Usage in Ambulatory Patients: Dihydrocodeine may impair the mental and/or physical abilities
required for the performance of potentially hazardous tasks such as driving a car or operating machinery.

Respiratory Depression: Respiratory depression is the most dangerous acute reaction produced
by opioid agonist preparations, although it is rarely severe with usual doses. Opioids decrease the
respiratory rate, tidal volume, minute ventilation, and sensitivity to carbon dioxide. Respiratory
depression occurs most frequently in elderly more debilitated patients, usually after large initial doses
in non-tolerant patients, or when opioids are given in conjunction with other agents that depress
respiration. This combination product should be used with caution in patients with significant chronic
obstructive pulmonary disease or cor pulmonale and in patients with a substantially decreased
respiratory reserve, hypoxia hypercapnia, or respiratory depression.

Hypotensive Effect: Dihydrocodeine, like all opioid analgesics, may cause hypotension in patients
whose ability to maintain blood pressure has been compromised by a depleted blood volume or who
receive concurrent therapy with drugs such as phenothiazines or other agents which compromise
vasomotor tone. POLY HIST DHC Liquid may produce orthostatic hypotension in ambulatory patients.
This combination product should be administered with caution to patients in circulatory shock, since
vasodilation produced by the drug may further reduce cardiac output and blood pressure.

Dependence: Dihydrocodeine can produce drug dependence of the codeine type and has the
potential of being abused. This product should be prescribed and administered with the appropriate
degree of caution. (See Drug Abuse and Dependence section).

PRECAUTIONS
General: This combination product should be used with caution in elderly or debilitated patients
or those with any of the following conditions: adrenocortical insufficiency (e.g., Addison's disease);
asthma; central nervous system depression or coma; chronic obstructive pulmonary disease;
decreased respiratory reserve (including emphysema, severe obesity, cor pulmonale, or
kyphoscoliosis); delirium tremens; diabetes; head injury; hypotension; hypertension; increased
intracranial pressure; myxedema or hypothyroidism; prostatic hypertrophy or urethral stricture; and
toxic psychosis. The benefits and risks of opioids in patients taking monoamine oxidase inhibitors
and in those with a history of drug abuse should be carefully considered. This combination product
may aggravate convulsions in patients with convulsive disorders, and like all opioids, may induce or
aggravate seizures in some clinical settings.

DRUG INTERACTIONS
General: Sympathomimetics may reduce the antihypertensive effects of methyldopa,
mecamylamine, reserpine and veratrum alkaloids.

Other Central Nervous System Depressants: