Editing Dihydrocodeine (section)

== Side effects ==
As with other opioids, tolerance and physical and psychological [[Drug addiction|dependence]] develop with repeated dihydrocodeine use. All opioids can impair the mental or physical abilities required for the performance of potentially hazardous tasks such as driving or operating machinery if taken in large doses.<ref>{{cite journal | vauthors = Bailey CP, Connor M | title = Opioids: cellular mechanisms of tolerance and physical dependence | journal = Current Opinion in Pharmacology | volume = 5 | issue = 1 | pages = 60–68 | date = February 2005 | pmid = 15661627 | doi = 10.1016/j.coph.2004.08.012 }}</ref><ref>{{cite journal | vauthors = Adriaensen H, Vissers K, Noorduin H, Meert T | title = Opioid tolerance and dependence: an inevitable consequence of chronic treatment? | journal = Acta Anaesthesiologica Belgica | volume = 54 | issue = 1 | pages = 37–47 | date = 2003 | pmid = 12703345 | url = https://pubmed.ncbi.nlm.nih.gov/12703345/ }}</ref>

Itching and flushing and other effects of blood vessel dilation are also common side-effects, due to histamine release in response to the drug using one or more types of receptors in the CNS or other responses elsewhere in the body.<ref>{{cite journal | vauthors = Ashina K, Tsubosaka Y, Nakamura T, Omori K, Kobayashi K, Hori M, Ozaki H, Murata T | title = Histamine Induces Vascular Hyperpermeability by Increasing Blood Flow and Endothelial Barrier Disruption In Vivo | journal = PLOS ONE | volume = 10 | issue = 7 | pages = e0132367 | date = 2015 | pmid = 26158531 | pmc = 4497677 | doi = 10.1371/journal.pone.0132367 | doi-access = free | bibcode = 2015PLoSO..1032367A }}</ref>  First-generation antihistamines such as [[tripelennamine]] (Pyrabenzamine), [[clemastine]] (Tavist), [[hydroxyzine]] (Atarax), [[diphenhydramine]] (Benadryl), [[cyproheptadine]] (Periactin), [[brompheniramine]] (Dimetapp), [[chlorphenamine]] (Chlor-Trimeton), [[doxylamine]] (NyQuil) and [[phenyltoloxamine]] (Percogesic Original Formula) not only combat the histamine-driven side-effects, but are analgesic-sparing (potentiating) in various degrees.<ref>{{Citation |title=Antihistamines |date=2012 |url=http://www.ncbi.nlm.nih.gov/books/NBK547896/ |work=LiverTox: Clinical and Research Information on Drug-Induced Liver Injury |place=Bethesda (MD) |publisher=National Institute of Diabetes and Digestive and Kidney Diseases |pmid=31643232 |access-date=2022-09-05}}</ref><ref>{{Cite web | vauthors = Fookes C |date=2019-02-05 |title=List of Common Antihistamines + Uses & Side Effects |url=https://www.drugs.com/drug-class/antihistamines.html |access-date= 5 September 2022 |website=Drugs.com |language=en}}</ref> The antihistamine [[promethazine]] (Phenergan) may also have a positive effect on hepatic metabolism of dihydrocodeine as it does with codeine. Higher doses of promethazine may interfere with most other opioids with the exception of the pethidine family (Demerol and the like) by this or other unknown mechanisms.<ref>{{cite book | vauthors = Southard BT, Al Khalili Y | chapter = Promethazine |date=2022 |chapter-url= http://www.ncbi.nlm.nih.gov/books/NBK544361/ | title = StatPearls |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=31335081 |access-date= 5 September 2022 }}</ref>

As with all drugs, side-effects depend on the person taking the medication. They can range in severity from mild to extreme, from headaches to difficulty breathing.<ref>{{Cite web |title=Dihydroergotamine Side Effects: Common, Severe, Long Term |url=https://www.drugs.com/sfx/dihydroergotamine-side-effects.html |access-date= 5 September 2022 |website=Drugs.com |language=en}}</ref><ref>{{Citation |title=Dihydrocodeine |date=2006 |url=http://www.ncbi.nlm.nih.gov/books/NBK500692/ |work=Drugs and Lactation Database (LactMed) |place=Bethesda (MD) |publisher=National Library of Medicine (US) |pmid=29999751 |access-date=2022-09-05}}</ref>

Constipation is the one side-effect of dihydrocodeine and almost all opioids which is near-universal.<ref>{{cite journal | vauthors = Canty SL | title = Constipation as a side effect of opioids | journal = Oncology Nursing Forum | volume = 21 | issue = 4 | pages = 739–745 | date = May 1994 | pmid = 8047473 | url = https://pubmed.ncbi.nlm.nih.gov/8047473/ }}</ref><ref>{{Cite web |title=Aspirin/caffeine/dihydrocodeine Side Effects: Common, Severe, Long Term |url=https://www.drugs.com/sfx/aspirin-caffeine-dihydrocodeine-side-effects.html |access-date= 5 September 2022 |website=Drugs.com |language=en}}</ref>  It results from the slowing of peristalsis in the gut and is a reason dihydrocodeine, ethylmorphine, codeine, opium preparations, and morphine are used to stop diarrhoea and combat [[irritable bowel syndrome]] (IBS) in its diarrhoeal and cyclical forms as well as other conditions causing hypermotility or intestinal cramping.<ref>{{Cite web |title=Irritable bowel syndrome – Symptoms and causes |url=https://www.mayoclinic.org/diseases-conditions/irritable-bowel-syndrome/symptoms-causes/syc-20360016 |access-date=  5 September 2022 |website=Mayo Clinic |language=en}}</ref> Opium/opioid preparations are used often as a last resort where pain is severe and the bowels are organically loose. It is generally better to treat IBS with a non psycho-tropic opioid such as loperamide hydrochloride which stays contained in the bowel,<ref name=":1">{{Cite web |title=Opioid-Induced Hyperalgesia: How Opioids Can Increase Pain |url=https://www.hss.edu/conditions_opioid-induced-hyperalgesia.asp |access-date= 5 September 2022 |website=Hospital for Special Surgery |language=en}}</ref> thereby not causing drowsy effects and allowing many people to work using machines etc. For IBS, hyoscine butylbromide ([[Butylscopolamine|Buscopan]] in the UK) and [[Mebeverine|mebeverine hydrochloride]] (Colofac) can be effective with or without an opium related compound.<ref name=":1" />