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Hydrocodone

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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 (marketed as Vicodin, Anexsia, Dicodid, Hycodan (or generically Hydromet), Hycomine, Lorcet, Lortab, Norco, Novahistex, Hydroco, Tussionex, Vicoprofen, Xodol) 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. Sales and production of this drug have increased significantly in recent years, as have diversion and illicit use. Hydrocodone is commonly available in tablet, capsule and syrup form.

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

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. 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 guifenisen and small amounts of ethanol as active ingredients. In Germany and elsewehere, 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 hot/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 addicts to use only single entity opiates such as OxyContin.

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.

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 ignored by some people.

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 debossed "VICODIN" on the other side		 Vicodin
7.5 mg
(750 mg acetaminophen)		 White tablets with tapered edges bisected on one side
and debossed "VICODIN ES" on the other side		 Vicodin ES
10 mg
(660 mg acetaminophen)		 White tablets bisected on one side
and debossed "VICODIN HP" on the other side		 Vicodin HP
7.5 mg
(200 mg ibuprofen)		 Round white tablets debossed on one side with "VP" above the Abbott logo
(a stylized, lower case "a") and blank on the other side		 Vicoprofen

UCB Pharma

Dosage Appearance Trademark Name
2.5 mg
(500 mg acetaminophen)		 White tablets with red specs bisected and debossed "901" on one side
and debossed "UCB" on the other side		 Lortab
5 mg
(500 mg acetaminophen)		 White tablets with blue specs bisected and debossed "902" on one side
and debossed "UCB" on the other side		 Lortab
7.5 mg
(500 mg acetaminophen)		 White tablets with green specs bisected and debossed "903" on one side
and debossed "UCB" on the other side		 Lortab
10 mg
(500 mg acetaminophen)		 Pink tablets bisected and debossed "910" on one side
and debossed "UCB" on the other side		 Lortab
5 mg
(500 mg aspirin)		 Red tablets mottled with white and debossed "500" on one side
and (possibly?) debossed "UCB" on the other side		 Lortab ASA
7.5 mg per 15 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)

Dosage Appearance Trademark Name
10 mg
(750 mg acetaminophen)		 Yellow tablets bisected on one side
and debossed "Maxidone 634" on the other side		 Maxidone®
5 mg
(325 mg acetaminophen)		 White tablets with orange specks bisected and debossed "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 debossed "NORCO 729" on the other side		 Norco® 7.5/325
10 mg
(325 mg acetaminophen)		 Yellow tablets bisected on one side
and debossed "NORCO 539" on the other side		 Norco®
Dosage Appearance Trademark Equivalent
2.5 mg
(500 mg acetaminophen)		 White tablets bisected on one side
and debossed "WATSON 388" on the other side		 Lortab®
5 mg
(325 mg acetaminophen)		 White tablets with orange specks bisected and debossed "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 debossed "WATSON 349" on the other side		 Vicodin®
7.5 mg
(325 mg acetaminophen)		 Light Pink oblong tablets bisected on one side
and debossed "WATSON 3203" on the other side		 Norco® 7.5/325
7.5 mg
(500 mg acetaminophen)		 White tablets bisected on one side
and debossed "WATSON 385" on the other side		 Lortab®
7.5 mg
(650 mg acetaminophen)		 Pink tablets bisected on one side
and debossed "WATSON 502" on the other side		 Lorcet Plus®
7.5 mg
(750 mg acetaminophen)		 White tablets bisected on one side
and debossed "WATSON 387" on the other side		 Vicodin ES®
10 mg
(325 mg acetaminophen)		 Yellow tablets bisected on one side
and debossed "WATSON 853" on the other side		 Norco®
10 mg
(500 mg acetaminophen)		 Bluish/purple tablets bisected on one side
and debossed "WATSON 540" on the other.		 Lortab®
10 mg
(650 mg acetaminophen)		 Light green tablets bisected on one side
and debossed "WATSON 503" on the other side		 Lorcet 10/650®
10 mg
(660 mg acetaminophen)		 White tablets bisected on one side
and debossed "WATSON 517" on the other side		 Vicodin HP®
10 mg
(750 mg acetaminophen)		 Yellow tablets bisected on one side
and debossed "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 debossed "M365 on the other side		 Vicodin®
5 mg
(500 mg acetaminophen)		 White tablets bisected on one side
and debossed "M357" on the other side		 Vicodin®
7.5 mg
(325 mg acetaminophen)		 White tablets bisected on one side
and debossed "M366" on the other side		 Vicodin®
7.5 mg
(500 mg acetaminophen)		 White tablets bisected on one side
and debossed "M358" on the other side		 Vicodin®
7.5 mg
(650 mg acetaminophen)		 White tablets bisected on one side
and debossed "M359" on the other side		 Vicodin®
7.5 mg
(750 mg acetaminophen)		 White tablets bisected on one side
and debossed "M360" on the other side		 Vicodin®
10 mg
(325 mg acetaminophen)		 Yellow tablets bisected on one side
and debossed "2032" on the other side		 Vicodin®
10 mg
(500 mg acetaminophen)		 Yellow tablets bisected on one side
and debossed "2050" on the other side		 Vicodin®
10 mg
(650 mg acetaminophen)		 Yellow tablets V on one side
and debossed "2065" on the other side		 Vicodin®
10 mg
(660 mg acetaminophen)		 Blue tablets V on one side
and debossed "2106" on the other side		 Vicodin®
10 mg
(750 mg acetaminophen)		 Blue tablets V on one side
and debossed "2107" on the other side		 Vicodin®

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]
  • In the first season of the FOX television series The OC, main character Marissa Cooper overdoses on vicodin while partying in Tiajuana, Mexico.

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.
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