Dihydrocodeine Addiction

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Medically Reviewed by Conor Sheehy, PharmD, BCPS, CACP

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Updated 12/29/2022

Key Takeaways

  • Dihydrocodeine is an opioid medication used to treat pain
  • Dihydrocodeine is only available in the United States as a combination tablet or capsule
  • The brand names for this combination are Panlor and Trezix
  • Addiction to dihydrocodeine is an opioid use disorder (OUD)
  • Addiction to dihydrocodeine can cause uncomfortable withdrawal symptoms
  • Drug rehab for dihydrocodeine usually occurs in a facility (inpatient) or at home (outpatient)

Dihydrocodeine is an opioid with a similar structure to codeine, which is a medication used as a cough syrup and pain reliever. Dihydrocodeine can be just as addictive.

Dihydrocodeine is a lesser-known opioid medication used to treat moderate to severe pain in the United States. Dihydrocodeine is not available by itself and is formulated in combination with acetaminophen (Tylenol) and caffeine.

People from the United Kingdom may recognize dihydrocodeine as an over-the-counter drug for pain or coughing. Dihydrocodeine and its combination products are not commonly seen in the United States because codeine has the same potency and efficacy. In other words, they can be given at the same doses and used for the same conditions.

Dihydrocodeine addiction is rare in the United States, but it is still possible if someone has access to the drug.

How Is Dihydrocodeine Abused?

Dihydrocodeine is misused when someone takes too much of a valid prescription or takes a prescription that does not belong to them.

All prescription dihydrocodeine products in the United States are formulated with acetaminophen and caffeine. Acetaminophen is the main ingredient in the over-the-counter (OTC) pain medication Tylenol and can treat pain and reduce fever.

Caffeine is commonly formulated with pain medications that are used to treat headaches. Caffeine most likely works by constricting blood vessels in the head. Vessel constriction may help by reducing the amount of blood and volume in the head, which gives brain cells more room to function.

The formulations currently available are tablets (Panlor) and capsules (Trezix). Both formulations are classified as Schedule III medications by the Drug Enforcement Agency (DEA). They have a recognized medical use but a high potential for misuse and addiction. Some people misuse the drug by snorting or smoking it, but this can have dangerous consequences:

  • Can you snort dihydrocodeine? Since dihydrocodeine is formulated with acetaminophen and caffeine, a person would be snorting these drugs as well. Snorting opioid-acetaminophen combination products can destroy cells in the sinus cavity. Cases of fungal infection have also been reported. Additionally, snorting caffeine may reduce blood flow to the sinuses, causing further tissue death.
  • Can you smoke dihydrocodeine? Since dihydrocodeine is always combined with other drugs, a person would be smoking caffeine and acetaminophen as well as the inactive ingredients used to create the tablet. Smoking Trezix and Panlor would deliver far less dihydrocodeine to the bloodstream than taking it by mouth. It also risks the health of the lungs.

Dihydrocodeine Addiction Symptoms

Addiction to dihydrocodeine is an opioid use disorder (OUD). OUD means someone is displaying more than two of the following symptoms:

  1. Continuing to use opioids even when it worsens physical or psychological problems
  2. Having to take more opioids to achieve the same effect
  3. Spending a lot of time using or obtaining an opioid
  4. Stopping activities because of opioid use
  5. Strong cravings or desire to use opioids
  6. Taking more or larger amounts than intended
  7. Taking opioids to prevent withdrawal symptoms
  8. Trouble fulfilling obligations at school, work or home
  9. Using opioids even if it causes physical harm
  10. Using opioids even when it creates social or interpersonal problems
  11. Wanting to quit using the opioid but being unable to, or trying unsuccessfully

Some people have four or more dihydrocodeine addiction symptoms, meaning they have moderate OUD. Severe OUD is defined as six or more at the same time.

Physical Signs

Physical signs of opioid addiction are usually easy to spot, but someone may take extra care to hide them as well. A person addicted to dihydrocodeine may display some of these symptoms:

  • Lack of concern for personal hygiene
  • Small, pinpoint pupils
  • Reduced motivation and drive
  • Slowness or dullness
  • Slurred speech

Behavioral Signs

Behavioral signs of addiction are changes in how a person acts or a change in personality. A friend or partner may suddenly start acting strange or hiding things when they never did before. Other signs include:

  • Changes in friends or activities
  • Changes in sleep patterns
  • Sudden changes in daily routine or loss of routine
  • Sudden trouble with money

Psychological Signs

Opioids can affect how a person thinks and feels. Psychological side effects show up much later than physical ones. Psychological side effects include:

  • Agitation
  • Mood swings
  • New anxiety or depression
  • Somnolence (excessive sleepiness)

Dihydrocodeine Side Effects List

Dihydrocodeine side effects would never occur on their own since it is formulated in combination with acetaminophen and caffeine. Combination products can cause side effects from any of the three active ingredients.

