Jump to content

Hydrocodone

From Wikipedia, the free encyclopedia

This is an old revision of this page, as edited by JonM.D. (talk | contribs) at 07:49, 25 December 2007 (→Overdosing risks: added information about overdose in relation to lack of education about hydrocodone and information about adverse reactions). The present address (URL) is a permanent link to this revision, which may differ significantly from the current revision.

Hydrocodone
Clinical data
Pregnancy
category
  • Category C (USA)
Routes of
administration		Oral, intravenous, intramuscular, subcutaneous, sublingual, intranasal
ATC code
Legal status
Legal status
Pharmacokinetic data
BioavailabilityHigh
MetabolismHepatic
Elimination half-life3.8 hours
Identifiers
  • 4,5a-Epoxy-3-methoxy-17-methylmorphinan-6-one tartrate (1:1) hydrate (2:5)
CAS Number
PubChem CID
DrugBank
CompTox Dashboard (EPA)
ECHA InfoCard100.004.304 Edit this at Wikidata
Chemical and physical data
FormulaC18H21NO3
Molar mass299.368 g·mol−1

Hydrocodone or dihydrocodeinone is a semi-synthetic opioid derived from two of the naturally occurring opiates, codeine and thebaine. Hydrocodone is an orally active narcotic analgesic and antitussive.

Marketed as Vicodin, Anexsia, Dicodid, Hycodan (or generically Hydromet), Hycomine, Lorcet, Lortab, Norco, Novahistex, Hydroco, Tussionex, Vicoprofen, Xodol. Bekadid, Calmodid, Codinovo, Duodin, Kolikodol,Orthoxycol, Mercodinone, Synkonin, Norgan,Hydrokon), Hydrocodone is commonly available in tablet, capsule and syrup form. Hydrocodone was invented in Germany in 1920 and approved by the FDA for use in the US on 27 May 1951.[citation needed]

File:650.jpg
Hydrocodone Bitartrate 10mg/
Acetaminophen 650mg

Overview

As a narcotic, hydrocodone relieves pain by binding to opioid receptors in the brain and spinal cord. It can be taken with or without food as desired. When taken with alcohol, it can intensify drowsiness. It may interact with monoamine oxidase inhibitors, as well as other drugs that cause drowsiness. It is in FDA pregnancy category C: its effect on an embryo or fetus is not clearly known and pregnant women should consult their physicians before taking it. Common side effects include dizziness, lightheadedness, nausea, drowsiness, euphoria, vomiting, and constipation. Some less common side effects are allergic reaction, blood disorders, changes in mood, mental fogginess, anxiety, lethargy, difficulty urinating, spasm of the ureter, irregular or depressed respiration, and rash.

Hydrocodone is habit-forming, and can lead to physical and psychological addiction; however, the potential for addiction varies from individual to individual depending on unique biological differences. Sales and production of this drug have increased significantly in recent years, as have diversion and illicit use. In the U.S., pure hydrocodone and forms containing more than 15 mg per dosage unit are considered Schedule II drugs. Those containing less than or equal to 15 mg per dosage unit in combination with acetaminophen or another non-controlled drug are called hydrocodone compounds and are considered Schedule III drugs. Hydrocodone is typically found in combination with other drugs such as paracetamol (acetaminophen), aspirin, ibuprofen and homatropine methylbromide. The purpose of the non-controlled drugs in combination is often twofold. 1) To provide increased analgesia via drug synergy. 2) To limit the intake of hydrocodone by causing unpleasant and often unsafe side effects at higher than prescribed doses (See Below). In the UK it is listed as a Class A drug under the Misuse of Drugs Act 1971. Hydrocodone is not available in pure form in the United States due to a separate regulation, and is always sold with an NSAID, acetaminophen or an antihistamine. The cough preparation Codiclear DH is the purest US hydrocodone item, containing guaifenesin and small amounts of ethanol as active ingredients. In Germany and elsewhere, hydrocodone is available as single-active-ingredient tablets as Dicodid (by analogy to the original manufacturer's other products Dilaudid and Dinarkon and others) available in 5 and 10 mg strengths.

