
Dihydrocodeine Versus Codeine
Overview
Codeine is a well-known painkiller, but dihydrocodeine is less widely known. They are both opioid medications used to treat moderate to severe pain (and occasionally other uses). These are typically prescribed short-term for acute pain management, such as after getting surgery or sustaining an injury. They can also be prescribed long-term for patients with chronic pain caused by issues such as herniated disks or fibromyalgia.
These two medications have a lot in common, but chemically, they are not the same thing. Their chemical difference is subtle. In the U.S., both medications require a prescription. In the U.K., you can purchase the lowest dose of codeine from a pharmacy, but need a prescription for higher doses and for dihydrocodeine. The codeine available at the pharmacy is mixed with either paracetamol, ibuprofen, or aspirin. Constipation and drowsiness are the most common side effects of these two medications. (7)
About Dihydrocodeine
Dihydrocodeine is an opioid pain medication derived from codeine. It is partially synthetic, but comes from a natural substance. This process happens in a laboratory under strict regulatory guidelines. Because this medication was synthesized in a lab, some of its properties are much stronger than codeine’s properties are. For example, it is about twice as effective as a painkiller, and it can sometimes produce a stronger euphoria effect.
This euphoria generally feels like a mild buzz, and it does not occur in all patients. The euphoria is largely why addiction is so common with this medication; the same can be said for codeine. Dihydrocodeine is sometimes used in other medications, namely anti-diarrhea pills and cough syrup. (1)
About Codeine
Codeine is a naturally occurring opioid that people use as a painkiller. It can be isolated from poppy seeds, and our bodies recognize it as a naturally occurring substance. Codeine is more mild than dihydrocodeine by about half, so it is more widely used. Codeine is usually chosen by doctors before dihydrocodeine. In the U.K., a low dose of codeine can be purchased from a pharmacy without a prescription. This medication can be used to treat cough and diarrhea, though it is typically used for pain management. (4)
When To Take Them
These two medications are so chemically similar that their uses, risks, and side effects almost entirely overlap. In most cases, a doctor will instruct you to take codeine or dihydrocodeine to treat your symptoms. It isn’t something that you should take without consulting with a healthcare professional first. It isn’t advisable to take this medication unless you need something stronger than what over the counter options have to offer. If you are able to ease your pain with paracetamol, ibuprofen, aspirin, or naproxen, use those first.
Codeine and dihydrocodeine can be taken to treat moderate to severe pain, as well as to treat diarrhea and cough. When using these for pain, keep in mind that it is best to take them at the first sign of a pain flare. Pain medication is more effective when taken sooner rather than later. Waiting until your pain is already bad decreases the chances of the medication working successfully. In the case of constant pain, take it as often as it’s directed so that there is no lapse in pain relief. (8)
Risks & Side Effects
All medications come with the risk of an allergic reaction. Common symptoms of this include difficulty breathing, difficulty swallowing, swelling of the face, and hives. Side effects include constipation, drowsiness, agitation, chills, dizziness, indigestion, nausea, restlessness, and sweating. Because these are opioid medications, there is also an increased chance of becoming addicted. Chemical dependence is likely to form if these are taken long-term. (5)
A Note About Addiction
Both medications are considered to carry a moderate to high risk of addiction. Because dihydrocodeine is partially synthetic, it has stronger properties and a higher potential for addiction. However, it is also less commonly abused overall because it is much harder for people to obtain.
Doctors are careful when prescribing opioids, and prefer to only use them in the short-term, when possible. If you know that you have a history of addictive behaviors, you should mention that to your doctor. It doesn’t mean that you can’t take the medication if you need it, but you may need to have an action plan in place in case you start noticing addictive behaviors. (3)
Addiction Versus Dependence
There is a difference between addiction and chemical dependence: addiction is when you misuse the medication behaviorally, and dependence is a chemical issue in your brain. Addiction feels uncontrollable; patients with opioid addiction can’t properly regulate their use of the medication, so it becomes a drug addiction. With dependency, your body becomes used to having the medication in your system, and that causes a chemical need for the medication.
This can be treated by tapering off of the medication. Both addiction and dependency are common around the world, and they are nothing to be ashamed of; just be honest with your doctor. Dependency is extremely high for all opioids, which is another reason why these medications are usually used short-term. This is also why opioids must be tapered off, rather than stopped cold turkey. (6)
Take-Home Message
Codeine and dihydrocodeine are very similar medications, both used to treat pain. They are also sometimes used for cough and diarrhea. Because they are opioids, extra precautions must be followed when taking them. Always ask your doctor if you have questions about your dose or medication schedule. Be careful not to take doses too close together, and be careful not to accidentally take a dose twice. These medications are quite effective against all kinds of pain. (2)
- Is Dihydrocodeine The Same As Codeine? | UK Meds
- Is Dihydrocodeine the Same as Codeine? - Opiate.c
- Dihydrocodeine as an opioid analgesic for the treatment of moderate to severe chronic pain - PubMed (nih.gov)
- codeine | drug | Britannica
- Codeine Side Effects: Common, Severe, Long Term - Drugs.com
- What Is Chemical Addiction, and How Is It Treated? - Arete Recovery
- Codeine Sulfate Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing - WebMD
- https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/codeine-information#:~:text=Codeine%20is%20an%20opioid%20pain,some%20cough%20and%20cold%20medications