Adult: Up to 50 mg 4-6 hourly via IM or SC inj. Elderly: Dose reduction may be needed. Child: ≥4 years 0.5-1 mg/kg 4-6 hourly via deep SC or IM inj.
Oral Moderate to severe pain
Adult: As 30 mg conventional tab: 30 mg 4-6 hourly. Elderly: Dose reduction may be needed. Child: As 30 mg conventional tab: 4-12 years 0.5-1 mg/kg (Max: 30 mg) 4-6 hourly; >12 years Same as adult dose. Dosage, age range of use, or treatment recommendations may vary among individual products and between countries (refer to detailed product guidelines).
Oral Non-productive cough
Adult: As 9.5 mg/5 mL oral solution: 5-10 mL 4-6 hourly. Elderly: Dose reduction may be needed. Child: As 9.5 mg/5 mL oral solution: 6-11 years 2.5-5 mL 4-6 hourly; ≥12 years Same as adult dose. Dosage, age range of use, or treatment recommendations may vary among individual products and between countries (refer to detailed product guidelines).
Oral Chronic pain, Severe pain
Adult: As 40 mg conventional tab: 40-80 mg tid. Max: 240 mg daily. As modified-release tab: 60-120 mg 12 hourly. Max: 240 mg daily. Elderly: Dose reduction may be needed. Child: >12 years As 40 mg conventional tab or modified-release tab: Same as adult dose.
What are the brands available for Dihydrocodeine in Malaysia?
Acute asthma attack, severe bronchial asthma, respiratory depression, obstructive airway disease, severe cor pulmonale; head injury, increased intracranial pressure, coma; acute alcoholism, known or at risk of paralytic ileus. Concurrent use or within 14 days of discontinuing MAOIs.
Special Precautions
Patient with asthma, cor pulmonale, decreased respiratory reserve; adrenocortical insufficiency (including Addison's disease), thyroid dysfunction (e.g. hypothyroidism), biliary tract dysfunction (including pancreatitis); inflammatory or obstructive bowel disorders, constipation; prostatic hyperplasia, urethral stricture; hypotension, shock, myasthenia gravis; seizure disorders, current or history of mental health conditions (e.g. anxiety disorders, depression, PTSD), current or history of substance use disorders; sleep apnoea, risk factors for sleep-related breathing disorders (e.g. heart failure, obesity). Debilitated patients. Not recommended as the 1st-line treatment for chronic pain management. Concomitant use with sedatives, including benzodiazepines or other CNS depressants. Avoid abrupt withdrawal. Renal and hepatic impairment. Children and elderly. Pregnancy and lactation.
Adverse Reactions
Significant: CNS depression; sleep-related breathing disorders (e.g. central sleep apnoea, sleep-related hypoxaemia) or worsening of pre-existing sleep apnoea; hyperalgesia; constipation, sphincter of Oddi constriction; suppressed mucociliary reflex (for doses >10 mg tid); may cause hypogonadism and hyperprolactinaemia (prolonged use); drug tolerance, psychological and physical dependence (prolonged use); withdrawal symptoms (after abrupt discontinuation). Cardiac disorders: Bradycardia, palpitations, tachycardia. Ear and labyrinth disorders: Vertigo. Eye disorders: Blurred vision, miosis. Gastrointestinal disorders: Abdominal pain, dry mouth, nausea, vomiting. General disorders and administration site conditions: Fatigue, malaise, oedema. Hepatobiliary disorders: Biliary colic. Nervous system disorders: Headache, dizziness, drowsiness, paraesthesia. Psychiatric disorders: Confusion, mood changes, hallucinations, euphoria, dysphoria. Renal and urinary disorders: Urinary retention. Reproductive system and breast disorders: Sexual dysfunction, decreased libido. Respiratory, thoracic and mediastinal disorders: Dyspnoea. Skin and subcutaneous tissue disorders: Rash, pruritus, sweating, urticaria. Vascular disorders: Hypotension, syncope, flushing. Potentially Fatal: Serious respiratory depression.
Patient Counseling Information
This drug may cause dizziness, drowsiness and visual disturbances, if affected, do not drive or operate machinery.
Monitoring Parameters
Monitor respiratory and mental status, pain relief, blood pressure and heart rate. Closely monitor for signs of drug misuse/abuse and respiratory depression (particularly when starting treatment and during dose escalation). Assess for signs of hypogonadism or hypoadrenalism.
Overdosage
Symptoms: Pin-point pupils, nausea, vomiting, CNS depression, somnolence progressing to stupor, and respiratory depression. Hypotension and tachycardia may also occur. Management: Symptomatic and supportive treatment. If an overdose presents within 1 hour of ingestion, consider activated charcoal administration. Ensure the airway is clear and monitor vital signs. For respiratory depression or coma, give naloxone via IV or SC inj, then repeat every 2-3 minutes as needed.
Drug Interactions
May antagonise the gastrointestinal effects of domperidone and metoclopramide. May delay the absorption of mexiletine. Metabolism may be inhibited by cimetidine. Additive hypotensive effects with antihypertensive agents. Potentially Fatal: Increased risk of profound sedation, respiratory depression and coma with sedatives, including benzodiazepines or other CNS depressants (e.g. anaesthetics, antipsychotics, TCAs, sedating antihistamines, anxiolytics, hypnotics). Increased risk of serotonin syndrome with MAOIs or other serotonergic agents (e.g. SSRIs, SNRIs, triptans, TCAs). May result in severe CNS excitation or depression with MAOIs.
Food Interaction
Enhanced sedative and respiratory depressive effects with alcohol.
Action
Description: Mechanism of Action: Dihydrocodeine is an opioid analgesic. It binds to opiate receptors in the CNS, thereby inhibiting the ascending pain pathways and altering the perception and response to pain. Additionally, it exhibits its antitussive effects through the direct activity on receptors in the cough centre of the medulla. Onset: Analgesia: 30 minutes (conventional tab). Duration: Analgesia: 4 hours (SC). Pharmacokinetics: Absorption: Well absorbed from the gastrointestinal tract. Bioavailability: Approx 20%. Time to peak plasma concentration: Approx 1.6-1.8 hours (conventional tab). Metabolism: Metabolised in the liver via O-demethylation primarily by CYP2D6 into dihydromorphine (active metabolite), N-demethylation mainly by CYP3A4 to form nordihydrocodeine, and via 6-keto reduction. Undergoes extensive first-pass metabolism. Excretion: Mainly via urine (as unchanged drug and metabolites). Elimination half-life: 3.5-5 hours (conventional tab).
Chemical Structure
Dihydrocodeine Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 5284543, Dihydrocodeine. https://pubchem.ncbi.nlm.nih.gov/compound/Dihydrocodeine. Accessed June 27, 2025.
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