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Indications/Uses
Listed in Dosage.
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Dosage/Direction for Use
Adult: PO Moderate to severe pain As immediate-release preparation: 30 mg 4-6 hourly. Severe or chronic pain As conventional tab: 40-80 mg tid. As prolonged-release tab: 60-120 mg 12 hourly. Max: 240 mg/day. Cough suppression 10 mg 4-6 hourly. IM/SC Severe pain 50 mg 4-6 hourly.
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Administration
Should be taken with food.
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Contraindications
Acute or severe respiratory depression, chronic obstructive airways disease, severe cor pulmonale, phaeochromocytoma, acute asthma attack, infective bronchial condition, risk of paralytic ileus, acute diarrhoeal condition (e.g. acute ulcerative colitis, antibiotic-associated colitis), raised intracranial pressure or head injury, heart failure secondary to lung disease, acute alcoholism, biliary tract disorders, comatose state. Children below 4 years. Concomitant or within 2 weeks of MAOI use.
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Special Precautions
Patient with asthma, adrenocortical insufficiency, prostatic hyperplasia, urethral stricture, hypotension, shock, inflammatory or obstructive bowel disorders, myasthenia gravis, hypothyroidism, history of drug abuse or dependence, depressed respiratory reserve, convulsive disorders. Renal and hepatic impairment. Pregnancy and lactation. Treatment with cough medicine in children should be considered carefully due to potential risks and limited evidence on efficacy. Elderly. Patient Counselling This drug may cause drowsiness and visual changes (e.g. blurred vision, double vision), if affected, do not drive or operate machinery.
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Adverse Reactions
Significant: Drowsiness, dependence and tolerance, increased serum prolactin, decreased plasma cortisol and testosterone.
Gastrointestinal disorders: Abdominal pain, constipation, dry mouth, nausea, vomiting.
Nervous system disorders: Somnolence, headache, vertigo.
Psychiatric disorders: Confusion, hallucinations, dysphoria, mood changes.
Renal and urinary disorders: Difficulty in micturition.
Skin and subcutaneous tissue disorders: Sweating, miosis, facial flushing, rashes, pruritus.
Vascular disorders: Postural hypotension.
Potentially Fatal: Respiratory depression. |
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Drug Interactions
May delay absorption of mexiletine. May enhanced the CNS depressant effects of anxiolytics (e.g. diazepam, chlordiazepoxide), hypnotics, antipsychotics, and TCAs. Enhanced respiratory/CNS depression and hypotension with anaesthetics, antihistamines and Na oxybate. Increased risk of severe constipation with loperamide and kaolin. May antagonise the effect of cisapride, metoclopramide and domperidone. Increased plasma concentration with cimetidine.
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CIMS Class
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ATC Classification
N02AA08 - dihydrocodeine ; Belongs to the class of natural opium alkaloids. Used to relieve pain.
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