Overdosing risks

The presence of acetaminophen in hydrocodone-containing products deters many drug users from taking excessive amounts. However, some users will get around this by extracting a portion of the acetaminophen using cold water, taking advantage of the water-soluble element of the drug. It is not uncommon for addicts to have liver problems from consuming excessive amounts of acetaminophen over a long period of time; taking 10,000 to 15,000 milligrams (10 to 15 grams) of acetaminophen in a period of 24 hours typically results in severe hepatotoxicity, and doses in the range of 15,000–20,000 milligrams a day have been reported as fatal.[1] It is this factor that leads many recreational users to use only single entity opiates such as OxyContin. One of the major problems today with the illicit use of hydrocodone, especially in younger populations, is that users are not even aware that hydrocodone pills contain acetaminophen. On top of that consuming more than 2,000 milligrams of acetaminophen a day can cause liver damage, jaundice, and even liver failure if the drug is being taken in narcotic effect seeking dosages for an extended period of time

Daily consumption of hydrocodone should not exceed 40 milligrams in patients not tolerant to opiates. However, the 2006 PDR (Physicians Desk Reference) clearly states that Norco 10, containing 10 milligrams of hydrocodone and 325 milligrams of APAP (viz., acetaminophen or paracetamol), can be taken at a dosage of up to twelve tablets per day (120 milligrams of hydrocodone). Such high amounts of hydrocodone are only intended for opiate-tolerant patients, and titration to such levels must be monitored very carefully. This restriction is only limited by the fact that twelve tablets, each containing 325 milligrams of APAP, puts the patient right below the 24-hour FDA maximum of 4,000 mg of APAP. Some specially compounded products are routinely given to chronic pain patients in doses of up to 180 mg of hydrocodone per day. Symptoms of hydrocodone overdosage include respiratory depression, extreme somnolence, coma, stupor, cold and/or clammy skin, sometimes bradycardia, and hypotension. A severe overdose may involve circulatory collapse cardiac arrest and/or death. Mixing hydrocodone with alcohol, cocaine, amphetimines, methylphenidate, benzodiazapines, barbituites, and a number of other medication can have severe adverse reactions including but not limited to: Heart failure, Heart attack, Respitory distress, pulminary failure, live or kidney failure, jaundice, amnesia, seizures, blackouts, and coma. mixing acetaminophen with other NSAID analgesics like sulindac or tramadal can cause serious damage to organs.

Alcohol

It is not recommended to mix any amount of hydrocodone with any amount of alcohol as doing so could cause health problems. APAP is metabolized solely by the liver. Therefore the risk of fatal overdose due to hepatotoxicity can occur with significantly lower levels of APAP when mixed with ethanol.[2] Due to the feeling of euphoria it provides, these potentially negative consequences are often ignored by physically and/or psychologically dependent users.

Commercial medications containing hydrocodone

When sold commercially in the USA, hydrocodone is always combined with another medication. Those combined with acetaminophen are known by various trademark names, such as Vicodin and Lortab. Hydrocodone also can be combined with aspirin (e.g., Lortab ASA), ibuprofen (e.g., Vicoprofen), and certain antihistamines (e.g., Chemdal HD). Pure Hydrocodone tablets or capsules are not offered currently by any USA drug company.

Combining an opioid such as hydrocodone with another analgesic can increase the effectiveness of the drug without increasing opioid-related side effects (e.g., nausea, constipation, sedation). Another argument for combining hydrocodone with acetaminophen is that it limits the potential for abuse. In tolerant users, hydrocodone can be taken in large doses relatively safely, but acetaminophen is fatally toxic to the liver in large quantities.

Below are some of the commercially available medications containing hydrocodone, listed by manufacturer.

Abbott Laboratories

Dosage Appearance Trademark Name
5 mg
(500 mg acetaminophen)		 White tablets bisected on one side
and impressed "VICODIN" on the other side		 Vicodin
7.5 mg
(750 mg acetaminophen)		 White tablets bisected on one side
and impressed "VICODIN ES" on the other side		 Vicodin ES
10 mg
(660 mg acetaminophen)		 White tablets bisected on one side
and impressed "VICODIN HP" on the other side		 Vicodin HP
7.5 mg
(200 mg ibuprofen)		 White disk-shaped tablets impressed
on one side with "VP" and the Abbott logo		 Vicoprofen

UCB Pharma

Dosage Appearance Trademark Name
2.5 mg
(500 mg acetaminophen)		 White tablets with red specs bisected and impressed "901" on one side
and impressed "UCB" on the other side		 Lortab
5 mg
(500 mg acetaminophen)		 White tablets with blue specs bisected and impressed "902" on one side
and impressed "UCB" on the other side		 Lortab
7.5 mg
(500 mg acetaminophen)		 White tablets with green specs bisected and impressed "903" on one side
and impressed "UCB" on the other side		 Lortab
10 mg
(500 mg acetaminophen)		 Pink tablets bisected and impressed "910" on one side
and impressed "UCB" on the other side		 Lortab
5 mg
(500 mg aspirin)		 Red tablets mottled with white and impressed "500" on one side
and impressed "UCB" on the other side		 Lortab ASA
7.5 mg per 5 ml
(500 mg acetaminophen)		 Yellow, tropical-punch flavored liquid with 7% alcohol Lortab Elixir

Watson Pharmaceuticals, Inc.

