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Dihydrocodeine tartrate.

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VOL: 101, ISSUE: 18, PAGE NO: 29

Generic/proprietary names

 

Generic/proprietary names
- Dihydrocodeine tartrate (tablets, oral solution, injection, cough syrup).

 

 

- DF118 (tablets).

 

 

- DHC Continus (modified-release tablets).

 

 

- Also an ingredient in some compound preparations.

 

 

Classification
- Legal: prescription-only medicine (tablets, oral solution); controlled drug (injection).

 

 

- Functional: narcotic analgesic.

 

 

Chemical: opioid.

 

 

Action
- Narcotic analgesic acting on opiate receptors in the central nervous system. Inhibits pain pathways, increasing pain threshold and lessening the perception of pain.

 

 

Indications
- Moderate to severe pain.

 

 

- Syrup for suppressing cough in palliative care.

 

 

Contraindications

 

 

- Respiratory depression.

 

 

- Head injury.

 

 

- Raised intracranial pressure.

 

 

- Acute alcoholism.

 

 

- Risk of paralytic ileus.

 

 

Cautions
- History of drug misuse.

 

 

- Asthma.

 

 

- Pregnancy, childbirth, lactation.

 

 

- Hypothyroidism.

 

 

- Hypotension.

 

 

- Renal impairment.

 

 

- Liver damage.

 

 

- Consider reducing dose for older or debilitated patients.

 

 

- Dihydrocodeine is not recommended for children under four years; DF118 and DHC Continus are not recommended for any children.

 

 

Side-effects
- Respiratory depression.

 

 

- Cough suppression.

 

 

- Exacerbation/precipitation of asthma.

 

 

- Drowsiness.

 

 

- Hallucinations.

 

 

- Altered mood.

 

 

- Nausea, vomiting (particularly in early stages).

 

 

- Constipation.

 

 

- Gastric irritation.

 

 

- Anorexia.

 

 

- Cramps.

 

 

- Dry mouth.

 

 

- Hypotension.

 

 

- Hypothermia.

 

 

- Palpitations.

 

 

- Bradycardia.

 

 

- Urinary retention.

 

 

- Tolerance, dependence.

 

 

- Decreased libido.

 

 

Interactions
- Risk of hypertensive crisis with monoamine oxidase inhibitors (MAOIs) or within 21 days of stopping them.

 

 

- Increased effects of hypnotics, other central nervous system depressants and alcohol.

 

 

Nursing considerations
- Assess pain to determine dosage, vital signs, level of consciousness, fluid balance.

 

 

- Administer with or after food, with anti-emetic if necessary.

 

 

- Provide fibre and fluids if patient becomes constipated.

 

 

- Evaluate the need for additional analgesics and the therapeutic response.

 

 

- Treatment of overdose: gastric lavage, intravenous naloxone, supportive treatment.

 

 

Patient teaching
- If affected by dizziness or drowsiness, do not drive or operate machinery.

 

 

- Take with food.

 

 

- Avoid alcohol.

 

 

- Explain possible side-effects and potential for dependence.

 

 

Nurses should refer to manufacturer’s summary of product characteristics and to appropriate local guidelines

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