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{{drugbox |
{{Cleanup|reason=significant portions of unreferenced, vague or incorrect information. Additionally, the areas that are cited are highly inappropriate citations.|date=August 2014}}
| IUPAC_name = 4,5-alpha-epoxy-3-methoxy-17-methyl-morphinan-6-ol
{{distinguish|hydrocodone|codeine}}
| image = Dihydrocodeine skeletal.svg
{{Drugbox
| Verifiedfields = changed
| Watchedfields = changed
| verifiedrevid = 464367349
| IUPAC_name = 4,5-alpha-epoxy-3-methoxy-17-methylmorphinan-6-ol
| image = Dihydrocodeine Wiki Str.png
 
| image2 = 220px-Dihydrocodeine3DanJ.gif
 
 
<!--Clinical data-->
| tradename = 
| Drugs.com = {{drugs.com|international|dihydrocodeine}}
| pregnancy_US = C
| legal_AU = S2
| legal_AU_comment = {{longitem|(S3) (S4) depending on dose and other constituents}}
| legal_CA = 
| legal_UK = Class B
| legal_US = Schedule II
| legal_status = 
| routes_of_administration = {{hlist |[[Oral administration|oral]] |[[Subcutaneous administration|subcutaneous]] |[[Intramuscular injection|intramuscular]] |[[Suppository|rectal]] |possibly&nbsp;[[Sublingual administration|sublingual]]{{\}}[[Buccal administration|buccal]]}}
<!--Pharmacokinetic data-->
| bioavailability = 20%<ref name="EurJClinPharmacol1983-Rowell">{{cite journal |author=Rowell F, Seymour R, Rawlins M |title=Pharmacokinetics of intravenous and oral dihydrocodeine and its acid metabolites |journal=Eur J Clin Pharmacol |volume=25 |issue=3 |pages=419–24 |year=1983 |pmid=6628531 |doi=10.1007/BF01037958}}</ref>
| metabolism = {{longitem|Mainly [[liver|hepatic]], through [[CYP3A4]] and [[CYP2D6]]}}
| elimination_half-life = 4 hours<ref name="EurJClinPharmacol1983-Rowell"/>
| excretion = 
<!--Identifiers-->
| CAS_number_Ref = {{cascite|changed|??}}
| CAS_number = 125-28-0
| CAS_number = 125-28-0
| ATC_prefix = N02  
| ATC_prefix = N02
| ATC_suffix = AA08  
| ATC_suffix = AA08
| PubChem = 6426647
| PubChem = 5284543
| DrugBank =  
| DrugBank_Ref = {{drugbankcite|correct|drugbank}}
| DrugBank = DB01551
| ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}}
| ChemSpiderID = 4447600
| UNII_Ref = {{fdacite|correct|FDA}}
| UNII = N9I9HDB855
| KEGG_Ref = {{keggcite|correct|kegg}}
| KEGG = D07831
| ChEMBL_Ref = {{ebicite|changed|EBI}}
| ChEMBL = 1595
<!--Chemical data-->
| C=18 | H=23 | N=1 | O=3  
| C=18 | H=23 | N=1 | O=3  
| molecular_weight = 301.38 g/mol
| molecular_weight = 301.38 g/mol
| bioavailability = 20%<ref name="EurJClinPharmacol1983-Rowell">{{cite journal | author=Rowell F, Seymour R, Rawlins M | title=Pharmacokinetics of intravenous and oral dihydrocodeine and its acid metabolites. | journal=Eur J Clin Pharmacol | volume=25 | issue=3 | pages=419-24 | year=1983 | id=PMID 6628531}}</ref>
| smiles = O[C@@H]1[C@@H]2OC3=C(OC)C=CC4=C3[C@@]2([C@H]5CC1)CCN(C)[C@@H]5C4
| metabolism = Mainly [[liver|hepatic]], through [[CYP3A4]] and [[CYP2D6]]
| InChI = 1/C18H23NO3/c1-19-8-7-18-11-4-5-13(20)17(18)22-16-14(21-2)6-3-10(15(16)18)9-12(11)19/h3,6,11-13,17,20H,4-5,7-9H2,1-2H3/t11-,12+,13-,17-,18-/m0/s1
| elimination_half-life = 4 hours<ref name="EurJClinPharmacol1983-Rowell"/>
| InChIKey = RBOXVHNMENFORY-DNJOTXNNBM
| excretion =  
| StdInChI_Ref = {{stdinchicite|correct|chemspider}}
| pregnancy_US = C
| StdInChI = 1S/C18H23NO3/c1-19-8-7-18-11-4-5-13(20)17(18)22-16-14(21-2)6-3-10(15(16)18)9-12(11)19/h3,6,11-13,17,20H,4-5,7-9H2,1-2H3/t11-,12+,13-,17-,18-/m0/s1
| legal_AU =
| StdInChIKey_Ref = {{stdinchicite|correct|chemspider}}
| legal_CA =  
| StdInChIKey = RBOXVHNMENFORY-DNJOTXNNSA-N
| legal_UK = Class B
| legal_US = Schedule II
| legal_status =
| routes_of_administration = Oral, [[intravenous|IV]], subcutaneous, rectal
}}
}}
'''Dihydrocodeine''', also called '''DHC''', '''Drocode''', '''Paracodeine''' and '''Parzone''' and by the brand names of '''Synalgos DC''', '''Panlor DC''', '''Panlor SS''', '''SS Bron''', '''Drocode''', '''Paracodin''', '''Codidol''', '''Didor Continus''', '''Dicogesic''', '''Codhydrine''', '''Dekacodin''', '''DH-Codeine''', '''Didrate''', '''Dihydrin''', '''Hydrocodin''', '''Nadeine''', '''Novicodin''', '''Rapacodin''', '''Rikodeine''','''Fortuss''', '''Remedeine''', '''Dico''', and '''DF-118''' amongst others, is a semi-synthetic [[opioid]] [[analgesic]] developed in Germany in the first decade of the XX. Century and put on the market in 1911.  It is prescribed for postoperative pain, severe [[dyspnea]], or as an [[antitussive]].  Dihydrocodeine tartrate is also present in [[co-dydramol]]. In some countries, controlled-release dihydrocodeine and/or the immediate release forumulations are used as an alternative to methadone in treatment of opioid dependency and addiction.
__NOTOC__
{{SI}}
{{CMG}}
== Overview ==


Commonly available as tablets, solutions, elixirs, and other oral forms, dihydrocodeine is also available in some countries as an injectable solution for deep subcutaneous and intra-muscular administration. Intravenous administration could be dangerous due to pulmonary oedema and the potential of anaphylaxis as it is with codeine. At one time in the past and possibly now, dihydrocodeine suppositories also existed.
'''Dihydrocodeine''' is a semi-[[Chemical synthesis|synthetic]] [[opioid]] [[analgesic]] prescribed for pain or severe [[dyspnea]], or as an [[antitussive]], either alone or compounded with [[paracetamol]] (as in [[co-dydramol]]) or [[aspirin]]. It was developed in Germany in 1908 and first marketed in 1911.<ref>http://books.google.co.uk/books?id=qoyYobgX0uwC&pg=PA404&lpg=PA404&dq=dihydrocodeine+1908+1911&source=bl&ots=Y7ALb1Yqjo&sig=FIkb3K4UwiXhn8LeO2EzXgxOGQk&hl=en&sa=X&ei=-mq9UsT5J4a10QXT0ID4CQ&ved=0CEQQ6AEwAzgK#v=onepage&q=dihydrocodeine%201908%201911&f=false</ref>


