Dihydrocodeine and codeine are proven effective pain killers. They are available on prescription only and are used to treat more severe pain, for example, following post-operation or injuries. Experiencing pain is unpleasant, and many people may want a quick solution to eliminate it completely. If you find over the counter medications such as paracetamol or ibuprofen have little or no effect and other pain relief methods have failed, your doctor may prescribe more potent medicines such as dihydrocodeine or codeine. Therefore, you may find it helpful to understand the differences between these pain relief medications. This blog explains what codeine and dihydrocodeine are, how they work, their common uses and some precautions. We also answer the question of whether dihydrocodeine is stronger than codeine.
What is codeine, and how does it work?
Codeine is an analgesic medication that belongs to a category of drugs known as opioids. Analgesics are a class of medications specifically for pain relief, and opioids are a type of medicine used to relieve pain by affecting how your brain responds to discomfort. It works within the central nervous system and the brain to inhibit pain signals sent to the rest of the body. Additionally, it alleviates the anxiety and stress associated with pain.
The effect of codeine on pain is due to its conversion into morphine in the body, transformed by an enzyme called CYP2D6. This process occurs differently for everyone due to variations in genetic makeup. For instance, people classified as ultra-rapid metabolizers (those who break down medicines rapidly) can transform codeine to morphine much faster than others. Morphine is a powerful opioid, so this rapid conversion can be potentially harmful because it may lead to significantly higher than normal levels of morphine in the body. Therefore, healthcare providers will look at a patient’s metabolizer status when prescribing medications like codeine.
What is codeine commonly used for?
Codeine is generally for short-term relief of mild to moderate pain. In addition to relieving pain it is also used to treat more severe coughs, like dry and painful coughs. It works by reducing the activity in the part of the brain that triggers coughing. Codeine is typically combined with other medications in both prescribed and over-the-counter medicines meant to treat coughs and colds.
Codeine is not ideal for chronic pain (pain that persists long-term). This is because prolonged use of codeine may lead to habitual use, causing mental or physical dependence. However, Mayo Clinic writes:
“People who have continuing pain should not let the fear of dependence keep them from using narcotics to relieve their pain.”
They continue, writing that narcotics used for pain relief are unlikely to cause mental dependence (addiction) but can lead to physical dependence. Suddenly stopping treatment may result in withdrawal side effects. So the individual should be mindful in how they take codeine, as these severe withdrawal effects can usually be avoided by gradually reducing the dosage before completely stopping the treatment.
What is dihydrocodeine, and how does it work?
Dihydrocodeine, like codeine, is considered an analgesic medication belonging to the opioid class of drugs. Therefore, it works by blocking pain signals, altering the way the brain and central nervous system respond to pain. As an opioid analgesic, dihydrocodeine works by binding to opioid receptors in the brain and other areas of the body to reduce the perception of pain. Dihydrocodeine is a semi-synthetic opioid, meaning it’s created from natural opiates (in this case, codeine) in a lab.
It has a similar chemical structure to codeine but with another hydrogen atom – hence the prefix ‘di’ (two). This change almost doubles its analgesic potency (strength).
What is dihydrocodeine commonly used for?
Dihydrocodeine was developed in Germany in 1908 as part of a global search to find a better antitussive agent (cough suppressant) to help stop the spread of airborne diseases like tuberculosis. Like codeine, dihydrocodeine can be used to prevent and relieve a persistent cough as it suppresses the cough reflex in the brain.
Dihydrocodeine is for treating moderate to severe pain. It may be used for long-term pain where over-the-counter medicines such as paracetamol or ibuprofen are not working. However, like codeine, persistent long-term use of dihydrocodeine may lead to habit-forming, leading to mental or physical dependence. As written above, the fear of dependency shouldn’t keep individuals from using stronger painkillers, however, it is important to use this medication as advised by your doctor or GP.
So, is dihydrocodeine stronger than codeine?
The answer lies in their analgesic potency. Yes, in regard to the strength of the pain relief. Generally, dihydrocodeine is roughly twice as strong as codeine. This means, milligram for milligram, dihydrocodeine is likely to provide more effective pain relief than codeine. However, the strength of the medication alone doesn’t determine how effective the drug is. Factors such as individual tolerance, the nature and severity of the pain, and other medical conditions can influence how well these medications work to reduce pain in individuals.
Side effects and precautions
Despite the higher strength of dihydrocodeine, the drug carries similar risks and side effects to codeine. These can include drowsiness, dizziness, constipation, nausea, and dependency if used for prolonged periods. Both drugs must be used as advised by your doctor and should not be taken in greater doses or for periods longer than prescribed. For a full list of side effects, check the leaflet inside your medicine packet.
NHS UK warns, ‘Do not take dihydrocodeine with painkillers that contain codeine’, as there is a greater risk of side effects. If you have been taking either of these medications for over a few weeks, you should not stop taking the medication suddenly or without consulting your doctor. They can advise you on how to stop medication, which usually involves slowly decreasing the dosage over time. Abruptly stopping medications can lead to withdrawal symptoms in individuals who have used these for a considerable time. Lowering the dosage over time can prevent or minimise withdrawal symptoms.
While dihydrocodeine is technically stronger than codeine, the suitability of these two drugs often comes down to the individual’s specific needs, medical history, and the nature of their pain. The strength of the medication does not necessarily mean it is a better option, so do not be concerned if you are prescribed a milder pain relief medication over a stronger one. Your doctor will determine which painkiller is best for you if over-the-counter or other pain relief methods have not worked. Whichever painkiller prescribed, you should always follow your doctor’s instructions to ensure safe and effective use.
This information is provided as a general guide. Always seek advice from your doctor before starting or changing any medication routine.
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