Dihydrocodeine: Difference between revisions

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'''Dihydrocodeine''' is a semi-synthetic opioid analgesic prescribed for pain or severe dyspnea, or as an antitussive, either alone or compounded with paracetamol (as in co-dydramol) or aspirin. It was developed in Germany in 1908 and first marketed in 1911. As with codeine, intravenous administration should be avoided, as it could result in anaphylaxis and life-threatening pulmonary edema. In the past, dihydrocodeine suppositories were used. Dihydrocodeine is available in suppository form on prescription.
{{Short description|An opioid analgesic used for pain management}}
{{Drugbox
| verifiedrevid = 477318282
| IUPAC_name = (5_,6_)-4,5-epoxy-3-methoxy-17-methylmorphinan-6-ol
| image = Dihydrocodeine.svg
| width = 200px
| image2 = Dihydrocodeine ball-and-stick model.png
| width2 = 200px
| tradename = Paracodin, Synalgos-DC, others
| legal_AU = S8
| legal_CA = Schedule I
| legal_UK = Class B
| legal_US = Schedule II
| routes_of_administration = Oral, subcutaneous, intramuscular
| bioavailability = 20% (oral)
| protein_bound = 20%
| metabolism = Hepatic
| elimination_half-life = 3.5–5 hours
| excretion = Renal
| CAS_number = 125-28-0
| ATC_prefix = R05
| ATC_suffix = DA20
| PubChem = 5284543
| DrugBank = DB01551
| ChemSpiderID = 4447628
| UNII = 2O91I053E7
| KEGG = D07880
| ChEBI = 28547
| ChEMBL = 1201201
| C=18
| H=23
| N=1
| O=3
| smiles = CN1CC[C@]23C4=C5C=CC(OC)=C4O[C@H]2[C@@H](O)C=C[C@H]3[C@H]1C5
| StdInChI = 1S/C18H23NO3/c1-19-7-6-18-10-3-4-11(20-2)16-17(18)12(10)8-13(21)14(18)9-15(19)22-16/h3-4,13-15,17,21H,6-9H2,1-2H3/t13-,14+,15-,17-,18-/m0/s1
| StdInChIKey = RBOXVHNMENFORY-CGTJXYLNSA-N
}}
 
'''Dihydrocodeine''' is a semi-synthetic opioid analgesic prescribed for the relief of moderate to severe pain. It is also used as an antitussive to suppress cough. Dihydrocodeine is a hydrogenated derivative of [[codeine]], and it is available in various formulations, including tablets, elixirs, and injectable solutions.


==Pharmacology==
==Pharmacology==
Dihydrocodeine is twice as strong as codeine. The bitartrate is freely soluble in water and ethanol. It is metabolized in the liver by demethylation and glucuronidation. Dihydrocodeine's onset of action is 20 to 30 minutes for oral administration, and 5–10 minutes for rectal administration. The half-life of dihydrocodeine is approximately 4 hours.
Dihydrocodeine acts primarily as an agonist at the [[mu-opioid receptor]], which is responsible for its analgesic effects. It also has some affinity for the [[delta-opioid receptor]] and [[kappa-opioid receptor]], contributing to its overall pharmacological profile. The drug is metabolized in the liver by the [[cytochrome P450]] enzyme system, primarily CYP2D6, into active metabolites such as [[dihydromorphine]].
 
===Mechanism of Action===
The analgesic effects of dihydrocodeine are mediated through its action on the central nervous system, where it binds to opioid receptors and inhibits the transmission of pain signals. This results in an increased pain threshold and altered perception of pain.


==Medical Uses==
==Medical Uses==
Dihydrocodeine is used as an alternative or adjunct to codeine for the aforementioned indications. The salt to free base conversion factors are 0.67 for the bitartrate, 0.73 for the phosphate, and 0.89 for the hydrochloride.
Dihydrocodeine is indicated for the management of moderate to severe pain, particularly when other analgesics such as [[paracetamol]] or [[nonsteroidal anti-inflammatory drugs]] (NSAIDs) are insufficient. It is also used as a cough suppressant in certain formulations.
 
===Dosage and Administration===
The dosage of dihydrocodeine varies depending on the formulation and the severity of the condition being treated. It is typically administered orally, but can also be given via subcutaneous or intramuscular injection. The usual adult dose ranges from 30 mg to 60 mg every 4 to 6 hours as needed for pain.