Dihydrocodeine is used as an alternative to or incrementation on codeine for the above mentioned spectrum of situations.  It is available as the following salts, in rough descending order of frequency of use:  bitartrate, phosphate, hydrochloride, tartrate, hydroiodide, methyliodide, hydrobromide, and sulphate. The salt to free base conversion factors are 0,67 for the bitartrate, 0,73 for the phosphate, and 0,89 for the hydrochloride.
Commonly available as tablets, solutions, elixirs, and other oral forms, dihydrocodeine is also available in some countries as an injectable solution for deep subcutaneous and intra-muscular administration. As with [[codeine]], intravenous administration should be avoided, as it could result in [[anaphylaxis]] and dangerous [[pulmonary edema]]. In past times, dihydrocodeine suppositories were used; however, dihydrocodeine is available in suppository form on prescription.


Dihydrocodeine was developed during the intense international search for more effective antitussives, especially to help reduce the airborne spread of tuberculosis, pertussis, pneumonia, and similar diseases, in the years from c.a. 1895 to 1915, and is similar in chemical structure to [[codeine]]. Depending on individual metabolism, dihydrocodeine is 100 to 150 percent as strong as codeine.  Although dihydrocodeine does have extremely active metabolites, in the form of [[dihydromorphine]] and dihydromorphine-6-glucuronide (one hundred times more potent), these metabolites are produced in such small amount that they do not have clinically important effects.<!--
Dihydrocodeine is used as an alternative or adjunct to codeine for the aforementioned indications. It is available as the following salts, in rough descending order of frequency of use:  bitartrate, phosphate, hydrochloride, tartrate, hydroiodide, methyliodide, hydrobromide, sulfate, and thiocyanate.  The salt to free base conversion factors are 0.67 for the bitartrate, 0.73 for the phosphate, and 0.89 for the hydrochloride.
  --><ref name="IntJClinPharmacolTher2003-Schmidt">{{cite journal | author=Schmidt H, Vormfelde S, Walchner-Bonjean M, Klinder K, Freudenthaler S, Gleiter C, Gundert-Remy U, Skopp G, Aderjan R, Fuhr U | title=The role of active metabolites in dihydrocodeine effects. | journal=Int J Clin Pharmacol Ther | volume=41 | issue=3 | pages=95-106 | year=2003 | id=PMID 12665158}}</ref>


==Indications==
Dihydrocodeine was developed during the intense international search for more effective antitussives, especially to help reduce the airborne spread of tuberculosis, pertussis, pneumonia, and similar diseases, in the years from c.a. 1895 to 1915, and is similar in chemical structure to [[codeine]]. Depending on individual metabolism, dihydrocodeine is 100 to 150 percent as strong as codeine{{Citation needed|date=January 2009}}.  Although dihydrocodeine does have extremely active metabolites, in the form of [[dihydromorphine]] and dihydromorphine-6-glucuronide (one hundred times more potent), these metabolites are produced in such small amount that they do not have clinically important effects.<ref name="IntJClinPharmacolTher2003-Schmidt">{{cite journal |author=Schmidt H, Vormfelde S, Walchner-Bonjean M, Klinder K, Freudenthaler S, Gleiter C, Gundert-Remy U, Skopp G, Aderjan R, Fuhr U |title=The role of active metabolites in dihydrocodeine effects |journal=Int J Clin Pharmacol Ther |volume=41 |issue=3 |pages=95–106 |year=2003 |pmid=12665158}}</ref>
Approved indication for dihydrocodeine is the management of moderate to moderately severe [[Pain and nociception|pain]] as well as coughing and shortness of breath.  As is the case with other drugs in this group, the antitussive dose tends to be less than the analgesic dose, and dihydrocodeine is a powerful cough suppressant like all other members of the immediate codeine family (see below) and their cousins '''[[hydrocodone]]''', '''[[oxycodone]]''' and '''[[ethylmorphine]]''' (a.k.a. dionine and codethyline)


For use against pain, dihydrocodeine is usually formulated as tablets or capsules containing a quarter grain (15 or 16 [[milligram|mg]]) or a half grain (30 or 32 mg) with or without other active ingredients such as [[aspirin]], [[paracetamol]], [[ibuprofen]], or others.  The usual dose is one tablet taken every 4-6 hours when necessary.
Dihydrocodeine is also the original member and chemical base of a number of similar semi-synthetic [[opiate]]s such as acetyldihydrocodeine, dihydrocodeine enol acetate, dihydroisocodeine, nicocodeine, and nicodicodeine.


Controlled-release dihydrocodeine is available for both pain and coughing as indicated below as waxy tablets containing 60 to 120 mg of the drug, and some formulations intended for use against coughing and the like have other active ingredients such as antihistamines, decongestants and others.  Generally, the starting dose would be 60 mg every 12 hours. 
== Indications ==


Approved indication for dihydrocodeine is the management of moderate to moderately severe [[pain]] as well as coughing and shortness of breath.  As is the case with other drugs in this group, the [[antitussive]] dose tends to be less than the [[analgesic]] dose, and dihydrocodeine is a powerful cough suppressant like all other members of the immediate codeine family (see below) and their cousins [[hydrocodone]], [[oxycodone]] and [[ethylmorphine]], whole opium preparations, and the strong opioid [[hydromorphone]].
For use against pain, dihydrocodeine is usually formulated as tablets or capsules containing a quarter grain (15 or 16&nbsp;[[Milligram|mg]]) or a half grain (30 or 32&nbsp;mg) with or without other active ingredients such as aspirin, paracetamol (acetaminophen), [[ibuprofen]], or others.  The usual dose is one tablet taken every 4–6 hours when necessary.
Controlled-release dihydrocodeine is available for both pain and coughing as indicated below as waxy tablets containing 60 to 120&nbsp;mg of the drug, and some formulations intended for use against coughing and the like have other active ingredients such as antihistamines, decongestants and others.  Generally, the starting dose would be 60&nbsp;mg every 12 hours.
<!-- Image with unknown copyright status removed: [[Image:Dhccontinus.jpg|thumb|Box of 56 controlled release 60mg dihydrocodeine tablets. 2 tablets a day=one month dosage (28 days)]] -->
Other oral formulations such as packets of effervescent powder, sublingual drops, elixirs and the like are also available in many places.
Other oral formulations such as packets of effervescent powder, sublingual drops, elixirs and the like are also available in many places.


Injectable dihydrocodeine is most often given as a deep subcutaneous shot.  
Injectable dihydrocodeine is most often given as a deep subcutaneous shot.


