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Dihydrocodeine

Dihydrocodeine, also called DHC or DF-118, is a synthetic opioid analgesic prescribed for postoperative pain, severe dyspnea, or as an antitussive. It was developed in the early 1900s, and is similar in chemical structure and pharmaceutical behaviour to codeine, but is approximately twice as potent. It has approximately 30% the potency of IM morphine. more...

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Although dihydrocodeine does have extremely active metabolites, in the form of dihydromorphine and dihydromorphine-6-glucuronide (100x more potent), these metabolites are produced in such small amount that they do not have clinically important effects².

Indications

Approved indication for dihydrocodeine is the management of moderate to severe pain. It is usually formulated as tablets containing 30 mg with one tablet taken every 4-6 hours when necessary.

Dihydrocodeine is sometimes marketed in combination preparations with paracetamol (acetaminophen) as co-dydramol (BAN) to provide greater pain relief than either agent used singly (q.v. Drug Synergy).

Side Effects

As with other opioids, tolerance and physical and psychological dependence develop with repeated dihydrocodeine use. All opioids can impair the mental and/or physical abilities required for the performance of potentially hazardous tasks such as driving or operating machinery if taken in large doses, but have the opposite effect in moderate doses .

Regulation

In the USA, it is a DEA Schedule II substance, although preparations containing small amounts of dihydrocodeine are classified as Schedule III or Schedule V, depending on the concentration of dihydrocodeine relative to other active constituents, such as acetaminophen.

In the United Kingdom dihydrocodeine is a Class B drug - making it (in principle) more dangerous than cannabis which is a class C drug. Illegal possession of dihydrocodeine can result in up to 5 years in prison and/or an unlimited fine.

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DRUG CHALLENGE
From Nursing, 12/1/03 by Gever, Marcy Portnoff

You routinely administer combination drugs...but do you know what's in them? To find out, match each combination of ingredients in Section II with its correct name in Section I.

SECTION I

_____1. Synalgos-DC (Women First)

_____2. Analpram-HC (Ferndale)

_____3. Diovan HCT (Novartis)

_____4. Vicks DayQuil (Procter & Gamble)

_____5. Trivora-28 (Watson)

SECTION II

a. dihydrocodeine bitartrate, 16 mg; aspirin, 356.4 mg; caffeine, 30 mg

Prescribed for moderate to severe pain, this drug contains dihydrocodeine, an opioid analgesic; aspirin, a nonopioid analgesic; and caffeine to enhance their effects. Your patient may feel drowsy and dizzy while taking it.

b. dextromethorphan HBr, 10 mg; pseudoephedrine HCl, 30 mg; acetaminophen, 250 mg

The capsule form of this nonprescription cold medication contains dextromethorphan, a nonopioid cough suppressant; pseudoephedrine, a decongestant; and acetaminophen, an analgesic. Warn your patient not to take it with other products that contain analgesics, such as ibuprofen, naproxen, aspirin, or acetaminophen.

c. levonorgestrel, 0.05 mg, 0.075 mg, 0.125 mg; ethinyl estradiol, 0.03 mg, 0.04 mg

This oral contraceptive consists of four tablet types with different concentrations of levonorgestrel, a progestin, and ethinyl estradiol, an estrogen. Three simulate natural hormone levels and one is inert. If your patient smokes, urge her to quit to reduce her risk of thromboembolism and stroke.

d. valsartan, 80 mg, 160 mg; hydrochlorothiazide, 12.5 mg, 25 mg

Prescribed to control hypertension, this combination contains valsartan, an angiotensin II antagonist, and hydrochlorothiazide, a thiazide diuretic. Warn your patient not to use salt substitutes that contain potassium, which could raise his blood potassium to a dangerous level.

e. hydrocortisone acetate, 2.5%; pramoxine HCl, 1% The primary care provider may prescribe this lotion to relieve inflammation and itching due to psoriasis. Hydrocortisone is a corticosteroid; pramoxine is a topical anesthetic. Tell your patient to shake the bottle well, apply a thin film of lotion to his skin, and add an occlusive dressing if his psoriasis is severe.

BY MARCY PORTNOFF GEVER, RPH, MED

Marcy Portnoff Gever is an independent pharmacist consultant and educator in Ringoes, N.J.

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