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Palliative cancer care - pain - Management
What issues should I consider before prescribing codeine or dihydrocodeine?
- Codeine and dihydrocodeine may cause nausea, vomiting, and drowsiness [BNF 56, 2008].
- Constipation is another common adverse effect [BNF 56, 2008].
- To prevent constipation, prescribe a stimulant laxative (such as senna or bisacodyl) and a softening laxative (such as docusate or lactulose):
- 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.
- For more information, see the CKS topic on Palliative cancer care - constipation.
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