The above doses are typical starting doses for "opioid naïve" patients.  Existing tolerance to opioids and more severe pain (up to about 6 or 7 on a 1 to 10 scale perhaps) call for higher doses; dihydrocodeine may be more like hydrocodone and '''[[oxycodone]]''' than '''codeine''' and '''ethylmorphine''' in lacking a theoretical analgesic ceiling, but toxicity of other ingredients (especially aspirin and paracetamol) and/or the side effects of the opioid itself -- especially [[Vasodilator|vasodilation]], itching, and other effects of the large quantities of histamine released in the body -- generally supervene and thus limit dihydrocodeine to the middle range of painkillers, viz. between [[ethylmorphine]] and [[nicocodeine]] on the continuum.  Controlled-release dihydrocodeine is often taken every 8 hours and even 6 especially when titrating the dose in chronic pain cases and similar situations.  Different authorities list the maximum daily dose for dihydrocodeine as being anywhere from 240 mg to 720 mg, all other things being equal.
The above doses are typical starting doses for "opioid naïve" patients.  Existing [[Drug tolerance|tolerance]] to opioids and more severe pain (up to about 6 or 7 on a 1 to 10 scale perhaps) call for higher doses; dihydrocodeine may be more like hydrocodone and [[oxycodone]] than codeine and ethylmorphine in lacking a theoretical analgesic ceiling, but toxicity of other ingredients (especially aspirin and paracetamol) and/or the side effects of the opioid itself—especially [[Vasodilator|vasodilation]], itching, and other effects of the large quantities of histamine released in the body—generally supervene and thus limit dihydrocodeine to the middle range of painkillers, viz. between [[ethylmorphine]] and [[nicocodeine]] on the continuum.  Controlled-release dihydrocodeine is often taken every 8 hours and even 6 especially when titrating the dose in chronic pain cases and similar situations.  Different authorities list the maximum daily dose for dihydrocodeine as being anywhere from 240&nbsp;mg to 720&nbsp;mg, all other things being equal.


Dihydrocodeine products which can be purchased over the counter in many European and Pacific Rim countries generally contain from 2 to 20 mg of dihydrocodeine per dosing unit combined with one or more other active ingredients such as paracetamol, aspirin, ibuprofen, antihistamines, decongestants, vitamins, medicinal herb preparations and other such ingredients.  In a subset of these countries and foreign possessions, 30 mg tablets and 60 mg controlled-release tablets are available over the counter and chemists may very well be able to dispense the 90 and 120 mg strengths at their discretion.
== Preparations and availability ==


In the United States, the most common analgesic brands with DHC are: DHC Plus (16 and 32 mg), Panlor SS (32 mg), ZerLor (32 mg), Panlor DC (16 mg) and Synalgos DC (16 mg).  These combination products also include paracetamol (acetaminophen) and [[caffeine]].  Aspirin is used in the case of Synalgos DC.
Dihydrocodeine products which can be purchased over the counter in many European and Pacific Rim countries generally contain from 2 to 20&nbsp;mg of dihydrocodeine per dosing unit combined with one or more other active ingredients such as paracetamol, aspirin, ibuprofen, antihistamines, decongestants, vitamins, medicinal herb preparations and other such ingredients.  In a subset of these countries and foreign possessions, 30&nbsp;mg tablets and 60&nbsp;mg controlled-release tablets are available over the counter and chemists may very well be able to dispense the 90 and 120&nbsp;mg strengths at their discretion.


The Panlor series is manufactured by Pan-American Laboratories of Covington, Louisiana, and they also market several dihydrocodeine-based prescription cough syrups in the United States.
In the United States, the most common analgesic brands with dihydrocodeine are: DHC Plus (16 and 32&nbsp;mg), Panlor SS (32&nbsp;mg), ZerLor (32&nbsp;mg), Panlor DC (16&nbsp;mg) and Synalgos DC (16&nbsp;mg).  These combination products also include paracetamol (acetaminophen) and [[caffeine]].  Aspirin is used in the case of Synalgos DC.


Dihydrocodeine is sometimes marketed in combination preparations with paracetamol as [[co-dydramol]] ([[British Approved Name|BAN]]) to provide greater pain relief than either agent used singly (q.v. [[Synergy#Examples|drug synergy]]).
Dihydrocodeine is sometimes marketed in combination preparations with paracetamol as [[co-dydramol]] ([[British Approved Name|BAN]]) to provide greater pain relief than either agent used singly (see [[Synergy#Examples|examples of synergy]]).


In the UK and other countries, 30-mg tablets containing only dihydrocodeine as the active ingredient (DF-118) are available.
In the UK and other countries, 30-mg tablets containing only dihydrocodeine as the active ingredient are available, also a 40-mg Dihydrocodeine tablet is available in the UK as DF-118 Forte.


The original dihydrocodeine product, Paracodin, is an elixir of dihydrocodeine hydroiodide also available as a Tussionex-style suspension in many European countries.
The original dihydrocodeine product, Paracodin, is an elixir of dihydrocodeine hydroiodide also available as a Tussionex-style suspension in many European countries.


In many European countries and elsewhere in the world, the most commonly-found dihydrocodeine preparations are extended-release tablets made by encasing granules of the ingredient mixture, almost always using the bitartrate salt of dihydrocodeine, of four different sizes in a wax-based binder.  The usual strengths are 60, 90, and 120 mg.  These tablets are used in some countries, such as Austria, as an alternative to [[methadone]] (MS-Contin/MST-Continus type medications and [[buprenorphine]] are also used for this purpose) for management of opiate addiction. Common trade names for the extended-release tablets are Didor Continus, Codidol, Codi-Contin, Dicodin (made in France and the major product containing the tartrate salt) and DHC Continus.
In many European countries and elsewhere in the world, the most commonly found dihydrocodeine preparations are extended-release tablets made by encasing granules of the ingredient mixture, almost always using the bitartrate salt of dihydrocodeine, of four different sizes in a wax-based binder.  The usual strengths are 60, 90, and 120&nbsp;mg.  These tablets are used in some countries, such as Austria, as an alternative to [[methadone]] (MS-Contin/MST-Continus type medications and [[buprenorphine]] are also used for this purpose) for management of opiate addiction. Common trade names for the extended-release tablets are Didor Continus, Codidol, Codi-Contin, Dicodin (made in France and the major product containing the tartrate salt), Contugesic, DHC, and DHC Continus.
 
Dihydrocodeine is available in Japan as tablets which contain 2½ mg of dihydrocodeine phosphate and caffeine, the decongestant [[N-Methylephedrine|d,l-methylephedrine HCl]], and the antihistamine [[chlorpheniramine]], and packets of granules which effervesce like Alka-Seltzer with 10&nbsp;mg of dihydrocodeine with [[lysozyme]] and chlorpheniramine, marketed for OTC sale as New Bron Solution-ACE.  These two formulations may have once contained [[phenyltoloxamine]] citrate as the antihistamine component.
 
<!-- for want of a section, group manufacture 'ads' here ??-->
Elsewhere in the Pacific Rim, Dicogesic in analogous to Glaxo/Smith-Kline's DF-118.


Dihydrocodeine is available in Japan as tablets which contain 2½ mg of dihydrocodeine phosphate and caffeine, the decongestant d,l-methylephedrine HCl, and the antihistamine [[chlorpheniramine]], and packets of granules which effervesce like Alka-Seltzer® with 10 mg of dihydrocodeine with [[lysozyme]] and chlorpheniramine, marketed for OTC sale as SS Bron.  These two formulations may have once contained [[phenyltoloxamine]] citrate as the antihistamine component.  The manufacturer of SS Bron, IsuIsu, also markets an ibuprofen with dihydrocodeine product called S.Tac EVE.  Elsewhere in the Pacific Rim and elsewhere, Dicogesic in analogous to Glaxo/Smith-Kline's DF-118.
The manufacturer of New Bron Solution-ACE; SS Pharmaceutical Co., Ltd, also markets an ibuprofen with dihydrocodeine product called S.Tac EVE, which also includes d,l-methylephedrine HCl, chlorpheniramine, anhydrous caffeine, and vitamins B1 and C.  
   
