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Hyperkinetic reaction to dihydrocodeine
James David van Oppen1,2, Neeta Patel2, Aamir Tarique2
1Department of Health Sciences, University of Leicester, Leicester, UK jvo3@leicester.ac.uk.
BMJ Case Reports
|January 24, 2020
Summary
Dihydrocodeine can cause serotonin toxicity, leading to restlessness and twitching. This rare side effect may be heightened when combined with cannabidiol, resolving upon drug withdrawal.
Area of Science:
- Pharmacology
- Neurology
- Toxicology
Background:
- Dihydrocodeine is an opioid analgesic used for pain relief.
- Suppurative otitis media is a bacterial infection of the middle ear.
- Serotonin toxicity is a potentially life-threatening condition caused by excessive serotonergic agonism.
Observation:
- A young male patient presented with restlessness and involuntary movements (twitching) of limbs.
- The patient had a fever but otherwise stable vital signs and no neurological deficits.
- He was using dihydrocodeine for ear pain secondary to suppurative otitis media.
Findings:
- The working diagnosis was a hyperkinetic reaction to dihydrocodeine, consistent with serotonin toxicity.
- Symptoms resolved spontaneously within 48 hours after discontinuing dihydrocodeine.
- A theoretical risk exists for potentiated side effects when dihydrocodeine is co-administered with cannabidiol-based products.
Implications:
- This case highlights serotonin toxicity as a rare but significant adverse effect of dihydrocodeine.
- Clinicians should consider serotonin toxicity in patients presenting with hyperkinetic symptoms while on dihydrocodeine.
- The potential for drug interactions, particularly with substances like cannabidiol, warrants further investigation.
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