Paracodin® is a drug from the group of antitussives (cough suppressants) and is used for unproductive irritable cough. The active ingredient contained in Paracodin is dihydrocodeine. Dihydrocodeine is a derivative of the opium alkaloid morphine and a derivative of codeine, which in turn is prescribed as an antitussive and painkiller. In Germany, Paracodin® falls under the narcotics law, which means that the drug’s release is subject to special controls.

Mode of action

The active ingredient dihydrocodeine contained in Paracodin® is a member of the opioid group. The term opioid refers to a group of natural and synthetic substances that are effective at opioid receptors. The main effects of opioids are strong analgesia (pain relief), sedation, respiratory depression (inhibition of the respiratory drive) and constipation.

With prolonged use, the development of dependence is possible. Dihydrocodeine has a strong analgesic effect, it is used mainly in short-term therapy to treat unproductive irritable cough. It can also be used for moderately severe pain.

Side effects

The active ingredient dihydrocodeine contained in Paracodin® can cause various side effects as a drug acting on the opioid receptor. Itching with reddening of the skin may occur after taking Paracodin®, which occurs in ? 0.1% of cases.

Severe allergic reactions can also occur, which can swell in intensity up to Steven-Johnson syndrome (? 0.01% of cases). Taking Paracodin® can lead to an increase in the muscle tone of the smooth muscles, which can lead to constipation in the gastrointestinal tract.

A further side effect is nausea, even vomiting, which occurs more frequently at the start of therapy. Occasionally there is dry mouth. Frequently (?

1% of cases) there is a slight headache and slight drowsiness, sleep disorders may also occur. As psychological side effects, euphoria and mood swings are sometimes observed. In addition, states of confusion are possible, also perception disorders with hallucinations occur (?

0.1%). In patients with pre-existing epilepsy or a tendency to seizures, the risk of convulsions (cramps) is increased during therapy with Paracodin® (? 0.1%).

Patients often complain of dizziness. At high doses, blood pressure drops and the resulting syncope, i.e. sudden fainting, are still possible. Moreover, patients who already have a lung dysfunction are predestined to develop pulmonary edema during high-dose therapy with dihydrocodeine.

In addition, respiratory disorders can occur, dyspnoea (shortness of breath) or respiratory depression (usually in the case of misuse of dihydrocodeine) are possible. In general, it must be noted that long-term high-dose therapy develops tolerance to over-the-counter drugs and that psychological and physical dependence develops. Taking Paracodin® with its active ingredient dihydrocodeine can also lead to a deterioration in vision because the performance of the eye muscles can be reduced.

Very rarely, a functional disorder of the eyes still occurs, which manifests itself as miosis (narrowing of the pupil) or scotoma (? 0.01%). Paracodin® or Dihydrocodeine should not be taken in certain diseases or conditions.

An important contraindication is certain diseases of the respiratory tract, such as respiratory insufficiency or respiratory depression, as both are exacerbated by dihydriocodein. In addition, the drug must not be taken in acute asthma attacks or chronic bronchial asthma. Dihydrocodeine preparations must not be taken even if the central control center of respiration, i.e. the respiratory center, is disturbed.

Furthermore, dihydrocodeine is generally contraindicated in children under the age of four. If the patient is addicted to opioids, alcohol or sedatives, dihydrocodeine must be used very carefully, otherwise the addiction will be aggravated. Care should be taken in patients who are to be treated with dihydrocodeine after surgical removal of the gallbladder.

In patients who have limited kidney function, the dose must be adjusted as excretion is slower.In general, one should be careful when using dihydrocodeine in the treatment of elderly patients, as the therapy may affect existing pre-existing conditions. Dihydrocodeine therapy should be weighed up particularly carefully in patients with pre-existing hypothyroidism, reduced liver function and/or existing seizure disorders (epilepsy). Caution is also required in patients with chronic constipation, as the opioid may tend to increase the risk of constipation.

Dihydrocodeine should also be weighed up very carefully during pregnancy. In the first three months of pregnancy it is possible to take the preparation if the indication is very strict. As soon as the birth is approaching, the administration of Dihydrocodeine is contraindicated because there would be a risk of respiratory depression for the newborn.

Studies have shown correlations between the intake of dihydrocodeine by pregnant women and deformities of the child. In addition, an unborn child may develop a dependency if it is taken over a longer period of time. Children whose mothers had repeatedly taken dihydrocodeine during pregnancy (in the last trimester) have been found to have withdrawal symptoms after birth. Dihydrocodeine is contraindicated during lactation because the active substance passes into breast milk and may cause side effects in the infant.