Dihydrocodeine Other names: Drocode Paracodeine Parzone

The concomitant use of opioids with sedative medicines such as benzodiazepines or related drugs increases the risk of sedation, respiratory depression, coma and death because of additive CNS depressant effect. The dose and duration of concomitant use should be limited. Drugs which depress the CNS include, but are not limited to, other opioids, anxiolytics, hypnotics and sedatives (including benzodiazepines), antipsychotics, antidepressants, phenothiazines and alcohol.

• Anxiolytics or hypnotics may increase CNS depression, particularly respiratory depression.
• Triciclic antidepressants (e.g. imipramine, amitriptyline) may enhance CNS depressive effects when taken with dihydrocodeine.
• Antipsychotic may enhance hypotensive and sedative effects.

Dihydrocodeine should be administered with caution in patients with impairment of hepatic function.

Dosage should be reduced in patients with chronic hepatic disease.

Dihydrocodeine should be administered with caution in patients with severe renal dysfunction.

The efficacy of analgesics is enhanced.

Dihydrocodeine should be administered with caution in patients with biliary tract disorders.

Patients with pre-existing seizure disorders should be observed with caution when prescribed dihydrocodeine.

Dihydrocodeine should be administered with caution in patients with chronic obstructive pulmonary disease.

Dihydrocodeine should be administered with caution in patients with constipation.

Dihydrocodeine should be administered with caution in patients with bronchial asthma.

Dihydrocodeine should be administered with caution in patients with prostatic hypertrophy.

Dihydrocodeine should be administered with caution in patients with hypothyroidism.

Dosage should be reduced.

Dihydrocodeine should be administered with caution in patients with reduced level of consciousness of uncertain origin.

Dihydrocodeine should be administered with caution in patients with sleep apnoea.

Opioids may cause worsening of pre-existing sleep apnoea.

Dihydrocodeine should be administered with caution in patients with pancreatitis.

Dihydrocodeine should be administered with caution in patients with respiratory depression with hypoxia.

Dihydrocodeine should be administered with caution in patients with an obstructive bowel disorder.

Dihydrocodeine should be administered with caution in patients with cor pulmonale.

There are no or limited amount of data from the use of dihydrocodeine in pregnant women. Regular use during pregnancy may cause drug dependence in the foetus, leading to withdrawal symptoms in the neonate. Dihydrocodeine should only be used during pregnancy and labour if considered essential due to the risk of neonatal respiratory depression. If opioid use is required for a prolonged period in a pregnant woman, advise the patient of the risk of neonatal opioid withdrawal syndrome and ensure that appropriate treatment will be available. Administration during labour may depress respiration in the neonate and an antidote for the child should be readily available. Infants born to mothers who have received opioids during pregnancy should be monitored for respiratory depression.

Administration to nursing women is not recommended as dihydrocodeine may be secreted in breast milk and may cause respiratory depression in the infant. It is advisable that dihydrocodeine only be administered to breast-feeding mothers if considered essential.

Dihydrocodeine may induce drowsiness. Patients receiving dihydrocodeine should not drive or operate machinery unless it has been shown not to affect physical or mental ability.