The Panlor series is manufactured by Pan-American Laboratories of Covington, Louisiana, and they also market several dihydrocodeine-based prescription cough syrups in the United States.


Dihydrocodeine is also the original member and chemical base of a number of similar semi-synthetic [[opiate]]s such as acetyldihydrocodeine, dihydrocodeine enol acetate, dihydroisocodeine, nicocodeine, nicodicodeine, and thebacon.
== Side-effects ==


==Side effects==
As with other opioids, tolerance and physical and psychological [[Drug addiction|dependence]] develop with repeated dihydrocodeine use. All opioids can impair the mental and/or physical abilities required for the performance of potentially hazardous tasks such as driving or operating machinery if taken in large doses.
As with other opioids, tolerance and physical and psychological [[Drug addiction|dependence]] develop with repeated dihydrocodeine use. All opioids can impair the mental and/or physical abilities required for the performance of potentially hazardous tasks such as driving or operating machinery if taken in large doses, but have the opposite effect in moderate doses.<!--
  --><ref name="Pain2000-ONeill">{{cite journal | author=O'Neill W, Hanks G, Simpson P, Fallon M, Jenkins E, Wesnes K | title=The cognitive and psychomotor effects of morphine in healthy subjects: a randomized controlled trial of repeated (four) oral doses of dextropropoxyphene, morphine, lorazepam and placebo. | journal=Pain | volume=85 | issue=1-2 | pages=209-15 | year=2000 | id=PMID 10692620}}</ref>


Itching and flushing and other effects of blood vessel dialation are also common side effects, due to histamine release in response to the drug using one or more types of receptors in the CNS and/or other responses elsewhere in the body.  First-generation antihistamines such as [[tripelennamine]] (Pyrabenzamine), [[clemastine]] (Tavist), [[hydroxyzine]] (Atarax), [[diphenhydramine]] (Benadryl), [[cyproheptadine]] (Periactin), [[brompheniramine]] (Dimetapp), [[chlorphenamine]] (Chlor-Trimeton), [[doxylamine]] (NyQuil) and [[phenyltoloxamine]] (Percogesic Original Formula) not only combat the histamine-driven side effects, but are analgesic-sparing (potentiating) in various degrees. The antihistamine [[promethazine]] (Phenergan) may also have a positive effect on hepatic metabolism of dihydrocodeine as it does with codeine. Higher doses of promethazine may interfere with most other opioids with the exception of the pethidine family (Demerol and the like) by this and/or other unknown mechanisms.
Itching and flushing and other effects of blood vessel dilation are also common side-effects, due to histamine release in response to the drug using one or more types of receptors in the CNS and/or other responses elsewhere in the body.  First-generation antihistamines such as [[tripelennamine]] (Pyrabenzamine), [[clemastine]] (Tavist), [[hydroxyzine]] (Atarax), [[diphenhydramine]] (Benadryl), [[cyproheptadine]] (Periactin), [[brompheniramine]] (Dimetapp), [[chlorphenamine]] (Chlor-Trimeton), [[doxylamine]] (NyQuil) and [[phenyltoloxamine]] (Percogesic Original Formula) not only combat the histamine-driven side-effects, but are analgesic-sparing (potentiating) in various degrees. The antihistamine [[promethazine]] (Phenergan) may also have a positive effect on hepatic metabolism of dihydrocodeine as it does with codeine. Higher doses of promethazine may interfere with most other opioids with the exception of the pethidine family (Demerol and the like) by this and/or other unknown mechanisms.


Other side effects include giddiness and a sense of hyperactivity. Many patients and experts have pointed out that many opiates have the effect of generating empathy and improving interpersonal skills in a manner analogous to, but subjectively different from, MDMA, MDA, and many related amphetamine-variant entheogen/empathogen/hallucinogenics.  Dihydrocodeine and hydrocodone seem to have this effect somewhat in excess of their theoretical analgesic potency as compared to other opioids.
As with all drugs, side-effects depend on the person taking the medication. They can range in severity from mild to extreme, from headaches to difficulty breathing.


As with all drugs, side effects depend on the person taking the medication. They can range in severity from mild to extreme, from headaches to difficulty breathing.
Constipation is the one side-effect of dihydrocodeine and almost all opioids which is near-universal.  It results from the slowing of peristalsis in the gut and is a reason why dihydrocodeine, ethylmorphine, codeine, opium preparations, and morphine are used to stop diarrhoea and combat [[irritable bowel syndrome]] (IBS) in its diarrhoeal and cyclical forms as well as other conditions causing hypermotility and/or intestinal cramping. Opium/Opioid preparations are used often as a last resort, where pain is severe and the Bowels are organically loose. It is generally better to treat IBS with a non psycho-tropic opioid such as Loperamide hydrochloride which stays contained in the Bowel, thereby not causing drowsy effects and allowing many people to work using machines etc. For IBS, hyoscine butylbromide ([[Butylscopolamine|Buscopan]] in the UK) and [[Mebeverine|mebeverine hydrochloride]] (Colofac) can be effective with or without an opium related compound.


Constipation is the one side-effect of dihydrocodeine and almost all opioids which is near-universal.  It results from the slowing of peristalsis in the gut and is a reason why dihydrocodeine, ethylmorphine, codeine, opium preparations, and morphine are used to stop diarrhoea and combat [[Irritable Bowel Syndrome]] (IBS) in its diarrhoeal and cyclical forms as well as other conditions causing hypermotility and/or intestinal cramping.  The gut itself contains its own opioid receptors, which also allows opioids which do not enter the CNS at all or in appreciable quantites following oral administration such as the pethidine-related drugs [[loperamide]], [[diphenoxylate]], and [[difenoxin]] to work in the same fashion in a significant percentage of the population.  These drugs also have direct anticholinergic effects which contribute to their action.  The loperamide-like drugs, however, can exacerbate cyclical IBS and have little or no effect on the cramps associated with all major forms of IBS and exacerbate the constipation-predominant manifestation of this condition.  As a result, the most effective opioids for this spectrum of GI complaints would be whole-opium preparations such as paregoric, laudanum, Dover's Powder, granulated opium, opium in pill form etc., with codeine and dihydrocodeine working very well also, especially on diarrhoeal and cyclical IBS.  Whole opium contains not only morphine and codeine and other narcotic alkaloids but also the alkaloid papaverine, a smooth-muscle relaxant, and other alkaloids, oils, resins and waxes which can help with cramping and other symptoms.  Preparations containing both paregoric and extract of belladonna were once available that were probably the strongest and most efficaceous of GI drugs.
== Regulation ==


==Regulation==
; Hong Kong : In Hong Kong, dihydrocodeine is regulated under Schedule 1 of Hong Kong's Chapter 134 ''Dangerous Drugs Ordinance''. It can only be used legally by health professionals and for university research purposes. A pharmacist can dispense Dihydrocodeine when furnished with a doctors prescription. Anyone who supplies the substance without a prescription can be fined $10000 (HKD). The penalty for trafficking or manufacturing the substance is a $5,000,000 ([[Hong Kong dollar|HKD]]) fine and life imprisonment. Possession of the substance for consumption, without a licence from the Department of Health, is illegal and carries a $1,000,000 (HKD) fine and/or 7 years imprisonment.
In [[Hong Kong]], Dihydrocodeine is regulated under Schedule 1 of [[Hong Kong|Hong Kong's]] Chapter 134 ''Dangerous Drugs Ordinance''. It can only be used legally by health professionals and for university research purporses. The substance can be given by pharmacists under a prescription. Anyone who supply the substance without prescription can be fined $10000 (HKD). The penalty for trafficking or manufacturing the substance is a $5,000,000 ([[Hong Kong dollar|HKD]]) fine and life imprisonment. Possession of the substance for consumption without license from the Department of Health is illegal with a $1,000,000 (HKD) fine and/or 7 years of jail time.


