Formulary
Dihydrocodeine tartrate: Indications, Dosing, Side Effects and Interactions
Dihydrocodeine tartrate clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 5 min read
Dihydrocodeine tartrate: Indications, Dosing, Side Effects and Interactions
Dihydrocodeine tartrate clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Moderate to severe pain**
- **Child** (By Mouth Using Immediate-Release Medicines): 12-17 years 30 mg every 4-6 hours.
- **Adult** (By Mouth Using Immediate-Release Medicines): Up to 50 mg every 4-6 hours as required.
**Chronic severe pain**
- **Child** (By Mouth Using Modified-Release Medicines): 12-17 years 60-120 mg every 12 hours.
- **Adult** (By Mouth Using Modified-Release Medicines): 60-120 mg every 12 hours.
**Severe pain**
- **Child** (By Mouth): 12-17 years 40-80 mg 3 times a day.
- **Adult** (By Mouth): 40-80 mg 3 times a day.
**Moderate to severe pain for dihydrocodeine tartrate**
- **Child 1-3 years** (By mouth using immediate-release medicines): 500 micrograms/kg every 4-6 hours.
- **Child 4-11 years** (By mouth using immediate-release medicines): 0.5-1 mg/kg every 4-6 hours (max. per dose 30 mg).
- **Child 12-17 years** (By mouth using immediate-release medicines): 30 mg every 4-6 hours.
- **Child 1-3 years** (By intramuscular injection, or by subcutaneous injection): 500 micrograms/kg every 4-6 hours.
- **Child 4-11 years** (By intramuscular injection, or by subcutaneous injection): 0.5-1 mg/kg every 4-6 hours (max. per dose 30 mg).
- **Child 12-17 years** (By intramuscular injection, or by subcutaneous injection): 30 mg every 4-6 hours, increased if necessary up to 50 mg every 4-6 hours.
**Chronic severe pain for dihydrocodeine tartrate**
- **Child 12-17 years** (By mouth using modified-release medicines): 60-120 mg every 12 hours.
**Severe pain for DF118 Forte**
- **Child 12-17 years** (By mouth): 40-80 mg 3 times a day.
Cautions
Adrenocortical insufficiency (reduced dose is recommended); asthma (avoid during an acute attack); central sleep apnoea; convulsive disorders; current or history of mental health disorder; current or history of substance use disorder; debilitated patients (reduced dose is recommended) (in adults); diseases of the biliary tract; elderly (reduced dose is recommended) (in adults); hypotension; hypothyroidism (reduced dose is recommended); impaired respiratory function (avoid in chronic obstructive pulmonary disease); inflammatory bowel disorders; myasthenia gravis; obstructive bowel disorders; prostatic hypertrophy (in adults); shock; urethral stenosis Cautions, further information Dependence and addiction Prolonged use of opioid analgesics may lead to drug dependence and addiction, even at therapeutic doses. There is an increased risk in individuals with current or history of substance use disorder or mental health disorders. See also Important safety information . Central sleep apnoea Opioids cause a dose-dependent increased risk of central sleep apnoea, consider total opioid dose reduction. M Palliative care In the control of pain in terminal illness, the cautions listed should not necessarily be a deterrent to the use of opioid analgesics. M Elderly In adults: Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information). Potentially inappropriate: if prescribed a strong , oral , or transdermal opioid (i.e. morphine, oxycodone, fentanyl, buprenorphine, diamorphine, methadone, tramadol, pethidine, pentazocine) as first-line therapy for mild pain (WHO analgesic ladder not observed) if used regularly without concomitant laxative (risk of severe constipation) if prescribed a long-acting (modified-release) opioid without a short-acting (immediate-release) opioid for breakthrough pain (risk of persistence of severe pain) Cautions For dihydrocodeine tartrate Pancreatitis; severe cor pulmonale
Contraindications
Acute respiratory depression; comatose patients; head injury (opioid analgesics interfere with pupillary responses vital for neurological assessment); raised intracranial pressure (opioid analgesics interfere with pupillary responses vital for neurological assessment); risk of paralytic ileus
Side effects
Common or very common Arrhythmias; confusion; constipation; dizziness; drowsiness; dry mouth; euphoric mood; flushing; hallucination; headache; hyperhidrosis; hypotension (with high doses); miosis; nausea (more common on initiation); palpitations; respiratory depression (with high doses); skin reactions; urinary retention; vertigo; visual impairment; vomiting (more common on initiation); withdrawal syndrome Uncommon Drug dependence; dysphoria; seizure Side-effects, further information Respiratory depression Respiratory depression is a major concern with opioid analgesics and it may be treated by artificial ventilation or be reversed by naloxone. Dependence, addiction, and withdrawal Long term use of opioids in non-malignant pain (longer than 3 months) carries an increased risk of dependence and addiction, even at therapeutic doses. At the end of treatment the dosage should be tapered slowly to reduce the risk of withdrawal effects; tapering from a high dose may take weeks or months. See also Important safety information . Overdose Opioids (narcotic analgesics) cause coma, respiratory depression, and pinpoint pupils. For details on the management of poisoning, see Opioids, under Emergency treatment of poisoning and consider the specific antidote, naloxone hydrochloride. Side-effects For dihydrocodeine tartrate General side-effects: Frequency not known Dysuria; mood altered Specific side-effects: Frequency not known With oral use Biliary spasm; bronchospasm; hypothermia; sexual dysfunction; ureteral spasm
Interactions
**Severe interactions:**
- The anticoagulant effect of warfarin and other coumarins may be enhanced by prolonged regular use of paracetamol with increased risk of bleeding; occasional doses have no significant effect.
**Other interactions (5):**
- Dihydrocodeine should be used with caution in patients taking monoamine oxidase inhibitors, CNS depressants or metoclopramide.
- The speed of absorption of paracetamol may be increased by metoclopramide and domperidone and absorption reduced by cholestyramine.
- Caution should be taken when paracetamol is used concomitantly with flucloxacillin as concurrent intake has been associated with high anion gap metabolic acidosis due to pyroglutamic acidosis,...
- Sedative medicines such as benzodiazepines or related drugs: The concomitant use of opioids with sedative medicines such as benzodiazepines or related drugs increases the risk of sedation,...
- Concomitant administration of codeine with anticholinergics or medications with anticholinergic activity (e.g.
Pregnancy
Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour.
Breast feeding
Specialist sources indicate caution-use the lowest effective dose for the shortest possible duration; monitor infant for adverse effects, including sedation, breathing difficulties, constipation, difficulty feeding and poor weight gain.
Hepatic impairment
Manufacturer advises caution; consider avoiding. Dose adjustments Manufacturer advises dose reduction, if used.
Renal impairment
Avoid use or reduce dose; opioid effects increased and prolonged and increased cerebral sensitivity occurs.
Medicinal forms
Solution,Tablet,Tablet,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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