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Palliative cancer care - pain - Management
Which weak opioid drug should I prescribe?
- Codeine or dihydrocodeine is recommended:
- If flexibility of dosing and titration of analgesic effect are required, prescribe the weak opioid separately to paracetamol.
- If compliance is likely to be a problem and analgesic requirements are stable, consider prescribing a product combining 500 mg of paracetamol with 30 mg of codeine.
- To prevent constipation, prescribe a stimulant laxative (such as senna or bisacodyl) and a softening laxative (such as docusate).
- A laxative with both properties (for example, co-danthramer or co-danthrusate) is also an option.
- Avoid dantron-containing laxatives in people who are incontinent as these drugs can cause a chemical burn (reddening) of the perianal area.
- Dantron can also colour the urine red and alarm the person.
Basis for recommendation
- CKS recommends codeine and dihydrocodeine because in clinical practice they are of equivalent potency and have approximately the same duration of action [Twycross and Wilcock, 2007; SIGN, 2008].
- The recommendation to use a laxative is based on expert opinion in the Palliative Care Formulary [Twycross and Wilcock, 2007] and reviewers.
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