Dihydrocodeine

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.

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.

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.

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.

See Also

• Opioid
• Analgesic
• Codeine

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