Opioid analgesic (weak opioid, codeine analogue)
Dihydrocodeine tartrate
Brand names: DF118 Forte, DHC Continus
Adult dose
Dose: 30mg PO QDS PRN; MR 60–120mg BD
Route: Oral / IM / SC
Frequency: q4–6h
Clinical pearls
- Schedule 5 CD
- NICE NG193 chronic pain: routine use of opioids not recommended for chronic primary pain
- FPM Opioids Aware: lowest effective dose, shortest duration
- No evidence dihydrocodeine more effective than codeine
Contraindications
- Respiratory depression
- Acute alcoholism
- Head injury / raised ICP
- Paralytic ileus
- Acute abdomen
- Concurrent or recent MAOI
- Severe asthma exacerbation
Side effects
- Constipation
- Nausea/vomiting
- Sedation
- Respiratory depression
- Dependence/abuse
- Confusion (elderly)
Interactions
- CNS depressants (alcohol, benzodiazepines)
- MAOIs
- Other opioids
Monitoring
- Pain score
- Sedation
- Respiratory rate
- Bowel function
- Dependence
Reference: BNF; FPM Opioids Aware; NICE NG193; NICE NG140; https://bnf.nice.org.uk/drugs/dihydrocodeine-tartrate/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- Morphine Milligram Equivalents (MME) Calculator · Pain / Opioids
- Opioid Conversion / Equianalgesic Guide · Pain Management
- Numeric Rating Scale (NRS) Pain Assessment and Management · Pain Management
- Finnegan Neonatal Abstinence Scoring Tool (FNAST) · Neonatal Abstinence Syndrome
- Modified Finnegan Neonatal Abstinence Score (NAS) · Neonatal
- Withdrawal Assessment Tool (WAT-1) for Paediatric Iatrogenic Withdrawal · Critical Care
Pathways
- Sepsis Screening and Sepsis Six · UK Sepsis Trust; NICE NG51; Surviving Sepsis Campaign 2021
- Unintentional Weight Loss Workup · NICE NG12; BSG
- Chronic Fatigue Workup · NICE NG206; BMJ Best Practice
- Lymphadenopathy Workup · NICE NG12; BMJ Best Practice
- Pre-op Medical Clearance · NICE NG45; ESC 2022
- Secondary Hypertension Workup · NICE NG136; ESH 2023