Dihydrocodeine is a opiate painkiller. It's used to treat moderate to severe pain, such as after an operation or a serious injury.

It's also used for long-standing pain when weaker painkillers, such as paracetamol, ibuprofen and aspirin, have not worked.

Dihydrocodeine is only available on prescription. It also comes mixed with paracetamol, this is called co-dydramol.

It comes as standard tablets, slow-release tablets and as a liquid that you swallow. It can also be given by an injection into the muscle or under the skin. This is usually done in hospital.

Dihydrocodeine is also known by the brand names DHC Continus and DF118 Forte.

• Dihydrocodeine works by stopping pain signals travelling along the nerves to the brain.
• Standard dihydrocodeine tablets take 1.5 to 2 hours to work fully.
• It's possible to become addicted to dihydrocodeine, but this is rare if you're taking it to relieve pain and you're taking it as a doctor has prescribed.
• Dihydrocodeine can cause withdrawal problems. Do not stop taking the medicine suddenly.
• The most common side effects are feeling or being sick, feeling drowsy or constipation.

Adults and children aged 4 years and over can take dihydrocodeine.

Dihydrocodeine is not suitable for some people. Tell a doctor before taking the medicine if you:

• have ever had an allergic reaction to dihydrocodeine or any other medicine
• have any stomach problems, such as irritable bowel syndrome (IBS) or Crohn's disease, or if you're taking medicines for these conditions
• have lung problems, asthma or breathing difficulties
• have a head injury or a condition that causes seizures or fits
• have an underactive thyroid gland (hypothyroidism)
• have an addiction to alcohol
• take any other painkillers (including those you buy from a pharmacy or supermarket)
• have liver or kidney problems
• have myasthenia gravis, a rare illness that causes muscle weakness
• are trying to become pregnant, are already pregnant or are breastfeeding
• are under 18 years and have had your tonsils or adenoids taken out to treat obstructive sleep apnoea
• have a rare condition causing problems with galactose intolerance

It's important to take dihydrocodeine as your doctor has asked you to.

Swallow the tablets whole with water. It's best to take them with or soon after a meal or snack.

How much will I take?

Dihydrocodeine tablets come in 5 different strengths. The tablets contain 30mg, 40mg, 60mg, 90mg or 120mg of dihydrocodeine.

How often you take your tablets will depend on the strength:

• 30mg tablet – 2 tablets up to 4 times in 24 hours
• 40mg tablet – 1 or 2 tablets up to 3 times in 24 hours
• 60mg, 90mg and 120mg tablets – up to 2 tablets in 24 hours, leaving 12 hours between doses

For children aged 4 to 12 years the usual dose is 0.5mg (1mg per kg of body weight) usually up to 4 times in 24 hours.

Slow-release dihydrocodeine tablets come in 3 different strengths. The tablets contain 60mg, 90mg or 120mg of dihydrocodeine. The usual dose is between 60mg and 120mg, taken twice a day.

The usual dose of dihydrocodeine liquid is one to three 5ml spoonfuls up to 4 times in 24 hours. One 5ml spoonful has 10mg of dihydrocodeine in it (3 spoonfuls contains 30mg).

If you're taking dihydrocodeine as a liquid, it will come with a plastic medicine spoon or syringe to help you measure the correct amount. Ask a pharmacist for one if you do not have it.

Do not measure the liquid with a kitchen teaspoon because it will not give the right amount.

Will my dose go up or down?

Usually you'll start on a low dose of standard dihydrocodeine. Your doctor may increase this gradually until your pain is well controlled.

What if I forget to take it?

This will vary depending on which type of dihydrocodeine you're taking.

If you forget to take a dose, check the patient information leaflet inside the packet or ask a pharmacist or doctor for advice on what to do.

Never take 2 doses at the same time to make up for a forgotten one.

If you often forget doses, it may help to set an alarm to remind you. You could also ask a pharmacist for advice on other ways to remember to take your medicine.

What if I take too much?

If you go to A&E, do not drive yourself – get someone else to drive you or call for an ambulance.

Take the dihydrocodeine box or leaflet inside the packet plus any remaining medicine with you.