In the [[United Kingdom]] dihydrocodeine is a [[Misuse of Drugs Act 1971#Class B drugs|Class B]] drug; however, it is available over-the-counter in small amounts (less than 8 mg), when combined with [[paracetamol]] (see [[co-dydramol]]).  Illegal possession of dihydrocodeine can result in up to 5 years in prison and/or an unlimited fine.
; Japan : In Japan, dihydrocodeine is available without a prescription; used in cough medicines such as New Bron Solution-ACE.  Dihydrocodeine is used as an antitussive in many products as a Dextromethorphan alternative.  Medicines in Japan which contain dihydrocodeine are coupled with caffeine to offset the sedative effects and discourage recreational use.  Cough medicines containing dihydrocodeine are controlled similarly to dextromethrophan in the United States, in that its sale is strictly limited by purchase quantity and is restricted to persons 20 and older for purchase.


In the [[USA]], it is a [[Drug Enforcement Administration|DEA]] [[Controlled Substances Act#Schedule II|Schedule II]] substance, although preparations containing small amounts of dihydrocodeine are classified as [[Controlled Substances Act#Schedule III drugs|Schedule III]] or [[Controlled Substances Act#Schedule V drugs|Schedule V]], depending on the concentration of dihydrocodeine relative to other active constituents, such as paracetamol (acetaminophen).  This scheduling is similar to [[codeine]]'s. The DEA's Drug Code for dihydrocodeine free base and all salts is 9120.
; United Kingdom : In the United Kingdom, dihydrocodeine is a [[List of controlled drugs in the United Kingdom#Class B drugs|Class B]] drug; but, it is available over-the-counter in small amounts (less than 8&nbsp;mg), when combined with [[paracetamol]] (see [[co-dydramol]]). Dihydrocodeine is listed in Schedule 5 of the Misuse of Drugs Regulations 2001 whereby it is exempt from prohibition on possession provided that it is in the form of a single preparation not being designed for [[Injection (medicine)|injection]] and less than 100&nbsp;mg (calculated as [[free base]]) or with a total concentration less than 2.5% (calculated as [[free base]]). Illegal possession of dihydrocodeine can result in up to 5 years in prison and/or an unlimited fine.


International treaties and the controlled-substances laws of most countries, such as the German Betäubungsmittelgesetz, regulate dihydrocodeine at the same level as codeine.  Dihydrocodeine-based pharmaceuticals are especially used where chronic pain patients are able to have essentially OTC access to them provided they are registered with the provincial or national government as such a patient.
; United States : In the USA, dihydrocodeine is a [[Drug Enforcement Administration|DEA]] [[Controlled Substances Act#Schedule II|Schedule II]] substance, although preparations containing small amounts of dihydrocodeine are classified as [[Controlled Substances Act#Schedule III drugs|Schedule III]] or [[Controlled Substances Act#Schedule V drugs|Schedule V]], depending on the concentration of dihydrocodeine relative to other active constituents, such as paracetamol (acetaminophen).  This scheduling is similar to the UK's.  The DEA's ACSCN for dihydrocodeine free base and all salts is 9120.  The 2013 annual aggregate manufacturing quota is 250 kilos.


Controlled-release dihydrocodeine is a non-prescription item in some places, especially the 60 mg strength.  A report by the Ivo Šandor Organisation in 2004 listed Andorra, Spain, Gibraltar, and Austria as having varying degrees of access to these and other dihydrocodeine, nicocodeine, and codeine products.
International treaties and the controlled-substances laws of most countries, such as the German ''[[Betäubungsmittelgesetz]]'', regulate dihydrocodeine at the same level as codeine.  Dihydrocodeine-based pharmaceuticals are especially used where chronic pain patients are able to have essentially OTC access to them provided they are registered with the provincial or national government as such a patient.


==Chemistry==
Controlled-release dihydrocodeine is a non-prescription item in some places, especially the 60&nbsp;mg strength.  A report by the Ivo Šandor Organisation in 2004 listed Andorra, Spain, Gibraltar and Austria as having varying degrees of access to these and other dihydrocodeine, nicocodeine and codeine products.
Dihydrocodeine is the parent drug of a series of moderately strong narcotics including [[hydrocodone]], [[nicocodeine]], [[nicodicodeine]], [[thebacon]], [[acetyldihydrocodeine]] and others.


From the point of view of the organic chemist, the removal of the double bond makes the structure much more stable. It is more resistant to metabolic attack (hence a duration of action of 6 hours rather than 4 for codeine). It is also more stable in acidic, high-temperature environments. Whereas converting [[codeine]] to [[morphine]] is a difficult and unrewarding task, dihydrocodeine can be converted to [[dihydromorphine]] with very high yields (over 95%).  [[Dihydromorphine]] is widely used in Japan. The dihydromorphine can be quantitatively converted to [[hydromorphone]] using potassium tert butoxide.
== Chemistry ==


==Recreational Use==
Dihydrocodeine is the parent drug of a series of moderately strong narcotics including, among others, [[hydrocodone]], [[nicocodeine]], [[nicodicodeine]], [[thebaine]] and [[acetyldihydrocodeine]].
Due to dihydrocodeine providing a relaxing and euphoric high when taken in higher than therapeutic doses it is quite commonly used recreationally.  As mentioned above, dihydrocodeine and its related drugs dihydromorphine and hydrocodone have a tendency to create subjective effects similar to those reported with MDMA such as enhanced empathy, euphoria, talkativeness and ability ro suspend or dissolve hang-ups and excessive defence mechanisms.  Other opioids may also produce similar effects, but compared to their analgesic strength the dihydrocodeine and hydrocodone series stand out as especially strong.


The onset of action of dihydrocodeine and the subsequent effects are often sufficient to satisfy and pleasantly surprise even heroin users; the article "Dihydrocodeine Information" quotes a heroin user as saying "[chewing Codidol extended-release tablets]...it's just like gear [i.e. heroin]!" 
From the point of view of the organic chemist, the removal of the double bond makes the structure much more stable. It is more resistant to metabolic attack (hence a duration of action of 6 hours rather than 4 for codeine). It is also more stable in acidic, high-temperature environments. Whereas converting [[codeine]] to [[morphine]] is a difficult and unrewarding task, dihydrocodeine can be converted to [[dihydromorphine]] with very high yields (over 95%). Dihydromorphine is widely used in Japan. The dihydromorphine can be quantitatively converted to [[hydromorphone]] using potassium tert butoxide.


