Formulary
Dihydrocodeine with paracetamol: Indications, Dosing, Side Effects and Interactions
Dihydrocodeine with paracetamol clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 5 min read
Dihydrocodeine with paracetamol: Indications, Dosing, Side Effects and Interactions
Dihydrocodeine with paracetamol clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Mild to moderate pain [using 10/500 preparations only]**
- **Adult** (By Mouth): 1-2 tablets every 4-6 hours as required, to be given using 10/500 mg strength tablet; maximum 8 tablets per day.
**Severe pain [using 20/500 preparations only]**
- **Adult** (By Mouth): 1-2 tablets every 4-6 hours as required, to be given using 20/500 mg strength tablet; maximum 8 tablets per day.
**Severe pain [using 30/500 preparations only]**
- **Adult** (By Mouth): 1-2 tablets every 4-6 hours as required, to be given using 30/500 mg strength tablet; maximum 8 tablets per day.
**Mild to moderate pain [using 10/500 preparations only] for dihydrocodeine with paracetamol**
- **Child 12-17 years** (By mouth): 1-2 tablets every 4-6 hours as required, to be given using 10/500 mg strength tablet; maximum 8 tablets per day.
**Severe pain [using 20/500 preparations only] for dihydrocodeine with paracetamol**
- **Child 12-17 years** (By mouth): 1-2 tablets every 4-6 hours as required, to be given using 20/500 mg strength tablet; maximum 8 tablets per day.
**Severe pain [using 30/500 preparations only] for dihydrocodeine with paracetamol**
- **Child 12-17 years** (By mouth): 1-2 tablets every 4-6 hours as required, to be given using 30/500 mg strength tablet; maximum 8 tablets per 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); diseases of the biliary tract; elderly (reduced dose is recommended); 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; 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 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 with paracetamol Alcohol dependence; before administering, check when paracetamol last administered and cumulative paracetamol dose over previous 24 hours; chronic alcoholism; chronic dehydration; chronic malnutrition; 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 with paracetamol Frequency not known Abdominal pain; blood disorder; leucopenia; malaise; neutropenia; pancreatitis; paraesthesia; paralytic ileus; severe cutaneous adverse reactions (SCARs); thrombocytopenia Overdose Liver damage (and less frequently renal damage) following overdosage with paracetamol.
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
For dihydrocodeine with paracetamol 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
For dihydrocodeine with paracetamol Manufacturer advises consider avoiding in mild to moderate impairment; avoid in severe impairment. Dose adjustments Manufacturer advises dose reduction in mild to moderate impairment, if used.
Renal impairment
For dihydrocodeine with paracetamol Reduce dose or avoid dihydrocodeine; increased and prolonged effect; increased cerebral sensitivity.
Medicinal forms
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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