Drug reference

Dihydrocodeine with paracetamol

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 500

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

Mild to moderate pain (using 10/500 preparations only) ▶BY MOUTH ▶Adult: 10/500–20/1000 mg every 4–6 hours as required; maximum 80/4000 mg per day Severe pain (using 20/500 preparations only) ▶BY MOUTH ▶Adult: 20/500–40/1000 mg every 4–6 hours as required; maximum 160/4000 mg per day Severe pain (using 30/500 preparations only) ▶BY MOUTH ▶Adult: 30/500–60/1000 mg every 4–6 hours as required; maximum 240/4000 mg per day DOSE EQUIVALENCE AND CONVERSION ▶A mixture of dihydrocodeine tartrate and paracetamol; the proportions are expressed in the form x/y, where x and y are the strengths in milligrams of dihydrocodeine and paracetamol respectively.

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Cautions

Alcohol dependence. before administering, check when paracetamol last administered and cumulative paracetamol dose over previous 24 hours. chronic alcoholism. chronic dehydration. chronic malnutrition. hepatocellular insufﬁciency. pancreatitis. severe cor pulmonale

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Prescribing And Dispensing Information

The MHRA advises when prescribing dihydrocodeine with paracetamol, the tablet strength and dose must be clearly indicated; when dispensing dihydrocodeine with paracetamol, ensure the prescribed strength is supplied— contact the prescriber if in doubt. The BP deﬁnes Co-dydramol Tablets as containing dihydrocodeine tartrate 10 mg and paracetamol 500 mg. l LESS SUITABLE FOR PRESCRIBING Dihydrocodeine with paracetamol is less suitable for prescribing.

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Safety

Important Safety Information

MHRA/CHM ADVICE: DIHYDROCODEINE WITH PARACETAMOL (CO- DYDRAMOL): PRESCRIBE AND DISPENSE BY STRENGTH TO MINIMISE RISK OF MEDICATION ERROR (JANUARY 2018) The MHRA has advised that dihydrocodeine with paracetamol preparations are prescribed and dispensed by strength to minimise dispensing errors and the risk of accidental opioid overdose—see Prescribing and dispensing information.

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Interactions

→Appendix 1: opioids. paracetamol

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Side Effects

Abdominal pain. blood disorder. leucopenia. malaise. neutropenia. pancreatitis. paraesthesia. paralytic ileus. severe cutaneous adverse reactions (SCARs). thrombocytopenia Overdose Liver damage (and less frequently renal damage) following overdosage with paracetamol.

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Breast Feeding

Amount of dihydrocodeine too small to be harmful but use only if potential beneﬁt outweighs risk.

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Hepatic Impairment

Manufacturer advises consider avoiding in mild to moderate impairment; avoid in severe impairment. Dose adjustments Manufacturer advises dose reduction in mild to moderate impairment, if used.

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Renal Impairment

Reduce dose or avoid dihydrocodeine; increased and prolonged effect; increased cerebral sensitivity.

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Dose and formulations

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 Tablet CAUTIONARY AND ADVISORY LABELS 2, 29, 30 ▶Dihydrocodeine with paracetamol (Non-proprietary) Dihydrocodeine tartrate 10 mg, Paracetamol 500 mg Co- dydramol 10mg/500mg tablets | 30 tablet P £2.40 DT = £1.21 m | 100 tablet P £8.00 DT = £4.03 m | 500 tablet P £20.15 m Dihydrocodeine tartrate 20 mg, Paracetamol 500 mg Co- dydramol 20mg/500mg tablets | 56 tablet P £5.87–£6.55 m | 112 tablet P £13.10 DT = £13.10 m Dihydrocodeine tartrate 30 mg, Paracetamol 500 mg Co- dydramol 30mg/500mg tablets | 56 tablet P £12.46 DT = £12.46 m ▶Eroset (M & A Pharmachem Ltd) Dihydrocodeine tartrate 10 mg, Paracetamol 500 mg Eroset 500mg/10mg tablets | 30 tablet P £0.68 DT = £1.21 m | 100 tablet P £1.91 DT = £4.03 m ▶Paramol (SSL International Plc) Dihydrocodeine tartrate 7.46 mg, Paracetamol 500 mg Paramol tablets | 12 tablet p £2.45 m | 24 tablet p £4.20 m | 32 tablet p £4.85 m ▶Remedeine (Crescent Pharma Ltd) Dihydrocodeine tartrate 20 mg, Paracetamol 500 mg Remedeine tablets | 56 tablet P £5.87 m | 112 tablet P £11.13 DT = £13.10 m Dihydrocodeine tartrate 30 mg, Paracetamol 500 mg Remedeine Forte tablets | 56 tablet P £6.82 DT = £12.46 m eiiii F 467

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Dose text by age group

Adult

10/500–20/1000 mg every 4–6 hours as required;

First-line fragment. Read the complete Indications and Dose section above.

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Adult

20/500–40/1000 mg every 4–6 hours as required;

First-line fragment. Read the complete Indications and Dose section above.

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Adult

30/500–60/1000 mg every 4–6 hours as required;

First-line fragment. Read the complete Indications and Dose section above.

PDF page 500

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.

Drug reference

Dihydrocodeine with paracetamol

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 500

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

PDF page 500

Cautions

PDF page 500

Prescribing And Dispensing Information

PDF page 500

Safety

Important Safety Information

PDF page 500

Interactions

→Appendix 1: opioids. paracetamol

PDF page 500

Side Effects

PDF page 500

Breast Feeding

Amount of dihydrocodeine too small to be harmful but use only if potential beneﬁt outweighs risk.

PDF page 500

Hepatic Impairment

Manufacturer advises consider avoiding in mild to moderate impairment; avoid in severe impairment. Dose adjustments Manufacturer advises dose reduction in mild to moderate impairment, if used.

PDF page 500

Renal Impairment

Reduce dose or avoid dihydrocodeine; increased and prolonged effect; increased cerebral sensitivity.

PDF page 500

Dose and formulations

Medicinal Forms

PDF page 500

Dose text by age group

Adult

10/500–20/1000 mg every 4–6 hours as required;

First-line fragment. Read the complete Indications and Dose section above.

PDF page 500

Adult

20/500–40/1000 mg every 4–6 hours as required;

First-line fragment. Read the complete Indications and Dose section above.

PDF page 500

Adult

30/500–60/1000 mg every 4–6 hours as required;

First-line fragment. Read the complete Indications and Dose section above.

PDF page 500

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.