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Opioid analgesic (weak opioid, codeine analogue) Pregnancy: SPC §4.6, verbatim: '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... Administration during labour may depress respiration in the neonate and an antidote for the child should be readily available.' Breastfeeding: '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 tartrate

Brand names: DF118 Forte, DHC Continus

Dihydrocodeine tartrate is a weak opioid analgesic used for moderate-to-severe pain, broadly comparable to codeine.

Adult dose

Dose: 120 mg every 12 hours (one 120 mg prolonged-release tablet 12-hourly)
Route: Oral — prolonged-release tablets. SPC §4.2: 'Method of administration Oral.'
Frequency: Every 12 hours
SCOPE: oral PROLONGED-RELEASE tablets for pain only. The fetched SPC contains no immediate-release regimen and no IM or SC regimen. Verbatim §4.2: 'Adults and children over 12 years: The usual dose is one tablet 12-hourly. Elderly: Dosage should be reduced. Prior to starting treatment with opioids, a discussion should be held with patients to put in place a strategy for ending treatment with dihydrocodeine in order to minimise the risk of addiction and drug withdrawal syndrome (see section 4.4).' The tablet strength is pinned by the product title (120 mg prolonged-release tablets). No maximum daily dose appears anywhere in the fetched SPC, so maxDose is left empty rather than inferred. §4.4, bearing directly on prescribing: 'Do not use for acute post-operative pain owing to the increased risk of persistent post-operative opioid use (PPOU) and opioid-induced ventilatory impairment (OIVI)'; and for concomitant benzodiazepines/sedatives, 'the lowest effective dose should be used, and the duration of treatment should be as short as possible'.

Paediatric dose

Route: Oral
Frequency: Every 12 hours (over 12 years only)
No mg/kg dosing exists anywhere in the fetched SPC, so dosePerKg is null and no weight-based calculation is possible. Verbatim §4.2: 'Adults and children over 12 years: The usual dose is one tablet 12-hourly' (120 mg 12-hourly for this presentation); 'Paediatric population Children 12 years or under: Not recommended.' §4.8: 'Neonatal respiratory depression and withdrawal symptoms may occur in the newborn of mothers undergoing treatment with dihydrocodeine.' Verify any paediatric opioid dose against a children's formulary before prescribing.

Dose adjustments

Renal

No numeric renal adjustment in the fetched SPC. §4.4 lists 'severe renal dysfunction' among conditions requiring caution; §4.2 states only 'Elderly: Dosage should be reduced'.

Hepatic

No numeric hepatic adjustment in the fetched SPC. §4.4 lists 'impairment of hepatic function' among conditions requiring caution.

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Hypersensitivity to the active substance or to any of the excipients (§4.3)
  • Severe respiratory depression with hypoxia (§4.3)
  • Severe chronic obstructive lung disease (§4.3)
  • Severe cor pulmonale (§4.3)
  • Severe bronchial asthma; dihydrocodeine may cause the release of histamine, so 'it should not be given during an asthma attack' (§4.3)
  • Paralytic ileus (§4.3)
  • Acute alcoholism (§4.3)
  • Rare hereditary problems of galactose intolerance, total lactase deficiency or glucose-galactose malabsorption (excipient-related, §4.3)

Side effects

  • Common (>=1%) per §4.8: somnolence, dizziness, headache, constipation, dry mouth, nausea, vomiting, abdominal pain
  • Uncommon (<1%) per §4.8: confusional state, hallucination, mood altered, dysphoria, convulsions, paraesthesia, sedation, blurred vision, vertigo, hypotension, flushing, dyspnoea, diarrhoea, biliary colic, hepatic enzymes increased, hyperhidrosis, pruritus, rash, urticaria, urinary retention, uretic spasm, decreased libido, asthenia, fatigue, malaise
  • Respiratory depression — §4.4: 'The primary risk of opioid excess is respiratory depression'
  • Sleep apnoea syndrome, including central sleep apnoea and sleep-related hypoxaemia; worsening of pre-existing sleep apnoea (§4.4, §4.8)
  • Drug dependence (addiction), drug tolerance, drug withdrawal syndrome and neonatal drug withdrawal syndrome (§4.8)
  • Paralytic ileus (§4.8)
  • Angioedema (§4.8)
  • Medication-overuse headache — §4.8: 'Prolonged use of a painkiller for headaches can make them worse'

Monitoring

  • Respiratory depression and sedation — §4.4: 'The patients should be followed closely for signs and symptoms of respiratory depression and sedation'; inform patients and carers of these symptoms
  • Central sleep apnoea — §4.4: 'In patients who present with CSA, consider decreasing the total opioid dosage'
  • Dependence, tolerance and misuse risk; §4.4 advises a comprehensive medication, medical and psychiatric history before starting, with additional support and monitoring for patients at risk of opioid misuse
  • An agreed plan for ending treatment, discussed before the first dose (§4.2)
  • Neonates of mothers treated during pregnancy — monitor for respiratory depression (§4.6)

Clinical monograph

How it works

It is a mu-opioid receptor agonist that is partly metabolised by CYP2D6 to dihydromorphine; the relative analgesic contribution of the parent drug and this metabolite is not fully established.

Prescribing in practice

  • As an opioid it can cause respiratory depression, dependence, tolerance and constipation, with additive central nervous system depression alongside alcohol, benzodiazepines and other sedatives.
  • Reduce the dose and use caution in the elderly, in hepatic or renal impairment, and in respiratory disease such as COPD.
  • Tolerance and dependence develop with prolonged use, so it should be prescribed for the shortest effective duration.

Monitoring

Monitor pain control, sedation, respiratory status and bowel function, with review for dependence during longer-term use.

Counselling the patient

  • Do not exceed the prescribed dose and avoid alcohol and other sedating medicines.
  • Manage constipation with fluids, fibre or a laxative.
  • Do not drive if you feel drowsy and report slow or shallow breathing.

Evidence & guidelines

Dihydrocodeine is an established opioid for moderate pain; guidance advises cautious, time-limited prescribing because of dependence risk.

Reference: FPM Opioids Aware; NICE NG193; NICE NG140; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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