A typical recreational dose amongst those with low tolerance will be between 150mg-240mg, however it should be made clear not to go too high over this dosage as there has been one instance of death with as low as 400mg with a person without any opiate tolerance.
Dihydrocodeine can be presumptively detected by the [[Froehde reagent]].


In both clinical and recreational respects, dihydrocodeine shares with hydrocodone the ability to be significantly boosted by the muscle relaxant [[Carisoprodol]] (Soma, Sanoma &c). The doses of both should be reduced and those who carelessly take these two drugs at the same time seriously endanger their health.  Nonetheless, this kind of mixture has a legitimate place in medicine and can he very helpful if undertaken properly: some proprietary Carisprodol preparations and doctors' orders for prescription compounding are mixtures of that drug with an NSAID, other ingredients like caffeine, dextromethorphan, vitamin C, cimetidine, paracetamol, antacids, antihistamines, all on top of a weak to moderately weak opioid such as codeine or dihydrocodeine. A common example is the three strengths of '''Soma Compound With Codeine''' No. 1, 2 or 3 -- i.e. with 8, 16 and 32 mg of codeine phosphate.
== Recreational use ==
As dihydrocodeine can provide a euphoric high when taken in higher-than-therapeutic doses, it is quite commonly abused recreationally. The typical recreational dose can be anything from 70&nbsp;mg to 500&nbsp;mg, or, in users with tolerance, even more.  [[Potentiators]] and [[adjuvants]] are often included when dihydrocodeine is used in an unsupervised fashion, especially [[carisoprodol]], [[hydroxyzine]] and [[first-generation antihistamine]]s, both to intensify the effect and lessen side-effects such as itching.<ref>Jack El-Hai : ''The Nazi and the Psychiatrist: [[Hermann Göring]], Dr. Douglas M. Kelley, and a Fatal Meeting of Minds at the End of WWII'', Publisher: PublicAffairs,  2013, ISBN 161039156X</ref>


==Footnotes==
==History==
<references/>
Two famous users of dihydrocodeine were [[William S. Burroughs]], who described it as "twice as strong as codeine and almost as good as heroin" and [[Hermann Göring]], who consumed up to 100 tablets (3 grams) of dihydrocodeine per day and was captured by the Allies with a large quantity of the drug in a suitcase, reportedly more than twenty thousand tablets, quite probably the entire world supply at the time.<ref>http://books.google.com/books?id=T93nvBI0gfIC&pg=PA34&dq=Hermann+Goering+pills&hl=en&ei=GbcaTLmNPI2TkAXWipWpBg&sa=X&oi=book_result&ct=result&resnum=6&ved=0CD4Q6AEwBQ#v=onepage&q&f=true</ref>  He was also very fond of morphine and oxycodone (Eukodal), beginning with therapeutic use of morphine after being wounded in the groin during the November 1923 Beer Hall Putsch in Munich and then specifically starting dihydrocodeine therapy in the early 1930s for a toothache.<ref>http://gaijinass.com/2010/07/12/world-leaders-that-had-serious-drug-addictions/</ref> <ref>http://books.google.com/books?id=T93nvBI0gfIC&pg=PA34&dq=Hermann+Goering+pills&hl=en&ei=GbcaTLmNPI2TkAXWipWpBg&sa=X&oi=book_result&ct=result&resnum=6&ved=0CD4Q6AEwBQ#v=onepage&q&f=true</ref>


==External links==
==Brand names==
Brand names for dihydrocodeine products include Drocode, Paracodeine and Parzone. Its many brand names include Synalgos DC, Panlor DC, Panlor SS, Contugesic, New Bron Solution-ACE, Huscode, Drocode, Paracodin,  Codidol, Dehace, Didor Continus, Dicogesic, Codhydrine, Dekacodin, DH-Codeine, Didrate, Dihydrin, Hydrocodin, Nadeine, Novicodin, Rapacodin, Fortuss, Paramol, Remedeine, Dico and DF-118.
 
== References ==
{{Reflist|2}}


{{opioids}}


{{Analgesics}}
{{Analgesics}}
{{Drugs used in addictive disorders}}
{{Cough and cold preparations}}
{{Opioidergics}}


[[de:Dihydrocodein]]
[[Category:drug]]
[[ja:ジヒドロコデイン]]
[[Category:Alcohols]]
[[sv:Dihydrokodein]]
[[Category:German inventions]]
[[th:ไดไฮโดรโคดีอีน]]
[[Category:Morphinans]]
 
[[Category:Mu-opioid agonists]]
[[Category:Opioids]]
[[Category:Phenol ethers]]
[[Category:Analgesics]]
[[Category:Semisynthetic opioids]]
[[Category:Semisynthetic opioids]]
[[Category:Drugs]]
[[pl:Dihydrokodeina]]

Latest revision as of 17:49, 13 April 2015

Template:Cleanup

Not to be confused with hydrocodone or codeine.
Dihydrocodeine
Clinical data
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  • US: C (Risk not ruled out)
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  • AU: S2 (Pharmacy only)
    (S3) (S4) depending on dose and other constituents
  • UK: Class B
  • US: Schedule II
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Bioavailability20%[1]
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Mainly hepatic, through CYP3A4 and CYP2D6
Elimination half-life4 hours[1]
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E number{{#property:P628}}
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FormulaC18H23NO3
Molar mass301.38 g/mol
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Dihydrocodeine is a semi-synthetic opioid analgesic prescribed for pain or severe dyspnea, or as an antitussive, either alone or compounded with paracetamol (as in co-dydramol) or aspirin. It was developed in Germany in 1908 and first marketed in 1911.[2]

Commonly available as tablets, solutions, elixirs, and other oral forms, dihydrocodeine is also available in some countries as an injectable solution for deep subcutaneous and intra-muscular administration. As with codeine, intravenous administration should be avoided, as it could result in anaphylaxis and dangerous pulmonary edema. In past times, dihydrocodeine suppositories were used; however, dihydrocodeine is available in suppository form on prescription.

Dihydrocodeine is used as an alternative or adjunct to codeine for the aforementioned indications. It is available as the following salts, in rough descending order of frequency of use: bitartrate, phosphate, hydrochloride, tartrate, hydroiodide, methyliodide, hydrobromide, sulfate, and thiocyanate. The salt to free base conversion factors are 0.67 for the bitartrate, 0.73 for the phosphate, and 0.89 for the hydrochloride.

Dihydrocodeine was developed during the intense international search for more effective antitussives, especially to help reduce the airborne spread of tuberculosis, pertussis, pneumonia, and similar diseases, in the years from c.a. 1895 to 1915, and is similar in chemical structure to codeine. Depending on individual metabolism, dihydrocodeine is 100 to 150 percent as strong as codeine[citation needed]. Although dihydrocodeine does have extremely active metabolites, in the form of dihydromorphine and dihydromorphine-6-glucuronide (one hundred times more potent), these metabolites are produced in such small amount that they do not have clinically important effects.[3]

Dihydrocodeine is also the original member and chemical base of a number of similar semi-synthetic opiates such as acetyldihydrocodeine, dihydrocodeine enol acetate, dihydroisocodeine, nicocodeine, and nicodicodeine.

