Codeine and dihydrocodeine are two commonly prescribed opioid medications with similar uses but notable differences in their pharmacology and effects. Understanding these distinctions is crucial for healthcare professionals and patients alike.

Codeine is a Food and Drug Administration (FDA) approved opioid analgesic medication that is naturally occurring and found in the poppy plant that is typically prescribed for things such as a severe cough and is used to relieve the symptoms of mild to moderate pain. When codeine is used for treating pain, it acts by changing the way your nervous system and brain respond to that pain.

It’s main difference when it comes to Chemical Composition and Derivatives is that Codeine is a naturally occurring alkaloid derived from the opium poppy plant and is chemically classified as an opiate, while Dihydrocodeine (DHC), which is also derived from the opium poppy plant, DHC is a semi-synthetic derivative of codeine, structurally similar but with some differences in its effects.

Codeine vs Dihydrocodeine

On the other hand, when it comes to potency and analgesic effect, DHC is generally considered to be more potent than codeine, providing stronger analgesic effects at equivalent doses.

Furthermore, when it comes to metabolism and pharmacokinetics, toth codeine and DHC undergo hepatic metabolism, primarily via the CYP2D6 enzyme pathway. However, DHC is metabolized more efficiently than codeine. Also, Codeine is metabolized into morphine via CYP2D6, which contributes significantly to its analgesic effects.

DHC is metabolized into dihydromorphine, which also contributes to its analgesic properties.

What is Dihydrocodeine?

Dihydrocodeine is also an opioid analgesic medication, but it is semi-synthetic. While it is structurally similar and related to codeine, and they also have the same activity and effects, it is twice as strong as codeine and has a higher euphoric impact on the person taking it, as well as a higher risk of dependence and abuse. Dihydrocodeine was developed in the hopes of finding a more effective and better alternative to codeine.

Dihydrocodeine is also used for the treatment of cough, used as a pain medication, and also is used for the treatment for dyspnea (difficult breathing). Also, unlike Codeine, which is generally only found in couch syrup form, dihydrocodeine can be found in more forms such as tablets, solutions, elixirs, and other oral forms. In some countries, dihydrocodeine can also be found as an injectable that is used for intramuscular and deep subcutaneous administration. This is unlike codeine, which cannot be injected due to the risk of anaphylaxis or pulmonary edema, along with a potential large histamine release.


  1. Combination Formulations:
    • Codeine is often formulated in combination with other medications, such as paracetamol (acetaminophen) or ibuprofen, to enhance its analgesic effects.
    • DHC may also be found in combination formulations with other analgesics or non-opioid medications.

The big difference: Dihydrocodeine is semi-synthetic and almost twice as strong as Codeine.

Similarities Between Codeine and Dihydrocodeine

While most of the differences between codeine and dihydrocodeine are primarily within the structure of the two substances, it is important to talk about the biggest similarity between the two. That is their risk of abuse and addiction. While these two substances may not be the most potent when taken as prescribed, if they are taken in excess and more often than needed, you risk the possibility of addiction.

After all, both substances are still opioids, which have a very high likelihood of misuse and physical dependence, like most pain relievers.  Not only is abuse and addiction to these two substances possible, but it also can act as a gateway to stronger opioid use like stronger prescription medications or illegal street drugs such as heroin.


How Does Codeine Help with Coughs?

When it is prescribed for a cough, it works by decreasing the activity in that particular part of the brain that causes coughing. Compared to other opioid medication options, codeine is thought to have pretty low potency and is not generally used for pain treatment due to there being better options available. While codeine is normally found in the form of cough syrup because it is most prescribed for that, it can also be found in tablet form.

Basically, it has two main uses:

  • Pain Management – Both codeine and DHC are used for pain relief, ranging from mild to moderate pain. However, DHC is often preferred for cases of moderate to severe pain due to its increased potency.
  • Antitussive Properties – Codeine is commonly used as an antitussive (cough suppressant), particularly in over-the-counter cough medications. DHC may also possess antitussive properties, although it is less commonly utilized for this purpose.

There are also prescribing considerations when taking codeine: 

  • Individual Variability – Due to genetic variability in the CYP2D6 enzyme, some individuals may metabolize codeine and DHC differently, leading to variations in efficacy and side effects.
  • Patient-Specific Factors – Prescribing decisions should consider factors such as the patient’s pain severity, medical history, concomitant medications, and risk of opioid misuse.

Aside from the prescribing consideration, users or patients may experience the following side effects and adverse effects, especially if they take more than what is prescribed. 

It’s common Side Effects for both codeine and DHC can cause side effects such as drowsiness, constipation, dry mouth, and sedation.

When it comes to respiratory depression and toxicity, high doses of both medications can lead to respiratory depression, a potentially life-threatening side effect, while toxicity risk increases with higher doses and prolonged use.

Meanwhile, if the user experiences an abrupt cessation of either medication, it can lead to withdrawal symptoms, including anxiety, insomnia, sweating, and gastrointestinal disturbances.


In conclusion, while codeine and dihydrocodeine share similarities in their opioid properties and therapeutic uses, there are notable differences in potency, metabolism, and side effect profiles. Healthcare professionals must consider these factors when prescribing these medications for pain management and cough suppression, taking into account individual patient needs and safety concerns.

Treatment for Codeine Abuse

We at Recreate Life Counseling understand the seriousness of drug dependence and abuse, no matter what the substance is, and we believe your addiction must be treated as soon as possible. We focus on treating addiction with a combination of effective treatments, predominantly focusing on group and individual therapy.

If you or someone you love has been struggling with substance abuse or addiction, please feel free to give us a call today. We will discuss treatment options and do our best to point you in the right direction. Now is the time to turn your life around. Let us help you do it.

Published on: 2020-07-05
Updated on: 2024-07-08