Side effects can happen even when a prescription drug is taken as prescribed. Panlor tablets and Trezix capsules can cause the following side effects:

  • Central nervous system depression (tiredness and slowness)
  • Constipation
  • Liver damage
  • Low blood pressure
  • Racing heart
  • Rash and other skin reactions
  • Slow breathing

The dihydrocodeine side effects list also includes all possible side effects of opioid pain medications.

Side Effects of Polysubstance Abuse

Polysubstance misuse is when a person misuses more than one drug at once.

Opioids are notably dangerous because they can slow breathing, and this is how many overdose deaths occur. Dihydrocodeine formulations contain a stimulant and another pain medication, creating problems for the heart and liver.

Dihydrocodeine and alcohol increase the potential of overdose and death because they are both depressants that slow breathing. Tramadol and dihydrocodeine interactions are an example of a mixture containing more than one opioid medication. Tramadol activates opioid receptors in the same way that opioids do, so mixing the two is like doubling the dose of dihydrocodeine.

See Related: Can you drink after taking Acetaminophen?

How Does Dihydrocodeine Addiction Begin?

Addiction to dihydrocodeine begins the same way any opioid addiction starts. Addiction can happen to people misusing medications intentionally, but it can also happen to people who are taking their medication as prescribed.

Addiction is a process that slowly unfolds as someone escalates doses of opioids and enters a cycle of euphoria, crash and craving. Some reported reasons for addiction include social pressure to use drugs, an injury where an opioid was prescribed or self-medicating with someone else’s prescription.

Dihydrocodeine Withdrawal Symptoms

Withdrawal symptoms are the effects of the drug “rewiring” different cellular and biological processes. Dihydrocodeine withdrawal symptoms happen when someone is dependent on the drug and they stop using it.

Withdrawal symptoms for opioids can be severe and include:

  • Abdominal cramping
  • Agitation
  • Anxiety
  • Diarrhea
  • Dilated pupils
  • Goosebumps
  • Insomnia
  • Muscle aches
  • Nausea
  • Vomiting
  • Yawning

Dihydrocodeine Abuse Facts and Statistics

Dihydrocodeine is rarely prescribed in the U.S., making it difficult to track specific facts and statistics. Since it is an opioid, however, we can look at general opioid statistics:

  • In 2015, 2 million Americans aged 12 and older had a substance use disorder involving prescription pain medication.
  • Prescription pain medication sales in 2010 were four times higher than the number of prescriptions in 1999. Overdose deaths have increased by the same rate in the same period.
  • In 2012 alone, almost 260 million prescriptions were written for opioid pain medications.

Dihydrocodeine Overdose

Symptoms of an overdose include:

  • The person goes limp and may lose consciousness
  • Breathing slows or stops
  • Fingernails or lips have a light purple or blue color
  • Heartbeat slows or stops
  • Skin is cold and a pale or light blue color
  • The person does not wake up or respond
  • The person makes gurgling sounds or vomits

For opioids such as dihydrocodeine, overdose can be fatal. An overdose is an emergency, and you should call 911 or emergency services immediately if you witness someone overdosing.

If you or the person overdosing has access to naloxone, it should be used at this time. Naloxone will temporarily reverse some of the effects of the overdose, but it will not remove the opioid from the body. The person still needs to go to the hospital for observation, as opioids may stay in the body longer than reversal agents like naloxone. Additionally, the other drugs formulated with dihydrocodeine can cause liver damage, and this should be evaluated at the hospital.

Dihydrocodeine Addiction Treatment

Dihydrocodeine addiction is treated the same as addiction to other opioids. First, an addiction specialist will perform a drug and alcohol assessment to measure the severity of the addiction. Once the facts about the addiction are established, a person may be recommended for inpatient or outpatient treatment.

Inpatient treatment takes place in a facility with a team of medical professionals. This form of rehab is the most intense type of rehab available. Addictions that are less harmful to health may be treated in outpatient therapy. Outpatient treatment can happen from home and includes a mixture of education, therapy and resources for healing.

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View Sources

Alexander, David; et al. “Intranasal Hydrocodone-Acetaminophen Abuse Induced Necrosis of the Nasal Cavity and Pharynx.” The Laryngoscope, September 10, 2012. Accessed July 21, 2019.

American Society of Addiction Medicine. “Opioid Addiction 2016 Facts & Figures.” American Society of Addiction Medicine, 2016. Accessed July 21, 2019.

Medline Plus. “Opioid Overdose.” National Library of Medicine, 2015  Accessed July 28, 2019.

National Institute of Health. “DailyMed – ACETAMINOPHEN, CAFFEINE, DIHYDROCODEINE BITARTRATE.” 2019. Accessed July 21, 2019.

American Psychiatric Association. “Opioid Use Disorder.” Accessed July 21, 2019.Royal College of Anaesthetists.

Dose Equivalent and Changing Opioids.” 2018. Accessed July 21, 2019.