a pharmacist.
Before taking dihydrocodeine
Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking dihydrocodeine, it is important that your doctor knows:
- If you are pregnant or breastfeeding.
- If you have a problem with the way your liver works, or a problem with the way your kidneys work.
- If you have prostate problems or any difficulties passing urine.
- If you have any breathing problems, such as asthma or chronic obstructive pulmonary disease (COPD).
- If you have been told you have low blood pressure.
- If you have any problems with your thyroid gland or adrenal glands.
- If you have epilepsy.
- If you have a problem with your bile duct or pancreas.
- If you have been constipated for more than a week or have an inflammatory bowel problem.
- If you have a condition causing muscle weakness, called myasthenia gravis.
- If you have recently had a severe head injury.
- If you have ever been dependent on drugs or alcohol.
- If you have ever had an allergic reaction to a medicine.
- If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.
How to take dihydrocodeine
- Before you start the treatment, read the manufacturer's printed information leaflet from inside the pack. It will give you more information about dihydrocodeine and will provide you with a full list of the side-effects which you may experience from taking it.
- Take dihydrocodeine exactly as your doctor tells you to. There are several different strengths of tablet available, so your doctor or pharmacist will tell you how often you should take your doses. As a guide, 30 mg tablets are usually taken every 4-6 hours as needed and prolonged-release tablets (DHC Continus® brand) are taken every 12 hours. The directions for taking the tablets will be printed on the label of the pack to remind you about what the doctor said to you.
- Swallow the tablets with a drink of water. Dihydrocodeine should preferably to taken after food, as this can help prevent feelings of sickness which can sometimes occur with the first few doses.
- If you have been given tablets called DHC Continus®, these are specially formulated to release dihydrocodeine slowly to give you a more even painkilling effect throughout the day. It is important that you swallow the tablets whole (do not chew or crush them), otherwise the medicine will be released into your bloodstream too quickly and cause problems.
- If you have been given dihydrocodeine liquid medicine for your child, check the label carefully to make sure you are giving the correct dose.
- If you forget to take a dose, take it as soon as you remember and then continue taking your doses as before. Do not take two doses together to make up for a forgotten dose.
Getting the most from your treatment
- You should not drink alcohol while you are taking dihydrocodeine. This is because dihydrocodeine will increase the risk that you experience side-effects from the alcohol, such as feeling dizzy and sleepy.
- If you are a driver, please be aware that dihydrocodeine is likely to affect your reactions and ability to drive. It is an offence to drive while your reactions are impaired. Even if your driving ability is not impaired, you are advised to carry with you some evidence that the medicine has been prescribed for you - a repeat prescription form or a patient information leaflet from the pack is generally considered suitable.
- You will not be given dihydrocodeine for longer than is necessary. This is because when you take dihydrocodeine repeatedly over a period of time and then stop taking it, it can cause withdrawal symptoms such as making you feel restless or irritable. If you have been taking it for some time and want to stop it, your doctor will recommend that you reduce your dose slowly in order to avoid the risk of these effects.
- Dihydrocodeine is normally prescribed for short periods of pain. If you take it over a longer period of time, your body can become used to it and it will not work as well. This is called tolerance.
- If you are having an operation or dental treatment, tell the person carrying out the treatment that you are taking dihydrocodeine.
- If you buy any medicines, check with a pharmacist that they are safe to take with an opioid painkiller.
Can dihydrocodeine cause problems?
Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with dihydrocodeine. You will find a full list in the manufacturer's information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.
|Common dihydrocodeine side-effects ||What can I do if I experience this?|
|Feeling sick (nausea) or being sick (vomiting), tummy (abdominal) pain||Stick to simple meals - avoid rich or spicy foods. Take your doses after food, as this may help protect your stomach|
|Constipation||Eat a well-balanced diet and drink plenty of water each day. If this continues to be a problem, speak with your doctor|
|Feeling dizzy or sleepy||Do not drive and do not use tools or machines. Do not drink alcohol|
|Dry mouth, mood changes, headache, tummy pain (may be caused by spasm of the bile ducts)||Speak with your doctor if troublesome|
Important: people taking dihydrocodeine, and their family and friends, should be aware of the risk of accidental overdose and know when to seek medical help. The risk is higher if you also take other medicines that make you feel drowsy. Signs you have taken too much medicine include:
- Feeling very sleepy or dizzy.
- Feeling sick (nausea) or being sick (vomiting).
- Breathing difficulties.
- Loss of consciousness.
If you have taken more dihydrocodeine than you should or someone else accidentally swallows your medication, call for an ambulance and tell them the name of your medicine.
If you experience other symptoms which you think may be due to dihydrocodeine, speak with your doctor or pharmacist for further advice.
How to store dihydrocodeine
- Keep all medicines out of the reach and sight of children.
- Store in a cool, dry place, away from direct heat and light.
Important information about all medicines
Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.
This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.
Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.
If you have any questions about this medicine ask your pharmacist.
Further reading and references
Manufacturer's PIL, Dihydrocodeine Tablets 30 mg; Accord-UK Ltd, The electronic Medicines Compendium. Dated February 2020.
Manufacturer's PIL, DHC Continus® prolonged-release tablets 60 mg, 90 mg and 120 mg; Napp Pharmaceuticals Limited, The electronic Medicines Compendium. Dated October 2020.
British National Formulary, 81st Edition (Mar 2021); British Medical Association and Royal Pharmaceutical Society of Great Britain, London.