Dihydrocodeine tartrate | Drugs | BNF content published by NICE (2023)

Indications and dose


For dihydrocodeine tartrate

Moderate to severe pain for dihydrocodeine tartrate

By mouth using immediate-release medicines

Child 4–11 years
0.5–1mg/kg every 4–6hours (max. per dose 30mg).

Child 12–17 years
30mg every 4–6hours.

30mg every 4–6hours as required.
By deep subcutaneous injection, or by intramuscular injection

Up to 50mg every 4–6hours if required.

Chronic severe pain for dihydrocodeine tartrate

By mouth using modified-release medicines

Child 12–17 years
60–120mg every 12hours.

60–120mg every 12hours.

For DF118 Forte®

Severe pain for DF118 Forte®

By mouth

Child 12–17 years
40–80mg 3 times a day; maximum 240mg per day.

40–80mg 3 times a day; maximum 240mg per day.

Unlicensed use

Unlicensed use For dihydrocodeine tartrate

In children:

Most preparations not licensed for use in children under 4 years.

Important safety information

Important safety information For all opioids

MHRA/CHM advice: Benzodiazepines and opioids: reminder of risk of potentially fatal respiratory depression (March 2020)

The MHRA reminds healthcare professionals that opioids co-prescribed with benzodiazepines and benzodiazepine-like drugs can produce additive CNS depressant effects, thereby increasing the risk of sedation, respiratory depression, coma, and death. Healthcare professionals are advised to only co-prescribe if there is no alternative and, if necessary, the lowest possible doses should be given for the shortest duration. Patients should be closely monitored for signs of respiratory depression at initiation of treatment and when there is any change in prescribing, such as dose adjustments or new interactions. If methadone is co-prescribed with a benzodiazepine or benzodiazepine-like drug, the respiratory depressant effect of methadone may be delayed; patients should be monitored for at least 2 weeks after initiation or changes in prescribing. Patients should be informed of the signs and symptoms of respiratory depression and sedation, and advised to seek urgent medical attention should these occur.

MHRA/CHM advice: Opioids: risk of dependence and addiction (September 2020)

New safety recommendations have been issued following a review of the risks of dependence and addiction associated with prolonged use (longer than 3 months) of opioids for non-malignant pain.

Healthcare professionals are advised to:

  • discuss with patients that prolonged use of opioids, even at therapeutic doses, may lead to dependence and addiction;
  • agree a treatment strategy and plan for end of treatment with the patient before starting opioids;
  • counsel patients and their carers on the risks of tolerance and potentially fatal unintentional overdose, as well as signs and symptoms of overdose;
  • provide regular monitoring and support to patients at increased risk, such as those with current or history of substance use disorder (including alcohol misuse) or mental health disorders;
  • taper dosage slowly at the end of treatment to reduce the risk of withdrawal effects associated with abrupt discontinuation (tapering high doses may take weeks or months);
  • consider hyperalgesia in patients on long-term opioid treatment who present with increased pain sensitivity;
  • consult product literature for the latest advice and warnings for opioid use during pregnancy (see also Pregnancy).

The MHRA has also issued a safety leaflet for patients—see Patient and carer advice.

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Contra-indications For all opioids

Acute respiratory depression; comatose patients; head injury (opioid analgesics interfere with pupillary responses vital for neurological assessment); raised intracranial pressure (opioid analgesics interfere with pupillary responses vital for neurological assessment); risk of paralytic ileus


Cautions For all opioids

Adrenocortical insufficiency (reduced dose is recommended); asthma (avoid during an acute attack); central sleep apnoea; convulsive disorders; current or history of mental health disorder; current or history of substance use disorder; debilitated patients (reduced dose is recommended) (in adults); diseases of the biliary tract; elderly (reduced dose is recommended) (in adults); hypotension; hypothyroidism (reduced dose is recommended); impaired respiratory function (avoid in chronic obstructive pulmonary disease); inflammatory bowel disorders; myasthenia gravis; obstructive bowel disorders; prostatic hypertrophy (in adults); shock; urethral stenosis

Cautions, further information

Dependence and addiction

Prolonged use of opioid analgesics may lead to drug dependence and addiction, even at therapeutic doses. There is an increased risk in individuals with current or history of substance use disorder or mental health disorders. See also Important safety information.

Central sleep apnoea

Opioids cause a dose-dependent increased risk of central sleep apnoea, consider total opioid dose reduction. M

Palliative care

In the control of pain in terminal illness, the cautions listed should not necessarily be a deterrent to the use of opioid analgesics. M

(Video) This Is What Happens to Your Brain on Opioids | Short Film Showcase

In adults:

Prescription potentially inappropriate (STOPP criteria):

  • if prescribed a strong, oral or transdermal opioid (i.e. morphine, oxycodone, fentanyl, buprenorphine, diamorphine, methadone, tramadol, pethidine, pentazocine) as first-line therapy for mild pain (WHO analgesic ladder not observed)
  • if used regularly without concomitant laxative (risk of severe constipation)
  • if prescribed a long-acting (modified-release) opioid without a short-acting (immediate-release) opioid for breakthrough pain (risk of persistence of severe pain)

See also Prescribing in the elderly.

