Brands of Dihydrocodeine in Kenya
DF118, GlaxoSmithKline Pharmaceutical Kenya Limited
DHC 30, Cosmos Limited
DIHYDROCODEINE MODE OF ACTION
Dihydrocodeine is a semi-synthetic narcotic analgesic with a potency between morphine and codeine. It acts on opioid receptors, in the brain to reduce the patient’s perception of pain and improve the psychological reaction to pain by reducing the associated anxiety.
INDICATIONS
Dihydrocodeine is used to relieve moderate to severe pain.
DOSAGE AND ADMINISTRATION
Adults:
30mg every four to six hours or at the discretion of the physician.
Elderly:
Dosage should be reduced
Children aged 4 to 12 years:
0.5 to 1mg/kg bodyweight every four to six hours.
Children under 4 years:
Not recommended
Chronic hepatic disease:
The dosage should be reduced
Moderate to severe renal impairment:
The dosage should be reduced
CONTRAINDICATIONS
- Acute respiratory depression.
- Obstructive airways disease
- Known hypersensitivity to dihydrocodeine, or other opioid analgesics, or to any of the excipients
- Acute alcoholism
- Severe hepatic dysfunction
- Head injury or raised intracranial pressure (in addition to the risk of respiratory depression and increased intracranial pressure, may affect papillary and other responses vital for neurological assessment).
- Children under 4 years of age.
- Dihydrocodeine should not be given to comatose patients.
- Dihydrocodeine is also contraindicated where there is a risk of paralytic ileus, or in acute diarrhoeal conditions such as acute ulcerative colitis or antibiotic associated colitis (e.g. pseudomembranous colitis) or diarrhoea caused by poisoning.
DRUG INTERACTIONS
Alcohol: The hypotensive, sedative and respiratory depressive effects of alcohol may be enhanced; alcohol should be avoided.
Anaesthetics: concomitant administration of dihydrocodeine and anaesthetics may cause increased CNS depression and/or respiratory depression and/or hypotension.
Anti-arrhythmics: Dihydrocodeine may delay absorption of mexiletine. The analgesic activity of dihydrocodeine may be significantly impaired by quinidine which impairs codeine metabolism.
Antidepressants, anxiolytics, hypnotics and antipsychotics: Opiates potentiate the effects of CNS depressants, including anxiolytics (e.g.: chlordiazepoxide, diazepam), hypnotics, antipsychotics and tricyclic antidepressants.
MAOIs taken with pethidine have been associated with severe CNS excitation or depression (including hypertension or hypotension). Although this has not been documented with dihydrocodeine, it is possible that a similar interaction may occur and therefore the use of dihydrocodeine should be avoided while the patient is taking MAOIs and for 2 weeks after MAOI discontinuation.
Antihistamines: concomitant administration of dihydrocodeine and antihistamines with sedative properties may cause increased CNS depression and/or respiratory depression and/or hypotension.
Antidiarrhoeal and antiperistaltic agents (e.g. loperamide, kaolin): concurrent use may increase the risk of severe constipation.
Motility stimulants: Dihydrocodeine has an antagonistic effect on cisapride, metoclopramide and domperidone.
Sodium oxybate: concomitant administration of dihydrocodeine and sodium oxybate may cause increased CNS depression and/or respiratory depression and/or hypotension.
Ulcer-healing drugs: Cimetidine may inhibit the metabolism of dihydrocodeine resulting in increased plasma concentrations.
Interference with laboratory tests: Opioids may interfere with gastric emptying studies as they delay gastric emptying and with hepatobiliary imaging using technetium Tc 99m disofenin as opioid treatment may cause constriction of the sphincter of Oddi and increase biliary tract pressure.
ADVERSE EFFECTS
Regular prolonged use of dihydrocodeine is known to lead to addiction and tolerance. Symptoms of restlessness and irritability may result when treatment is then stopped.
Prolonged use of a painkiller for headaches can make them worse.
Tolerance and some of the most common side effects – drowsiness, nausea, and vomiting, and confusion – generally develops with long term use.
Immune system disorders: maculopapular rash has been seen as part of a hypersensitivity syndrome associated with oral codeine phosphate; fever, splenomegaly and lymphadenopathy also occurred.
Endocrine disorders: hyperglycaemia
Metabolism and nutrition disorders: anorexia.
Psychiatric disorders: mental depression, hallucinations and nightmares, restlessness, confusion, mood changes, euphoria, dysphoria.
Nervous System disorders: convulsions (especially in infants and children), dizziness, drowsiness, headache, (prolonged use of a painkiller for headaches can make them worse). Raised intracranial pressure may occur in some patients.
Eye disorders: blurred or double vision or other changes in vision. Miosis.
Ear and labyrinth disorders: vertigo.
Cardiac disorders: tachycardia, palpitations and bradycardia.
Vascular disorders: postural hypotension, facial flushing. Large doses produce hypotension.
Respiratory, thoracic and mediastinal disorders: Dyspnoea. Larger doses produce respiratory depression.
Gastrointestinal disorders: nausea, vomiting, constipation, dry mouth, stomach cramps, pancreatitis.
Hepatobiliary disorders: Biliary spasm (may be associated with altered liver enzyme values).
Skin and subcutaneous tissue disorders: allergic reactions, such as skin rash, pruritus, urticaria, sweating, facial oedema.
Musculoskeletal and connective tissue disorders: Uncontrolled muscle movements. Muscle rigidity may occur after high doses.
Renal and urinary disorders: urinary retention, difficulty with micturition, ureteric spasm, dysuria. An antidiuretic effect may also occur with codeine.
Reproductive system and breast disorders: sexual dysfunction, erectile dysfunction, decreased potency. Decreased libido.
General disorders and administration site conditions: malaise, tiredness, hypothermia.
Dose-related increased post-operative pain has been reported following dental surgery.
Reporting of suspected adverse reactions
The PPB Department of Pharmacovigilance was set up with a vision to develop, implement and continuously upgrade an appropriate system for detecting, reporting and monitoring adverse drug reactions (ADRs) and other relevant problems with medicines in Kenya. The department strives to ensure the safety and efficacy of pharmaceutical products in Kenya.
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals/ Patients are encouraged to report any suspected adverse reactions via Pharmacovigilance Yellow Form, pv@pharmacyboardkenya.org or clicking below button:
Dihydrocodeine in Kenya
Dihydrocodeine in Kenya
Dihydrocodeine in Kenya
Dihydrocodeine in Kenya
Dihydrocodeine in Kenya
Dihydrocodeine in Kenya
Clinical | Pharmacokinetic data
Pregnancy Category: C
Routes of Administration: oral subcutaneous intramuscular rectal possibly sublingual / buccal
Bioavailability: 20%
Protein Binding: Not Available
Metabolosim: Mainly hepatic, through CYP3A4 and CYP2D6
Onset of Action: Not Available
Elimination Half life: 4 hours
Excretion:
Legal Status | Dosage forms & Strengths
Prescription Category:
Prescription only Medicine (POM) , â„ž-only
Narcotic Drugs and Psychotropic Substances (Control ) Act Schedule:
This is a controlled Schedule 1 Drug ,Narcotic Drugs and Psychotropic Substances (Control ) Act
Dosage Forms | Strengths:
Tablets
Drug Indentifiers:
| CAS Number | |
|---|---|
| PubChem CID | |
| IUPHAR/BPS | |
| DrugBank | |
| ChemSpider | |
| UNII | |
| KEGG | |
| ChEMBL | |
| CompTox Dashboard (EPA) | |
| ECHA InfoCard | |
Drug Images