paracetamol and dihydrocodeine

CLINICAL USE

Analgesic

DOSE IN NORMAL RENAL FUNCTION

1–2 tablets up to 4 times a day

PHARMACOKINETICS

Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Paracetamol: 151.2; dihydrocodeine: 451.5 (as tartrate)

%Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Paracetamol: 20–30; dihydrocodeine: –

%Excreted unchanged in urine &nbsp &nbsp : Paracetamol: <5; dihydrocodeine: 13–22

Volume of distribution (L/kg) &nbsp &nbsp &nbsp :Paracetamol: 1–2; dihydrocodeine: 1.1

half-life – normal/ESRD (hrs)&nbsp &nbsp &nbsp :Paracetamol: 1–4/Unchanged; dihydrocodeine: 3.5–5/6+

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 &nbsp &nbsp : Dose as in normal renal function

10 to 20 &nbsp &nbsp : 50–100% of dose every 6 hours

<10 &nbsp &nbsp &nbsp &nbsp &nbsp : 50–100% of dose every 6–8 hours

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp:Not dialysed. Dose as in GFR <10 mL/min

HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Not dialysed. Dose as in GFR <10 mL/min

HDF/high flux &nbsp :Unknown dialysability. Dose as in GFR <10 mL/min

CAV/VVHD &nbsp &nbsp &nbsp:Unknown dialysability. Dose as in GFR 10 to 20 mL/min

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugsNone known

ADMINISTRATION

Reconstition

–

Route

Oral

Rate of Administration

–

Comments

–

OTHER INFORMATION

Active metabolites of dihydrocodeine accumulate in renal impairment (drowsiness/lightheadedness/constipation). Increased cerebral sensitivity in patients with renal failureCo-dydramol

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