Cautions For dihydrocodeine tartrate

Pancreatitis; severe cor pulmonale


View interactions for dihydrocodeine


Side-effects For all opioids

Common or very common

Arrhythmias; confusion; constipation; dizziness; drowsiness; dry mouth; euphoric mood; flushing; hallucination; headache; hyperhidrosis; miosis; nausea (more common on initiation); palpitations; respiratory depression (with high doses); skin reactions; urinary retention; vertigo; vomiting (more common on initiation); withdrawal syndrome


Drug dependence; dysphoria

Side-effects, further information

Respiratory depression

Respiratory depression is a major concern with opioid analgesics and it may be treated by artificial ventilation or be reversed by naloxone.

Dependence, addiction, and withdrawal

Long term use of opioids in non-malignant pain (longer than 3 months) carries an increased risk of dependence and addiction, even at therapeutic doses. At the end of treatment the dosage should be tapered slowly to reduce the risk of withdrawal effects; tapering from a high dose may take weeks or months. See also Important safety information.

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Opioids (narcotic analgesics) cause coma, respiratory depression, and pinpoint pupils. For details on the management of poisoning, see Opioids, under Emergency treatment of poisoning and consider the specific antidote, naloxone hydrochloride.

Side-effects For dihydrocodeine tartrate

General side-effects:

Frequency not known

Dysuria; mood altered; postural hypotension

Specific side-effects:

Frequency not known

With oral use

Biliary spasm; bronchospasm; hypothermia; sexual dysfunction; ureteral spasm


Pregnancy For all opioids

Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour.

Breast feeding

Breast feeding For dihydrocodeine tartrate

Specialist sources indicate caution—use the lowest effective dose for the shortest possible duration; monitor infant for adverse effects, including sedation, breathing difficulties, constipation, difficulty feeding and poor weight gain.

Hepatic impairment

Hepatic impairment For dihydrocodeine tartrate

Manufacturer advises caution; consider avoiding.

Dose adjustments

Manufacturer advises dose reduction, if used.

Renal impairment

Renal impairment For dihydrocodeine tartrate

Avoid use or reduce dose; opioid effects increased and prolonged and increased cerebral sensitivity occurs.

Treatment cessation

Treatment cessation For all opioids

Avoid abrupt withdrawal after long-term treatment; they should be withdrawn gradually to avoid abstinence symptoms.

(Video) Opioid Withdrawal: How Long Does Detox Last?

Prescribing and dispensing information

Prescribing and dispensing information For all opioids

The Faculty of Pain Medicine has produced resources for healthcare professionals around opioid prescribing:http://www.fpm.ac.uk/faculty-of-pain-medicine/opioids-aware

Patient and carer advice

Patient and carer advice For all opioids

MHRA safety leaflet: Opioid medicines and the risk of addiction


Driving and skilled tasks

Drowsiness may affect performance of skilled tasks (e.g. driving); effects of alcohol enhanced. Driving at the start of therapy with opioid analgesics, and following dose changes, should be avoided.

For information on 2015 legislation regarding driving whilst taking certain controlled drugs, including opioids, see Drugs and driving under Guidance on prescribing.

Profession specific information

Profession specific information For dihydrocodeine tartrate

Dental practitioners' formulary

Dihydrocodeine tablets 30mg may be prescribed.

Medicinal forms

There can be variation in the licensing of different medicines containing the same drug.

Forms available from special-order manufacturers include: oral suspension, oral solution.

View all medicinal forms and pricinginformation

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Or jump straight to:

  • Tablet
  • Modified-release tablet
  • Oral solution
  1. Analgesics

Other drugs in class

Other drugs in classOpioids

  1. Alfentanil
  2. Aspirin with codeine
  3. Bupivacaine with fentanyl
  4. Buprenorphine
  5. Buprenorphine with naloxone
  6. Co-codamol
  7. Codeine phosphate
  8. Diamorphine hydrochloride
  9. Dihydrocodeine with paracetamol
  10. Dipipanone hydrochloride with cyclizine
  11. Fentanyl
  12. Hydromorphone hydrochloride
  13. Meptazinol
  14. Methadone hydrochloride
  15. Morphine
  16. Oxycodone hydrochloride
  17. Oxycodone with naloxone
  18. Paracetamol with buclizine hydrochloride and codeine phosphate
  19. Pentazocine
  20. Pethidine hydrochloride
  21. Remifentanil
  22. Tapentadol
  23. Tramadol hydrochloride
  24. Tramadol with dexketoprofen
  25. Tramadol with paracetamol


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