Where to store dihydrocodeine

If you're prescribed dihydrocodeine, it's really important that you:

• store it properly and safely at home
• keep it out of the sight and reach of children
• do not give your medicine to anyone else
• return any unused dihydrocodeine to a pharmacy so they can throw it away in the right way

It's safe to take dihydrocodeine with paracetamol, ibuprofen or aspirin (do not give aspirin to children under 16 years of age).

Do not take dihydrocodeine with painkillers that contain codeine. You will be more likely to get side effects.

Painkillers that contain codeine include co-codamol (codeine and paracetamol), Nurofen Plus (codeine and ibuprofen), co-codaprin (codeine and aspirin) and Solpadeine (codeine, paracetamol, ibuprofen and caffeine).

Like all medicines, dihydrocodeine can cause side effects in some people, but many people have no side effects or only minor ones.

You're more likely to have side effects if you take the higher strengths of dihydrocodeine.

Common side effects

Common side effects happen in more than 1 in 100 people. Talk to a doctor or pharmacist if the side effects bother you or do not go away:

• constipation
• feeling or being sick (nausea or vomiting)
• feeling sleepy
• confusion, feeling dizzy and vertigo (a sensation of spinning)
• dry mouth
• headaches

Serious side effects

Serious side effects happen in less than 1 in 100 people. Call a doctor straight away if you get any of the following:

• muscle stiffness
• feel dizzy, tired and have low energy – this could be a sign of low blood pressure (hypotension)

Serious allergic reaction

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to dihydrocodeine.

These are not all the side effects of dihydrocodeine. For a full list see the leaflet inside your medicine packet.

What to do about:

• feeling or being sick – take dihydrocodeine with or just after a meal or snack to ease feelings of sickness. If you're being sick, try small frequent sips of water. This side effect should wear off after a few days. Talk to a doctor about taking an anti-sickness medicine if it carries on for longer.
• feeling sleepy – this side effect should go away within a few days as your body gets used to dihydrocodeine. Talk to a doctor if it carries on for longer.
• confusion, feeling dizzy and vertigo – if dihydrocodeine makes you feel dizzy when you stand up, try getting up very slowly or stay sitting down until you feel better. If you begin to feel dizzy, lie down so that you do not faint, then sit until you feel better. This side effect should wear off within a few days as your body gets used to dihydrocodeine. Talk to a doctor if it carries on for longer.
• dry mouth – try chewing sugar-free gum or sucking sugar-free sweets. A doctor can also prescribe an artificial saliva substitute to keep your mouth moist. This comes as a spray, gel or lozenge.
• headaches – it's safe to take a painkiller such as paracetamol or ibuprofen. Talk to a doctor if headaches last longer than a week or are severe.

Dihydrocodeine is generally not recommended during pregnancy or breastfeeding. There may be safer medicines that you can take – ask a doctor or pharmacist for advice.

In early pregnancy, it's been linked to some problems for your baby. If you take dihydrocodeine at the end of pregnancy there's a risk that your baby may get withdrawal symptoms or be addicted to dihydrocodeine when they're born.

However, it's important to treat pain in pregnancy. For some pregnant women with severe pain, dihydrocodeine might be the right option. Your doctor is the best person to help you decide what's right for you and your baby.

Dihydrocodeine and breastfeeding

Dihydrocodeine is not usually recommended if you're breastfeeding.

Small amounts of dihydrocodeine pass into breast milk and can cause breathing problems in your baby.

Speak to a doctor as they may be able to recommend a different painkiller.

Some medicines interfere with the way dihydrocodeine works.

Tell a doctor if you're taking these medicines before you start taking dihydrocodeine:

• sleeping pills or tranquillisers
• medicines for depression or other mental health problems
• medicines to stop you feeling sick or vomiting, such as domperidone or metoclopramide
• antihistamines or hay fever tablets
• medicines to treat anxiety

Mixing dihydrocodeine with herbal remedies and supplements

It's not possible to say that dihydrocodeine is safe to take with herbal remedies and supplements. They're not tested for the effect they have on other medicines in the same way pharmacy and prescription medicines are.