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Care of opiate users: maintenance treatment
Published in Berry Beaumont, David Haslam, Care of Drug Users in General Practice, 2021
Buprenorphine (Subutex) is now increasingly used in the UK for maintenance treatment and whilst most studies have been carried out in non-UK settings, the evidence base for its efficacy as maintenance treatment is considerable.17,18 Whilst there is some evidence for the efficacy of prescribed diamorphine maintenance,19 this is not yet recommended for general practice use and requires a special Home Office licence. The use of injectable methadone in primary care is not currently recommended. Dihydrocodeine has been used widely as an opiate substitute in primary care in spite of the fact that it is not licensed for this indication and that there is little evidence for its efficacy. Its use is not recommended.
Drugs Affecting the Musculoskeletal System
Published in Radhwan Nidal Al-Zidan, Drugs in Pregnancy, 2020
Risk Summary: It should be used with caution during the 1st and 2nd Trimesters. However, it is better to avoid the use of Dihydrocodeine near term because of the risk of neonatal respiratory depression if used close to delivery.
Compatibility of commonly used drugs in lactation
Published in Amy Brown, Wendy Jones, A Guide to Supporting Breastfeeding for the Medical Profession, 2019
Dihydrocodeine or tramadol can be considered during breastfeeding. This should be at the lowest effective dose and for the shortest duration. Regular use of any opioid in a breastfeeding mother beyond 3 days should be under close medical supervision.
Comparative risk-benefit profiles of weak opioids in the treatment of osteoarthritis: a network meta-analysis of randomized controlled trials
Published in Postgraduate Medicine, 2022
Wei Li, Hongyi He, Zidan Yang, Ziying Wu, Dongxing Xie
World Health Organization has announced a 3-step pain ladder for pain management: 1) the use of a non-opioid drug for mild pain; 2) the use of a weak opioid for moderate pain; and 3) the use of a strong opioid for severe pain [52]. Since the use of strong opioids is associated with the development of physical dependence and tolerance, weak opioids are still the most commonly prescribed therapy to relieve OA-related pain [6]. Codeine is a natural derivative of opium alkaloids that frequently causes constipation, to a varying degree, that may jeopardize the continuation of treatment [53]. Tramadol, is a less active prodrug characterized by a dual mode of action as a noradrenaline reuptake inhibitor and as an agonist of the μ-opioid receptor [54,55]. Our results were consistent with the literature reports suggesting that tramadol and codeine had an excellent efficacy profile but an inferior therapeutic safety than placebo. Dextropropoxyphene is considered a weak narcotic and is a third to a half as potent as codeine [56]. Our results indicated that dextropropoxyphene was a weak opioid with a better safety profile but poor efficacy. Dihydrocodeine, a semi-synthetic opioid, has established analgesic efficacy; its parenteral potency is approximately one-sixth of morphine and equipotent to codeine [57]. Dihydrocodeine has been licensed in most countries to treat moderate to severe pain, but its efficacy in OA treatment is still uncertain due to the lack of evidence for multiple-treatment comparisons [58].
Impact of opioid agonist treatment on mental health in patients with opioid use disorder: a systematic review and network meta-analysis of randomized clinical trials
Published in The American Journal of Drug and Alcohol Abuse, 2021
Ehsan Moazen-Zadeh, Kimia Ziafat, Kiana Yazdani, Mostafa M. Kamel, James S. H. Wong, Amirhossein Modabbernia, Peter Blanken, Uwe Verthein, Christian G. Schütz, Kerry Jang, Shahin Akhondzadeh, R. Michael Krausz
Only one study was included comparing oral dihydrocodeine and oral methadone in patients with opioid dependence (Table 1) (30). The majority of patients were using other comorbid substances at baseline. The prevalence of serious comorbid conditions was low in the sample. No significant difference was reported in the improvement of psychological health after 36 months of therapy (Table 1).