Dihydrocodeine is a semi-synthetic opioid that’s derived from codeine. It’s most commonly prescribed for the treatment of mild to moderate pain. Dihydrocodeine is also effective at reducing coughing and pain associated with shortness of breath.
Several formulas of dihydrocodeine exist that combine it with over-the-counter pain relievers such as acetaminophen, ibuprofen, and aspirin. Caffeine is included in select formulas. Formulas such as these are manufactured specifically for pain reduction. Doses for mild to moderate pain include 15 mg and 30 mg dihydrocodeine tablets. Controlled release versions are also available that contain 60 mg to 120 mg.
Select dihydrocodeine products include antihistamines. Antihistamines can reduce side effects like itchiness and flushed skin that are common with dihydrocodeine and codeine use. In addition to oral tablets, dihydrocodeine comes in sublingual drops, liquid elixirs, and powder forms. Injectable dihydrocodeine should be administered with caution due to its potential for a life-threatening allergic reaction.
Dihydrocodeine is roughly twice as powerful as codeine. The Federal Drug Administration classifies dihydrocodeine as a Schedule II substance due to its highly addictive potential. Dihydrocodeine misuse and abuse is a contributing factor to the opioid overdose epidemic that began in the late 1990s and has continued through to today.
Preparations of dihydrocodeine that contain small amounts of the drug and higher quantities of anti-inflammatories may be classified as Schedule III or Schedule V substances, depending on the level of dihydrocodeine content.
Dihydrocodeine is commonly taken with hydroxyzine, carisoprodol, and first-generation antihistamines. These substances decrease undesirable histamine reactions like itchy skin. At the same time, they intensify dihydrocodeine’s effects by optimizing the metabolism of the drug.
Dihydrocodeine is often abused recreationally due to the euphoric high that can result from using high doses of the drug. The high end of a standard dihydrocodeine dose is 30 mg for immediate-release oral tablets. People who abuse the drug recreationally often take between 70 mg to 500 mg at one time in order to achieve the desired effects.
Dihydrocodeine achieves its pain-relieving effects by binding to opioid receptors in the body. By binding to these receptors, the drug activates them and reduces the patient’s perception of pain. Due to the histamine release that’s triggered by the drug, dihydromorphine typically causes the skin to become itchy and flushed.
Other side effects of dihydrocodeine can include headaches, difficulty breathing, and constipation. Constipation is a common side effect of nearly all opioids. This is because opioids like dihydrocodeine slow the activity of smooth muscles in the digestive tract. In fact, in cases of chronic diarrhea, opioids like morphine or dihydrocodeine are given as a last resort to inhibit bowel movements.
Dihydrocodeine is well absorbed when taken orally, reaching peak plasma levels within two hours of ingestion. The mean elimination half-life of dihydrocodeine is four hours. Roughly 90% of the drug and its metabolites are eliminated from the body within the first 24 hours. The remaining 10% remains at testable levels in the body for up to four days.
Several factors influence how long dihydrocodeine stays the body. These include the patient’s metabolism, size, age, opioid tolerance, liver, and kidney health. High doses of dihydrocodeine typically take longer to eliminate than low doses. The patient’s frequency of use plays a role as well, with higher frequency correlating to longer clearance times. Doses that are administered intravenously have both a faster onset and faster clearance time.
Short-lasting opioids like dihydrocodeine are only detectable in the urine for roughly three days following the time of ingestion. Clearance times can be longer for patients with poorly functioning liver and kidneys, or for those who take the drug frequently and at high doses. Blood plasma clearance times for dihydrocodeine are approximately 300 ml/min. Typical opioids break down into morphine in the body, which is then tested for in the urine. Dihydromorphine does not break down into morphine and, therefore, does not test positive in standard opiate urine tests.
If you or someone you love is dealing with opioid misuse or abuse, The Recovery Village is available to answer any questions you may have. You can visit us online at www.TheRecoveryVillage.com or call toll-free at 855-548-9825 to learn more.
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