Dihydrocodeine with paracetamol

How it works

Dihydrocodeine is a mu-opioid receptor agonist providing central analgesia, while paracetamol contributes analgesic and antipyretic effects through poorly understood central mechanisms; the two act by complementary routes.

Prescribing in practice

• Because the product contains paracetamol, avoid concomitant paracetamol from other sources to prevent inadvertent overdose and hepatotoxicity.
• The opioid component carries risks of respiratory depression, constipation, dependence and tolerance, with additive sedation alongside alcohol and other CNS depressants.
• Use reduced doses and caution in the elderly and in hepatic or renal impairment, and prescribe for the shortest effective period.

Monitoring

Monitor pain control, sedation, bowel function and total daily paracetamol intake from all sources during use.

Counselling the patient

• Do not take any other paracetamol-containing products alongside this medicine.
• Avoid alcohol and report excessive drowsiness or slow breathing.
• Use measures to prevent constipation and do not exceed the stated dose.

Evidence & guidelines

Compound analgesics combining a weak opioid with paracetamol are recognised options for moderate pain when simple analgesia is insufficient.