Dihydrocodeine is an opioid pain medication available in two different formulations in the United States: Trezix and Panlor. Both forms contain a combination of dihydrocodeine, acetaminophen (Tylenol) and caffeine.
Physicians rarely prescribe dihydrocodeine in the United States, but it may sound familiar because most people have heard of codeine. Dihydrocodeine can be thought of as the United Kingdom’s version of codeine. The drugs have the same potency and can be interchanged dose for dose. They also treat the same conditions of pain and coughing.
Dihydrocodeine is a combination formulation that should only be used for pain. This is because acetaminophen and caffeine are not useful for the treatment of coughing.
Like other opioids, dihydrocodeine has a high potential for misuse and addiction. Once someone has become addicted, dihydrocodeine withdrawal symptoms can occur if the person tries to stop taking the drug. This is called drug dependence.
What Leads to Dihydrocodeine Withdrawal?
Dihydrocodeine withdrawal symptoms come after addiction or dependence.
Medications like dihydrocodeine are called mu-opioid receptor agonists. They act as an “on” switch for mu-opioids receptors, which control pain and pleasure signals in our nervous system. Pain and pleasure signals are used by the brain to encourage or discourage certain behaviors. For example, touching a hot stove is painful, and the pain discourages us from doing it in the future.
Under normal biological circumstances, pleasure signals follow the pain signal to “turn off” the feeling of pain. Opioids abnormally activate pleasure signals even when the body is not intending for them to be activated. When a lot of opioid medications are in the body for a long time, the cells begin to adjust. The body learns to counter the constant pleasure signals to maintain normal functioning. Withdrawal symptoms begin to emerge.
Withdrawal symptoms do not just impact people with addiction, however. Someone taking their prescription exactly as directed can experience symptoms after taking their medication for just a few weeks.
What Are the Symptoms of Dihydrocodeine Withdrawal?
Dihydrocodeine withdrawal symptoms can range from mild to severe. For example, taking it for a few weeks is very likely to induce diarrhea once the drug stops, but a person must be taking it for months or years to experience sweating and goosebumps.
The list of withdrawal symptoms includes:
- Agitation and irritability
- Dilated pupils
- Muscle aches
- Nausea and vomiting
- Runny nose
- Stomach pain
- Trouble sleeping
Withdrawal can also lead to other conditions:
- Post-Acute Withdrawal Syndrome (PAWS): PAWS is a group of symptoms that can last well past the initial detox and withdrawal. Symptoms may last weeks to months but do not happen for everyone. Symptoms may include difficulty with learning and memory, depressed mood, increased stress sensitivity and disturbed sleep patterns. Estimates place the rate of PAWS in recovering opioid users at 90%.
- Protracted withdrawal: This is another term for PAWS, which is a condition where symptoms of acute withdrawal last much longer than they should. PAWS and protracted withdrawal are new topics of discussion within addiction medication, so there is not much research about it at this time.
How Is Dihydrocodeine Withdrawal Diagnosed?
Diagnosing symptoms of dihydrocodeine withdrawal is straightforward. It is diagnosed when a person who uses the drug chronically stops usage and begins experiencing symptoms within a day or two.
Opioid withdrawal symptoms are almost always uncomfortable, but some can be life-threatening. Diarrhea, nausea and vomiting can cause dehydration, which can lead to hospitalization. Recognition of serious symptoms is important to prevent serious harm.
Major barriers to treatment of withdrawal symptoms are access to treatment and honesty with the medical provider. Someone who thinks they are experiencing symptoms should seek medical attention and should not hide their drug use. By answering questions honestly, patients can help providers to better treat the condition.
How Long Does Dihydrocodeine Withdrawal Last?
Without rehab treatment, withdrawal symptoms can last days or weeks. Admission to drug rehab can eliminate the need to enter withdrawal.
First-line treatment for opioid use disorder (OUD) is medication-assisted treatment (MAT), which can stop the symptoms. Symptomatic medications for nausea and diarrhea are usually available in rehab as well.
Dihydrocodeine Detox for Treatment of Withdrawal
Drugs leave the body through the detox process. Note that withdrawal and detox are not the same things. Even after detox has occurred, withdrawal symptoms can continue for several days or weeks. Withdrawal symptoms usually happen after detox, which takes about 24 hours for dihydrocodeine.
Medical detox happens in an inpatient facility with trained medical staff. Staff will manage uncomfortable withdrawal symptoms with medication and non-medication approaches.
Outpatient detox gives patients access to medical specialists but lets them return to the comfort of their home at the end of the day. Some outpatient programs provide prescription medications while detox happens at home. Others have patients staying at the facility for most of the day with medical supervision.
Detoxing at Home
Opioid withdrawal is generally not life-threatening, so detox can be done at home. The most dangerous complication of opioid withdrawal is dehydration, so someone attempting home detox needs to make sure to drink plenty of water and eat normal meals.
Finding a Detox Center
The Substance Abuse and Mental Health Services Administration (SAMHSA) has good resources for locating a nearby detox center. SAMHSA is a neutral, government-funded organization that helps create addiction medicine legislation and practice. SAMHSA has a search tool that can be accessed here.
There are a few options to choose from when deciding on a treatment location:
- Inpatient vs. outpatient: Inpatient treatment happens in a 24-hour live-in facility. This treatment option is best for people who have a lot of trouble controlling cravings and cannot detox while exposed to temptations.
- Local vs. distant: Distance plays a larger role than many people realize when choosing a rehab facility. Some people prefer privacy from their normal life, and treatment at a facility far away may be the best option. Others may prefer a location close to loved ones for social support.
Key Points: Understanding Dihydrocodeine Withdrawal and Detox
There are a few things to remember about dihydrocodeine:
- Dihydrocodeine is an opioid formulated with acetaminophen and caffeine
- Dihydrocodeine formulations have the potential for misuse and addiction
- Dihydrocodeine withdrawal is often uncomfortable but can be made easier with treatment
- Detox centers usually have both inpatient and outpatient options depending on the severity of the addiction
- SAMHSA has a useful tool for locating detox centers near you
Dihydrocodeine and other opioids can be very addictive. If you or someone you know struggles with opioid addiction, take the first steps toward treatment by calling The Recovery Village Palm Beach at Baptist Health today. We can help you find a treatment plan and recovery program that works well for your situation.
MedlinePlus. “Opiate and Opioid Withdrawal: MedlinePlus Medical Encyclopedia.” 2016. Accessed July 22, 2019.
National Institute of Health. “DailyMed – Acetaminophen, Caffeine, Dihydrocodeine Bitartrate.” 2019. Accessed July 22, 2019.
SAMHSA. “National Helpline.” 2014. Accessed July 22, 2019.
UCLA Semel Institute for Neuroscience and Human Behavior. “Post-Acute Withdrawal Syndrome (PAWS).” 2019. Accessed July 22, 2019.
Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.