==Side Effects==
==Side Effects==
The side effects are similar to those of other opioids: constipation, itch, nausea, dizziness, drowsiness, dry mouth, miosis, orthostatic hypotension, male ejaculatory difficulty, vomiting, and sweating. Extended use can result in drug tolerance and physical dependence.
Common side effects of dihydrocodeine include [[nausea]], [[vomiting]], [[constipation]], [[drowsiness]], and [[dizziness]]. As with other opioids, there is a risk of [[respiratory depression]], particularly at higher doses or in combination with other central nervous system depressants.


==See Also==
==Precautions==
* [[Opioid]]
Dihydrocodeine should be used with caution in patients with a history of [[substance abuse]], [[respiratory disorders]], or [[hepatic impairment]]. It is classified as a Schedule II controlled substance in the United States, indicating a high potential for abuse and dependence.
* [[Analgesic]]
 
==Related Pages==
* [[Opioid analgesic]]
* [[Codeine]]
* [[Codeine]]
* [[Pain management]]
* [[Cough suppressant]]


[[Category:Medicine]]
[[Category:Pharmacology]]
[[Category:Opioids]]
[[Category:Opioids]]
 
[[Category:Analgesics]]
{{stub}}
[[Category:Antitussives]]
<gallery>
File:Dihydrocodeine_skeletal.svg|Skeletal structure of Dihydrocodeine
File:Dihydrocodeine3DanJ.gif|3D animation of Dihydrocodeine molecule
File:Dhccontinus.jpg|Dihydrocodeine Continus tablets
File:Dihydrcodeine_Tablets_Package_Almus_30_mg_2017.jpg|Dihydrocodeine Tablets Package Almus 30 mg
</gallery>

Revision as of 17:33, 18 February 2025

An opioid analgesic used for pain management


Dihydrocodeine
File:Dihydrocodeine.svg
INN
Drug class
Routes of administration Oral, subcutaneous, intramuscular
Pregnancy category
Bioavailability 20% (oral)
Metabolism Hepatic
Elimination half-life 3.5–5 hours
Excretion Renal
Legal status
CAS Number 125-28-0
PubChem 5284543
DrugBank DB01551
ChemSpider 4447628
KEGG D07880


Dihydrocodeine is a semi-synthetic opioid analgesic prescribed for the relief of moderate to severe pain. It is also used as an antitussive to suppress cough. Dihydrocodeine is a hydrogenated derivative of codeine, and it is available in various formulations, including tablets, elixirs, and injectable solutions.

Pharmacology

Dihydrocodeine acts primarily as an agonist at the mu-opioid receptor, which is responsible for its analgesic effects. It also has some affinity for the delta-opioid receptor and kappa-opioid receptor, contributing to its overall pharmacological profile. The drug is metabolized in the liver by the cytochrome P450 enzyme system, primarily CYP2D6, into active metabolites such as dihydromorphine.

Mechanism of Action

The analgesic effects of dihydrocodeine are mediated through its action on the central nervous system, where it binds to opioid receptors and inhibits the transmission of pain signals. This results in an increased pain threshold and altered perception of pain.

Medical Uses

Dihydrocodeine is indicated for the management of moderate to severe pain, particularly when other analgesics such as paracetamol or nonsteroidal anti-inflammatory drugs (NSAIDs) are insufficient. It is also used as a cough suppressant in certain formulations.

Dosage and Administration

The dosage of dihydrocodeine varies depending on the formulation and the severity of the condition being treated. It is typically administered orally, but can also be given via subcutaneous or intramuscular injection. The usual adult dose ranges from 30 mg to 60 mg every 4 to 6 hours as needed for pain.

Side Effects

Common side effects of dihydrocodeine include nausea, vomiting, constipation, drowsiness, and dizziness. As with other opioids, there is a risk of respiratory depression, particularly at higher doses or in combination with other central nervous system depressants.

Precautions

Dihydrocodeine should be used with caution in patients with a history of substance abuse, respiratory disorders, or hepatic impairment. It is classified as a Schedule II controlled substance in the United States, indicating a high potential for abuse and dependence.

Related Pages