(NOTE: Watson manufactures under its own Trademarks and generic Trademark Equivalents. Watson Pharmaceucticals also has a subsidiary Andrx Pharmaceuticals)

Dosage Appearance Trademark Names
10 mg
(750 mg acetaminophen)		 Yellow tablets bisected on one side
and impressed "Maxidone 634" on the other side		 Maxidone®
5 mg
(325 mg acetaminophen)		 White tablets with orange specks bisected and impressed "Watson" on one side
and "Watson 913" on the other side		 Norco® 5/325
7.5 mg
(325 mg acetaminophen)		 Light orange oblong tablets bisected on one side
and impressed "NORCO 729" on the other side		 Norco® 7.5/325
10 mg
(325 mg acetaminophen)		 Yellow tablets bisected on one side
and impressed "NORCO 539" on the other side		 Norco®
Dosage Appearance Trademark Equivalents
2.5 mg
(500 mg acetaminophen)		 White tablets bisected on one side
and impressed "WATSON 388" on the other side		 Lortab®
5 mg
(325 mg acetaminophen)		 White tablets with orange specks bisected and impressed "Watson" on one side
and "3202" on the other side		 Norco® 5/325
5 mg
(500 mg acetaminophen)		 White oblong tablets bisected on one side
and impressed "WATSON 349" on the other side		 Vicodin®
7.5 mg
(325 mg acetaminophen)		 Light Pink oblong tablets bisected on one side
and impressed "WATSON 3203" on the other side		 Norco® 7.5/325
7.5 mg
(500 mg acetaminophen)		 White tablets bisected on one side
and impressed "WATSON 385" on the other side		 Lortab®
7.5 mg
(650 mg acetaminophen)		 Pink tablets bisected on one side
and impressed "WATSON 502" on the other side		 Lorcet Plus®
7.5 mg
(750 mg acetaminophen)		 White tablets bisected on one side
and impressed "WATSON 387" on the other side		 Vicodin ES®
10 mg
(325 mg acetaminophen)		 Yellow tablets bisected on one side
and impressed "WATSON 853" on the other side		 Norco®
10 mg
(500 mg acetaminophen)		 Bluish/purple tablets bisected on one side
and impressed "WATSON 540" on the other.		 Lortab®
10 mg
(650 mg acetaminophen)		 Light green tablets bisected on one side
and impressed "WATSON 503" on the other side		 Lorcet 10/650®
10 mg
(660 mg acetaminophen)		 (Discontinued) White tablets bisected on one side
and impressed "WATSON 517" on the other side		 Vicodin HP®
10 mg
(660 mg acetaminophen)		 (Replacement)White tablets bisected on one side
and impressed "Andrx Logo 567" on the other side		 Vicodin HP®
10 mg
(750 mg acetaminophen)		 Yellow tablets bisected on one side
and impressed "WATSON 3228" on the other side		 Maxidone®

Mallinckrodt Pharmaceuticals

Dosage Appearance Trademark Name
5 mg
(325 mg acetaminophen)		 White tablets bisected on one side
and impressed "M365 on the other side		 Norco®
5 mg
(500 mg acetaminophen)		 White tablets bisected on one side
and impressed "M357" on the other side		 Vicodin®
7.5 mg
(325 mg acetaminophen)		 White tablets are NOT bisected on one side
and impressed "M366" on the other side		 Norco 7.5®
7.5 mg
(500 mg acetaminophen)		 White tablets bisected on one side
and impressed "M358" on the other side		 Lortab®
7.5 mg
(650 mg acetaminophen)		 White tablets bisected on one side
and impressed "M359" on the other side		 Lorcet Plus®
7.5 mg
(750 mg acetaminophen)		 White tablets bisected on one side
and impressed "M360" on the other side		 Vicodin ES®
10 mg
(325 mg acetaminophen)		 White tablets bisected on one side
and impressed "M367" on the other side		 Norco 10/325®
10 mg
(500 mg acetaminophen)		 White tablets bisected on one side
and impressed "M363" on the other side		 Lortab®
10 mg
(325 mg acetaminophen)		 Yellow tablets V on one side
and impressed "3601" on the other side		 Norco 10/325®
10 mg
(650 mg acetaminophen)		 Blue tablets V on one side
and impressed "3597" on the other side		 Lorcet 10/650®
10 mg
(660 mg acetaminophen)		 White tablets bisected on one side
and impressed "M362" on the other side		 Vicodin HP®

