Dihydrocodeine narcosis in renal failure.

Barnes, J.N.; Goodwin, F. J.

doi:10.1136/bmj.286.6363.438-a

Cited by 32 publications

(9 citation statements)

References 5 publications

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“…A reduction in systemic clearance and increase in its bioavailability have been postulated, given the high peak plasma concentrations and AUC found in patients with renal failure, despite a normal elimination halflife. 9 It is likely that these high concentrations also reflect the presence of other substances. Reports exist of prolonged narcosis in patients with renal failure.…”

Section: Codeinementioning

confidence: 99%

Opioids and renal function

Mercadante¹,

Arcuri²

2004

The Journal of Pain

125

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Section: Codeinementioning

confidence: 99%

Opioids and renal function

Mercadante¹,

Arcuri²

2004

The Journal of Pain

125

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“…The accumulation of active metabolites has been suggested as a possible cause of persistent narcosis despite decreasing drug concentrations in a recent case of dihydrocodeine narcosis in renal failure. 8 Unfortunately, it was not possible to determine the cause of the acute hepatic and renal impairment which was present on admission. An overdose of paracetamol two to three days before the dihydrocodeine overdose would cause renal impairment, but a raised bilirubin concentration and greater y-glutamyltransferase activity would also be expected.…”

Section: Commentmentioning

confidence: 99%

Dihydrocodeine overdose treated with naloxone infusion.

Redfern¹

1983

BMJ

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Naloxone is used to treat opioid overdosage as it antagonises the respiratory depression, hypotension, and diminished conscious level caused by narcotics.' The recommended dosage is 0-4 mg repeated twice at two or three minute intervals if required (manufacturer's data sheet), although it is likely that larger doses are often used.2 In renal and hepatic impairment narcotic effects may be prolonged45 and larger or repeated doses of naloxone may be needed. I report a case of self poisoning with dihydrocodeine in a patient with acute renal and hepatic impairment who required naloxone treatment for four days. Case reportA 29 year old man with biochemical evidence of renal and hepatic dysfunction was admitted to hospital 13 hours after an overdose of 70 dihydrocodeine (30 mg) tablets. The history obtained from relatives did not indicate other drug ingestion and screening of the plasma for paracetamol, salicylate, and alcohol was negative. He had been assaulted several hours before taking the overdose and bruising was noted over his right buttock and thigh. On admission he was drowsy but moved in response to command, his pupils were pinpoint, the respiratory rate was 15 per minute, and the arterial blood pressure was 100/70 mm Hg. Gastric lavage was carried out but no tablets were returned. After naloxone 0-4 mg had been given intravenously his speech became coherent and he moved spontaneously. A further three doses of naloxone 0-4 mg were given intravenously over the next 25 hours. By this time, however, he was unconscious, unresponsive to pain, and had a respiratory rate of 4 per minute, a systolic blood pressure of 75 mm Hg, an arterial carbon dioxide tension (Paco2) of 6 2 kPa (47 mm Hg,, and a pH of 7 18. Naloxone 1-2 mg was given intravenously with good effect and an intravenous infusion of 0-2 mg/hour started. He had not passed urine since admission and catheterisation produced 250 ml.

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“…In the literature there is a case report of a serious adverse event of DHC (a fall in blood pressure, loss of consciousness, myoclonic jerks, respiratory depression) in a 41 year old female patient with renal failure, who underwent peritoneal dialyzotherapy and for 4 days treated with oral DHC in a dose 60 mg three times daily (the total dose administered was 600 mg) [24]. The symptoms disappeared after a few days of treatment using continuous naloxone infusion (the total dose was 8 mg administered within 48 h) and breathing support.…”

Section: Dihydrocodeine Adverse Effects and Possible Drug Interactionsmentioning

confidence: 98%

Dihydrocodeine as an Opioid Analgesic for the Treatment of Moderate to Severe Chronic Pain

Leppert

2010

CDM

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Dihydrocodeine (DHC) is a semi-synthetic analogue of codeine which was formed by the hydrogenation of the double tie in the main chain of the codeine molecule. DHC is used as an analgesic, antitussive and antidiarrhoeal agent; it is also used for the treatment of opioid addiction. Limited data is available on the relative potency of DHC to other opioids. The analgesic effect of DHC is probably twice as potent as codeine for the parenteral and slightly stronger for an oral route. DHC possesses approximately 1/6(th) of the morphine analgesic effect when drugs are administered orally. In this article pharmacokinetics, pharmacodynamics, dosing guidelines, adverse effects and clinical studies of DHC in pain management are shown with focus on cancer pain. The impact of CYP2D6 activity on DHC analgesia was discussed and a proposal of calculation equianalgesic doses of DHC to other opioids was put forward.

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Dihydrocodeine narcosis in renal failure.

Cited by 32 publications

References 5 publications

Opioids and renal function

Opioids and renal function

Dihydrocodeine overdose treated with naloxone infusion.

Dihydrocodeine as an Opioid Analgesic for the Treatment of Moderate to Severe Chronic Pain

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