Saturday, 5 May 2012

Football + Broken Rib = Dihydrocodeine

A few years ago, 4 years I guess, I went for an 11-a-side match with my friend Jorge Escriba (then a PhD student of modern languages, nowadays a Professor of Spanish in the University of Newcastle). It was common to be invited for football, the real one, the European one, that you actually play with your feet, not with your hands, regardless of the participation of the keeper.

We used to play every Monday around 7pm to "chillax" from the the return to the working days of the week. It was nice all the guys getting together to play some ball and enjoy the exercise. Some of us are competitive, some just take the opportunity to enjoy the sports, I for one like to enjoy my football whilst trying to win. However, my teams's victory is not important if my team gave the very best they could. This is a rule in life for me, I don't mind losing, not everyone in life can win everyday, there'll be a day you'll eventually lose... but if you're in my team and you're not giving your very best I get pissed off. 

So, we play and have fun, but for the sake of my patience if we're investing our time let's try to win. That is the soul I put in all my football matches, and that attitude makes a lot of people upset because even though their football might be awesome (and believe me I have always considered my football to be of an excellent level, with proper club experience and stuff) I will cut all the passing lines, I will run, I will distribute, I will apologise to my fellows for losing that ball and I'll support them whenever they mess up. I will be there with my team 'til the end. 

Well, as I was saying, eleven-a-side, 5 minutes of football, I get the ball in front of the goal ready to score and a perfect idiot with no chance to take the ball from me at all tackles me from behind destroying my right foot and putting an end to my football days. He laughed and mocked me on my way home and left me in a bed for two weeks compromising two weeks of work on my Masters. 

After promising my wife my football days would be over, I decided to give it a second shot against her will and best advise. Another invitation, this time from James in CBS (where both work) and an accidental push on my back hitting my chest against the turf... broken rib... liquid in my lung... 6 weeks without any tough exercise, 2 weeks until I am allowed simple low cardio exercising.

After NHS proved what I already knew, when it comes to dangerous injuries or serious diseases they will give you their very best at all times. On the contrary, try to show up there with a "simple" twisted ankle and you'll see!!! Nevertheless, I was very well treated and am now in bed updating the blog with the latest news, i.e., football plus broken rib equals dihydrocodeine.

I was so high on this analgesic yesterday that I decided to let the world know everything important that there is to know about this pharmaceutical. So, welcome to the history, pharmacokinetics and some other facts of


This potent semisynthetic narcotic analgesic with strong antitussive activity can come as a white flat/bevel edged tablet. It is an analgesic indicated for the relief of pain ranging from moderate to severe [1]. Tablets contain dihydrocodeine tartrate (30mg) that should be taken orally if possible after you've eaten because that will get you to feel very sleepy and your heart rate will lower too. As any analgesic it is completely forbidden to mix it with alcohol, a serious cerebral damage can be the consequence of takings with any alcoholic beverage. Any physician would advise you not to do that, as well as checking you out for any type of high intracranial pressure or head injury as this pharmaceutical "affects papillary response vital for neurological assessment". Health staff assessing you would also check you for respiratory problems too... and the usual restrictions known to every single person who suffers with renal and/or hepatic complications, opioid abuse or even hypotension. 

Because dihydrocodeine is so good "killing pain" it might make you insensitive to it if you're a chronic user. In addition, it can cause dependence!, and that is why I am having it today and replacing it for good old Paracetamol as soon as possible. I never liked substances that eventually might have the potential to cause dependence. I've always liked to be totally aware and in control of my actions and thoughts. What's the point of seeing pink elephants sharing a tea with you whilst going all philosophical on the ideas of Confucius??? Yeah, you pink elephant, I'm talking to you, stop waving that big hose towards me. Is that a nose? Is that a penis? God damn philosophical pink elephants coming every morning to join me for tea!!!!!!!

There is an incredibly high risk of addiction when taking this opioid agonists for too long, and I have always avoided substances that might get you wrapped in their web. That's why I stopped smoking 5 years ago after 10 years of regular smoking. Dihydrocodeine's potency can be put in between morphine and codeine. It acts in the brain by reducing the perception of pain and anxiety associated to the painful state. Dihydrocodein acts over the brain stem respiratory centres, hence, it is important for those taking it to know if they have at any point a respiratory depression [1].

There is a world of information concerning dihydrocodeine, a very dangerous psychotropic if used irresponsably. My idea for this post is just to provide general information for the curious ones. Its antitussive characteristics come from the "depression of the cough reflex by direct effect on the cough centre in the medulla" [1]. When taking it constipation is expected as it does act by reducing "motility associated with an increase in smooth muscle tone in the antrum of the stomach and duodenum."

Finally, a few more curious facts about this drug:

- mainly metabolised in the liver with produced metabolites (o-demethylation, n-demethylation and 6-keto reduction, DHC-6-glucuronide [2]) being excreted in the urine;
- "doses up to 2500 mg a day are prescribed in substitution therapy for heroin drug addicted people [2].

I'll see you guys soon, as soon as I get better and go back to work. For the coming days I am planning to watch all the four episodes of a very nice series I found the other day about Victorian Pharmacies.

Have a nice weekend.


[1] dihydrocodeine - summary of product characteristics,, last access on the 05th of May 2012, last update on the 12th of April 2011.

[2] Ammon, S.; Hofmann, U.; Griese, E-U.; Gugeler, N.; Mikus, G. (11999). "Pharmacokinetics of dihydrocodeine and its active metabolite after single and multiple oral dosing". Journal of Clinical Pharmacology, 48, pp. 317-322.

Image taken from dihydrocodeine - Bristol Laboratories Ltd, [], last access on the 05th of May 2012, last update unknown.

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