Additional preparations

  • Endo Pharmaceuticals
    • Hycodan®[1]
      1.5 mg homatropine methylbromide and 5mg hydrocodone bitartrate (tablet and syrup formulations)
    • Zydone®[2]
      400 mg acetaminophen and 5 mg, 7.5 mg or 10 mg hydrocodone bitartrate (tablet formulations)
  • BLG Laboratories
    • Generic hydrocodone preparation 7.5mg pure concentration[3]
      • ID: White to off-white tablet. Inscribed. Embossed.
  • NULABO Pharmaco
    • Pure hydrocodone bitartrate avaialable in 5mg and 7.5mg
      • Drug Identification and Description: 5mg= White to off-white crystalline powder. Round, white tablets inscribed "C.oD" and plainface. 7.5mg= White to off-white crystalline powder aggregate. Oval, white tablets inscribed "C.oD". References avaialbe. Photo ID N/A via ref.ID num. WHSLR ID rqrd. On file with EHD.
  • WOIAL Co
    • Hydrocodone bitartrate. Aggregate compounds available. Tablets in 5mg, 7.5mg. Oral, tablet and suspensions. Suspensions available as 7.5mg per metered dose.
    • IDENTIFICATION: Tablets- 5mg= white to off-white. Round. Inscribed "C5". 7.5mg= white to off white. Round. Inscribed "C7". No photo available. On record HD.
  • PDP
    • Hydrocodone preparations (pure) available in the UK as a Class A substance. The US classified as a Schedule II drug.
  • In the TV series House, Dr. Gregory House exhibits and admits to a high dependence on Vicodin to treat chronic pain resulting from past muscle infarction in his right thigh.
  • In the TV series The Book of Daniel, Daniel Webster is dependent on hydrocodone.
  • In the book Generation Rx by Greg Critser, the author talks about a friend, who is an executive at a major studio, that has "Vicodin Fridays" with the entire staff.[3]
  • In the film Just Friends, the mother of the protagonist exhibits euphoric and often loopy characteristics, a behavioral malady later attributed to her Vicodin consumption.
  • In the TV series General Hospital, Lucky Spencer and Alan Quartermaine have both developed and recovered from hydrocodone dependency. In 1999, Stuart Damon won a "Best Supporting Actor" Emmy award for his portrayal of Dr. Quartermaine's addiction
  • Rapper Eminem has a Vicodin tattoo on his left arm. [4]
  • A song by the alternative rock back The Matches called "Papercut Skin" mentions the use of vicodin.
  • A song by rock band Queens of the Stone Age, "Feel Good Hit of the Summer" features Vicodin as one of only seven words in the song (the others being cocaine, nicotine, valium, marijuana, ecstacy, and alcohol.) The song is the first track on their second album, Rated R.
  • In the TV series Two and a Half Men, Charlie Harper is seen lying on his couch, after having been beaten up by Steven Tyler, using counted-thread embroidery to write "I love Vicodin" on a piece of cloth.
  • In the second season of the HBO series Six Feet Under, the character of Sarah, played by Patricia Clarkson, is addicted to vicodin. Her sister Ruth, played by Frances Conroy, and her friend Betina, played by Kathy Bates, assist her in kicking the vicodin habit. At one point Ruth and Betina need to tie Sarah to her bed to keep her from raiding her secret vicodin supply. In the fifth season, Brenda uses Vicodin to deal with the pain from her miscarriage.

See also

References

  1. ^ "Hycodan package insert" (PDF). Endo Pharmaceuticals. November 2001. Retrieved 2006-12-06.
  2. ^ "Zydone package insert" (PDF). Endo Pharmaceuticals. August 1, 2003. Retrieved 2006-12-06.
  3. ^ "BLG Labs Products". Retrieved 2007-04-19.
Retrieved from "https://en.wikipedia.org/enwiki/w/index.php?title=Hydrocodone&oldid=180080678"