Dihydrocodeine is an opioid 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-term pain if weaker painkillers, such as paracetamol, ibuprofen and aspirin, have not worked.

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.
Key facts

• Standard dihydrocodeine tablets take between 1 and a half and 2 hours to work fully. Slow-release tablets may take longer to work but they last longer.
• It’s possible to become addicted to dihydrocodeine, but your doctor will explain how to reduce the risks of becoming addicted.
• If you need to take dihydrocodeine for more than a few weeks, your treatment plan may include details of how and when to stop taking this medicine.
• The most common side effects are feeling or being sick, feeling drowsy, and constipation.

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.

Who may not be able to take dihydrocodeine

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.

Standard tablets

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)

Slow-release tablets

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

Liquid

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:

• yawning
• sneezing
• muscle twitching
• sweating
• 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 forget to take it

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

How to store dihydrocodeine

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