Indications

Approved indication for dihydrocodeine is the management of moderate to moderately severe pain as well as coughing and shortness of breath. As is the case with other drugs in this group, the antitussive dose tends to be less than the analgesic dose, and dihydrocodeine is a powerful cough suppressant like all other members of the immediate codeine family (see below) and their cousins hydrocodone, oxycodone and ethylmorphine, whole opium preparations, and the strong opioid hydromorphone.

For use against pain, dihydrocodeine is usually formulated as tablets or capsules containing a quarter grain (15 or 16 mg) or a half grain (30 or 32 mg) with or without other active ingredients such as aspirin, paracetamol (acetaminophen), ibuprofen, or others. The usual dose is one tablet taken every 4–6 hours when necessary.

Controlled-release dihydrocodeine is available for both pain and coughing as indicated below as waxy tablets containing 60 to 120 mg of the drug, and some formulations intended for use against coughing and the like have other active ingredients such as antihistamines, decongestants and others. Generally, the starting dose would be 60 mg every 12 hours. Other oral formulations such as packets of effervescent powder, sublingual drops, elixirs and the like are also available in many places.

Injectable dihydrocodeine is most often given as a deep subcutaneous shot.

The above doses are typical starting doses for "opioid naïve" patients. Existing tolerance to opioids and more severe pain (up to about 6 or 7 on a 1 to 10 scale perhaps) call for higher doses; dihydrocodeine may be more like hydrocodone and oxycodone than codeine and ethylmorphine in lacking a theoretical analgesic ceiling, but toxicity of other ingredients (especially aspirin and paracetamol) and/or the side effects of the opioid itself—especially vasodilation, itching, and other effects of the large quantities of histamine released in the body—generally supervene and thus limit dihydrocodeine to the middle range of painkillers, viz. between ethylmorphine and nicocodeine on the continuum. Controlled-release dihydrocodeine is often taken every 8 hours and even 6 especially when titrating the dose in chronic pain cases and similar situations. Different authorities list the maximum daily dose for dihydrocodeine as being anywhere from 240 mg to 720 mg, all other things being equal.

Preparations and availability

Dihydrocodeine products which can be purchased over the counter in many European and Pacific Rim countries generally contain from 2 to 20 mg of dihydrocodeine per dosing unit combined with one or more other active ingredients such as paracetamol, aspirin, ibuprofen, antihistamines, decongestants, vitamins, medicinal herb preparations and other such ingredients. In a subset of these countries and foreign possessions, 30 mg tablets and 60 mg controlled-release tablets are available over the counter and chemists may very well be able to dispense the 90 and 120 mg strengths at their discretion.

In the United States, the most common analgesic brands with dihydrocodeine are: DHC Plus (16 and 32 mg), Panlor SS (32 mg), ZerLor (32 mg), Panlor DC (16 mg) and Synalgos DC (16 mg). These combination products also include paracetamol (acetaminophen) and caffeine. Aspirin is used in the case of Synalgos DC.

Dihydrocodeine is sometimes marketed in combination preparations with paracetamol as co-dydramol (BAN) to provide greater pain relief than either agent used singly (see examples of synergy).

In the UK and other countries, 30-mg tablets containing only dihydrocodeine as the active ingredient are available, also a 40-mg Dihydrocodeine tablet is available in the UK as DF-118 Forte.

The original dihydrocodeine product, Paracodin, is an elixir of dihydrocodeine hydroiodide also available as a Tussionex-style suspension in many European countries.

In many European countries and elsewhere in the world, the most commonly found dihydrocodeine preparations are extended-release tablets made by encasing granules of the ingredient mixture, almost always using the bitartrate salt of dihydrocodeine, of four different sizes in a wax-based binder. The usual strengths are 60, 90, and 120 mg. These tablets are used in some countries, such as Austria, as an alternative to methadone (MS-Contin/MST-Continus type medications and buprenorphine are also used for this purpose) for management of opiate addiction. Common trade names for the extended-release tablets are Didor Continus, Codidol, Codi-Contin, Dicodin (made in France and the major product containing the tartrate salt), Contugesic, DHC, and DHC Continus.

Dihydrocodeine is available in Japan as tablets which contain 2½ mg of dihydrocodeine phosphate and caffeine, the decongestant d,l-methylephedrine HCl, and the antihistamine chlorpheniramine, and packets of granules which effervesce like Alka-Seltzer with 10 mg of dihydrocodeine with lysozyme and chlorpheniramine, marketed for OTC sale as New Bron Solution-ACE. These two formulations may have once contained phenyltoloxamine citrate as the antihistamine component.

Elsewhere in the Pacific Rim, Dicogesic in analogous to Glaxo/Smith-Kline's DF-118.

The manufacturer of New Bron Solution-ACE; SS Pharmaceutical Co., Ltd, also markets an ibuprofen with dihydrocodeine product called S.Tac EVE, which also includes d,l-methylephedrine HCl, chlorpheniramine, anhydrous caffeine, and vitamins B1 and C.

The Panlor series is manufactured by Pan-American Laboratories of Covington, Louisiana, and they also market several dihydrocodeine-based prescription cough syrups in the United States.

Side-effects

As with other opioids, tolerance and physical and psychological dependence develop with repeated dihydrocodeine use. All opioids can impair the mental and/or physical abilities required for the performance of potentially hazardous tasks such as driving or operating machinery if taken in large doses.

Itching and flushing and other effects of blood vessel dilation are also common side-effects, due to histamine release in response to the drug using one or more types of receptors in the CNS and/or other responses elsewhere in the body. First-generation antihistamines such as tripelennamine (Pyrabenzamine), clemastine (Tavist), hydroxyzine (Atarax), diphenhydramine (Benadryl), cyproheptadine (Periactin), brompheniramine (Dimetapp), chlorphenamine (Chlor-Trimeton), doxylamine (NyQuil) and phenyltoloxamine (Percogesic Original Formula) not only combat the histamine-driven side-effects, but are analgesic-sparing (potentiating) in various degrees. The antihistamine promethazine (Phenergan) may also have a positive effect on hepatic metabolism of dihydrocodeine as it does with codeine. Higher doses of promethazine may interfere with most other opioids with the exception of the pethidine family (Demerol and the like) by this and/or other unknown mechanisms.

As with all drugs, side-effects depend on the person taking the medication. They can range in severity from mild to extreme, from headaches to difficulty breathing.

Constipation is the one side-effect of dihydrocodeine and almost all opioids which is near-universal. It results from the slowing of peristalsis in the gut and is a reason why dihydrocodeine, ethylmorphine, codeine, opium preparations, and morphine are used to stop diarrhoea and combat irritable bowel syndrome (IBS) in its diarrhoeal and cyclical forms as well as other conditions causing hypermotility and/or intestinal cramping. Opium/Opioid preparations are used often as a last resort, where pain is severe and the Bowels are organically loose. It is generally better to treat IBS with a non psycho-tropic opioid such as Loperamide hydrochloride which stays contained in the Bowel, thereby not causing drowsy effects and allowing many people to work using machines etc. For IBS, hyoscine butylbromide (Buscopan in the UK) and mebeverine hydrochloride (Colofac) can be effective with or without an opium related compound.

