Dihydrocodeine

Dihydrocodeine is a semi-synthetic opioid analgesic used to manage moderate to severe pain. Structurally related to codeine, it offers stronger pain relief and is sometimes prescribed for persistent coughs or shortness of breath due to chronic lung conditions.

First developed in the early 20th century, dihydrocodeine remains in medical use but is tightly regulated because of its addiction potential.

Medical Uses of Dihydrocodeine

Doctors may prescribe dihydrocodeine when other non-opioid pain relievers prove insufficient. Common uses include:

• Post-surgical pain management

• Chronic pain conditions (such as arthritis, back pain)

• Severe injury pain (fractures, trauma)

• Cough suppression (rarely in modern practice)

It is available in both immediate-release and extended-release forms, often combined with paracetamol (acetaminophen) in formulations similar to co-codamol.

How Dihydrocodeine Works

Dihydrocodeine binds to mu-opioid receptors in the central nervous system. This reduces the brain’s perception of pain and creates a sense of calm and relief.

Effects include:

• Pain reduction

• Sedation

• Euphoria (depending on dose and patient sensitivity)

• Cough suppression (by reducing activity in the brain’s cough center)

Because of these properties, it carries a significant risk of misuse.

Side Effects of Dihydrocodeine

Like all opioids, dihydrocodeine produces side effects ranging from mild to severe.

Mild side effects:

• Constipation

• Drowsiness

• Nausea

• Itching

• Dry mouth

Serious risks:

• Respiratory depression (slowed breathing)

• Physical dependence and withdrawal symptoms

• Addiction (opioid use disorder)

• Overdose, particularly when combined with alcohol, sedatives, or benzodiazepines

Dosage and Administration

Dihydrocodeine is available in several forms:

• Immediate-release tablets (commonly 30 mg)

• Modified-release tablets/capsules (60–120 mg) for chronic pain

• Liquid formulations for cough suppression (less common today)

 Doctors emphasize strict adherence to prescribed doses due to risk of tolerance, dependence, and accidental overdose.