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.
Hydrocodone Bitartrate 10mg/
Acetaminophen 650mg
As a narcotic, hydrocodone relieves
pain by binding to
opioid receptors in the
brain and
spinal cord. 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.
| 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 orange 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) |
Blueish/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 |
Generic |
5 mg
(500 mg
acetaminophen) |
White tablets bisected on one side
and debossed "M357" on the other side |
Generic |
7.5 mg
(325 mg
acetaminophen) |
White tablets bisected on one side
and debossed "M366" on the other side |
Generic |
7.5 mg
(500 mg
acetaminophen) |
White tablets bisected on one side
and debossed "M358" on the other side |
Generic |
7.5 mg
(650 mg
acetaminophen) |
White tablets bisected on one side
and debossed "M359" on the other side |
Generic |
7.5 mg
(750 mg
acetaminophen) |
White tablets bisected on one side
and debossed "M360" on the other side |
Generic |
10 mg
(325 mg
acetaminophen) |
White tablets bisected on one side
and debossed "M367" on the other side |
Generic |
10 mg
(500 mg
acetaminophen) |
White tablets bisected on one side
and debossed "M363" on the other side |
Generic |
10 mg
(650 mg
acetaminophen) |
Blue tablets bisected on one side
and debossed "M361" on the other side |
Generic |
10 mg
(660 mg
acetaminophen) |
White tablets bisected on one side
and debossed "M362" on the other side |
Generic |
10 mg
(750 mg
acetaminophen) |
White tablets bisected on one side
and debossed "M364" on the other side |
Generic |
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.
Hydrocodone in popular culture
- 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 TV series
Baywatch (episode Hijacked, season 8, episode 11) the character Neely Capshaw (
Gena Lee Nolin) suffers from a Vicodin dependency.
- 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 film
The Ring, when Katie's mother calls, her friend Becca (spending the night at Katie's house), asks her to ask her mother "where she keeps the Vicodin".
- 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
- In the TV series Two and a Half Men, Charlie constructs a sewed picture saying " God Bless Vicodin"
- Political radio talk show host
Rush Limbaugh became dependent on Vicodin after an unsuccessful back operation that resulted in his entering rehab to break the addiction the Vicodin consumption that resulted in legal troubles for Limbaugh in Palm Beach County, Florida.
- Rapper
Eminem has a Vicodin tattoo on his left arm.
[4]
See also
References
-
^
Hycodan package insert (PDF). Endo Pharmaceuticals (November 2001). Retrieved on
2006-12-06.
-
^
Zydone package insert (PDF). Endo Pharmaceuticals (August 1, 2003). Retrieved on
2006-12-06.
-
^
BLG Labs Products. Retrieved on
2007-04-19.
External links
-
Links to external chemical sources
|
Analgesics
(
N02A
,
N02B
) |
|
Opioids |
Buprenorphine,
Butorphanol,
Codeine,
Dextropropoxyphene,
Diamorphine, Dihydrocodeine,
Fentanyl, Hydrocodone,
Hydromorphone,
Ketobemidone,
Levorphanol,
Methadone,
Morphine,
Nicomorphine,
Opium,
Oxycodone,
Oxymorphone, Pethidine (see also
longer list) |
|
Salicylic acid and derivatives |
Aspirin (Acetylsalicylic Acid),
Diflunisal,
Ethenzamide,
|
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