Regulation

Hong Kong
In Hong Kong, dihydrocodeine is regulated under Schedule 1 of Hong Kong's Chapter 134 Dangerous Drugs Ordinance. It can only be used legally by health professionals and for university research purposes. A pharmacist can dispense Dihydrocodeine when furnished with a doctors prescription. Anyone who supplies the substance without a prescription can be fined $10000 (HKD). The penalty for trafficking or manufacturing the substance is a $5,000,000 (HKD) fine and life imprisonment. Possession of the substance for consumption, without a licence from the Department of Health, is illegal and carries a $1,000,000 (HKD) fine and/or 7 years imprisonment.
Japan
In Japan, dihydrocodeine is available without a prescription; used in cough medicines such as New Bron Solution-ACE. Dihydrocodeine is used as an antitussive in many products as a Dextromethorphan alternative. Medicines in Japan which contain dihydrocodeine are coupled with caffeine to offset the sedative effects and discourage recreational use. Cough medicines containing dihydrocodeine are controlled similarly to dextromethrophan in the United States, in that its sale is strictly limited by purchase quantity and is restricted to persons 20 and older for purchase.
United Kingdom
In the United Kingdom, dihydrocodeine is a Class B drug; but, it is available over-the-counter in small amounts (less than 8 mg), when combined with paracetamol (see co-dydramol). Dihydrocodeine is listed in Schedule 5 of the Misuse of Drugs Regulations 2001 whereby it is exempt from prohibition on possession provided that it is in the form of a single preparation not being designed for injection and less than 100 mg (calculated as free base) or with a total concentration less than 2.5% (calculated as free base). Illegal possession of dihydrocodeine can result in up to 5 years in prison and/or an unlimited fine.
United States
In the USA, dihydrocodeine is a DEA Schedule II substance, although preparations containing small amounts of dihydrocodeine are classified as Schedule III or Schedule V, depending on the concentration of dihydrocodeine relative to other active constituents, such as paracetamol (acetaminophen). This scheduling is similar to the UK's. The DEA's ACSCN for dihydrocodeine free base and all salts is 9120. The 2013 annual aggregate manufacturing quota is 250 kilos.

International treaties and the controlled-substances laws of most countries, such as the German Betäubungsmittelgesetz, regulate dihydrocodeine at the same level as codeine. Dihydrocodeine-based pharmaceuticals are especially used where chronic pain patients are able to have essentially OTC access to them provided they are registered with the provincial or national government as such a patient.

Controlled-release dihydrocodeine is a non-prescription item in some places, especially the 60 mg strength. A report by the Ivo Šandor Organisation in 2004 listed Andorra, Spain, Gibraltar and Austria as having varying degrees of access to these and other dihydrocodeine, nicocodeine and codeine products.

Chemistry

Dihydrocodeine is the parent drug of a series of moderately strong narcotics including, among others, hydrocodone, nicocodeine, nicodicodeine, thebaine and acetyldihydrocodeine.

From the point of view of the organic chemist, the removal of the double bond makes the structure much more stable. It is more resistant to metabolic attack (hence a duration of action of 6 hours rather than 4 for codeine). It is also more stable in acidic, high-temperature environments. Whereas converting codeine to morphine is a difficult and unrewarding task, dihydrocodeine can be converted to dihydromorphine with very high yields (over 95%). Dihydromorphine is widely used in Japan. The dihydromorphine can be quantitatively converted to hydromorphone using potassium tert butoxide.

Dihydrocodeine can be presumptively detected by the Froehde reagent.

Recreational use

As dihydrocodeine can provide a euphoric high when taken in higher-than-therapeutic doses, it is quite commonly abused recreationally. The typical recreational dose can be anything from 70 mg to 500 mg, or, in users with tolerance, even more. Potentiators and adjuvants are often included when dihydrocodeine is used in an unsupervised fashion, especially carisoprodol, hydroxyzine and first-generation antihistamines, both to intensify the effect and lessen side-effects such as itching.[4]

History

Two famous users of dihydrocodeine were William S. Burroughs, who described it as "twice as strong as codeine and almost as good as heroin" and Hermann Göring, who consumed up to 100 tablets (3 grams) of dihydrocodeine per day and was captured by the Allies with a large quantity of the drug in a suitcase, reportedly more than twenty thousand tablets, quite probably the entire world supply at the time.[5] He was also very fond of morphine and oxycodone (Eukodal), beginning with therapeutic use of morphine after being wounded in the groin during the November 1923 Beer Hall Putsch in Munich and then specifically starting dihydrocodeine therapy in the early 1930s for a toothache.[6] [7]

Brand names

Brand names for dihydrocodeine products include Drocode, Paracodeine and Parzone. Its many brand names include Synalgos DC, Panlor DC, Panlor SS, Contugesic, New Bron Solution-ACE, Huscode, Drocode, Paracodin, Codidol, Dehace, Didor Continus, Dicogesic, Codhydrine, Dekacodin, DH-Codeine, Didrate, Dihydrin, Hydrocodin, Nadeine, Novicodin, Rapacodin, Fortuss, Paramol, Remedeine, Dico and DF-118.

References

  1. ↑ 1.0 1.1 Rowell F, Seymour R, Rawlins M (1983). "Pharmacokinetics of intravenous and oral dihydrocodeine and its acid metabolites". Eur J Clin Pharmacol. 25 (3): 419–24. doi:10.1007/BF01037958. PMID 6628531.
  2. ↑ http://books.google.co.uk/books?id=qoyYobgX0uwC&pg=PA404&lpg=PA404&dq=dihydrocodeine+1908+1911&source=bl&ots=Y7ALb1Yqjo&sig=FIkb3K4UwiXhn8LeO2EzXgxOGQk&hl=en&sa=X&ei=-mq9UsT5J4a10QXT0ID4CQ&ved=0CEQQ6AEwAzgK#v=onepage&q=dihydrocodeine%201908%201911&f=false
  3. ↑ Schmidt H, Vormfelde S, Walchner-Bonjean M, Klinder K, Freudenthaler S, Gleiter C, Gundert-Remy U, Skopp G, Aderjan R, Fuhr U (2003). "The role of active metabolites in dihydrocodeine effects". Int J Clin Pharmacol Ther. 41 (3): 95–106. PMID 12665158.
  4. ↑ Jack El-Hai : The Nazi and the Psychiatrist: Hermann Göring, Dr. Douglas M. Kelley, and a Fatal Meeting of Minds at the End of WWII, Publisher: PublicAffairs, 2013, ISBN 161039156X
  5. ↑ http://books.google.com/books?id=T93nvBI0gfIC&pg=PA34&dq=Hermann+Goering+pills&hl=en&ei=GbcaTLmNPI2TkAXWipWpBg&sa=X&oi=book_result&ct=result&resnum=6&ved=0CD4Q6AEwBQ#v=onepage&q&f=true
  6. ↑ http://gaijinass.com/2010/07/12/world-leaders-that-had-serious-drug-addictions/
  7. ↑ http://books.google.com/books?id=T93nvBI0gfIC&pg=PA34&dq=Hermann+Goering+pills&hl=en&ei=GbcaTLmNPI2TkAXWipWpBg&sa=X&oi=book_result&ct=result&resnum=6&ved=0CD4Q6AEwBQ#v=onepage&q&f=true


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