Extended-release hydrocodone – gift or curse?

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• J Pain Res
• v.6; 2013
• PMC3555555

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J Pain Res. 2013; 6: 53–57.

Published online 2013 Jan 10. doi: 10.2147/JPR.S33062

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Hydrocodone is a semisynthetic opioid, which has been used for decades as a short-acting analgesic combined with acetaminophen (or less commonly ibuprofen). Several long-acting, non-acetaminophen-containing hydrocodone formulations are undergoing trials in the US under the auspices of the US Food and Drug Administration, and may be available shortly. This article reviews some of the advantages (including drug familiarity and lack of acetaminophen toxicity) and potential disadvantages (including altered use patterns and high morphine equivalent dosing) of such a medication formulation. We also discuss the abuse potential of long-acting versus short-acting opioids in general and hydrocodone specifically, as well as the metabolism of hydrocodone.

Keywords: hydrocodone, long-acting opioids, opioid abuse, acetaminophen toxicity, tamper-resistant opioids

Hydrocodone, especially prescribed in combination with acetaminophen, is the most commonly prescribed opioid in the US.¹ It is marketed in the US under a wide variety of names, depending upon the amount of acetaminophen present. As an example, Lortab^® (UCB Pharma, Brussels, Belgium) has 500 mg of acetaminophen per tablet, Lorcet^® (UAD Laboratories, St Louis, MO) has 650 mg, Vicodin^® (Abbott Laboratories, Abbott Park, IL) has 750 mg, while Zydone^® has 400 mg (Endo Pharmaceuticals Inc, Chadds Ford, PA) and Norco^® (Watson Pharma, Corona, CA) has only 325 mg. In tablet form, with acetaminophen, hydrocodone is available in 2.5, 5, 7.5 and 10 mg tablets. Vicoprophen^® (Halo Pharmaceutical Inc, Whippany, NJ, for Abbott Laboratories) has 7.5 mg hydrocodone with 200 mg of ibuprofen per tablet. Each of these products has a dosing interval of 4–6 hours, with the number of tablets per day limited primarily by the acetaminophen dose. Currently, the recommended dose for chronic acetaminophen use is 3000 mg/day,² which corresponds to 4–9 tablets per day of mixed hydrocodone/acetaminophen products, depending on the formulation. Acetaminophen is the most common cause of acute liver failure in the US, accounting for nearly half of the cases.³ Because of concerns regarding the recent rise in hepatic toxicity seen with acetaminophen-containing medications, in January 2011 the US Food and Drug Administration (FDA) mandated that combination products should contain no more that 325 mg of acetaminophen per tablet by 2014.⁴

The Drug Enforcement Agency classifies hydrocodone, in combination with acetaminophen or ibuprofen, as a Schedule III drug, because the adjuvant analgesic medication (the acetaminophen) supposedly precludes excessive usage. As a Schedule III medication, it can be called into the pharmacy, and up to six refills given. Unfortunately, this can lead to easy over-prescribing, and has the potential for abuse among chronic pain patients. It is concerning that a US government study identified significant numbers of middle school-aged and high school-aged teenagers in the US as having abused hydrocodone with acetaminophen, presumably because of its easy availability.⁵ A study of emergency department visits in the US from 2004 to 2008 showed that hydrocodone, along with oxycodone and methadone, caused the highest number of emergency department visits among the opioids.⁶ However, an estimate of the abuse risk of hydrocodone adjusted for the volume of prescribing suggested that hydrocodone has one of the lowest rates of abuse for its volume of prescribing.⁷

Medications containing only hydrocodone are rare and are not primarily used as analgesics, but rather are considered to be antitussives. This began to change in 2012, when the US Congress passed an FDA reform bill, instructing the Drug Enforcement Agency to reclassify all products containing hydrocodone from Schedule III to Schedule II.⁸ The Senate version of the bill did not contain these instructions, and the final bill signed into law simply instructs the Drug Enforcement Agency to hold hearings on the matter. The intention of Congress appears to be related to combating prescription opioid abuse; however, multiple medical and pharmacy groups have come out against this proposed rule change, as evidenced by the multiple open letters sent to the members of both Houses.

There have been only a few studies that have compared the different long-acting opioids. Key measures that were identified and compared in different trials of one or more long-acting opioids included reduction of pain, improved functional outcomes, pattern suggesting superiority of one agent over another, and rate of adverse events, as well as any subpopulation of patients in which long-acting opioids are more effective (race, age, gender, or type of pain). Eight trials found no statistical difference in pain relief or function between long-acting opioids. In general, there was insufficient evidence to prove that different long-acting opioids are associated with different efficacy or different adverse event rates. Only one poor quality trial directly compared different long-acting opioids, ie, transdermal fentanyl versus long-acting morphine, and gave inconclusive results. Studies that provided indirect data were too heterogeneous in terms of study design, patient populations, interventions, outcomes assessed, and results to make accurate judgments regarding comparative efficacy and adverse event rates. In addition, evidence was insufficient to determine if long-acting opioids as a class are more effective or associated with less harm than short-acting opioids.⁹

A recent review of the scientific literature concerning long-acting opioids concluded that the evidence did not show significant differences between currently available long-acting opioids, and the results were insufficient to draw any conclusions about the relative role of long-acting versus short-acting opioid analgesics. ⁴ A more limited study by Manchikanti et al comparing patients with chronic pain on short-acting hydrocodone preparations versus long-acting methadone found no difference in compliance or rates of abuse, as assessed by urine drug toxicology.¹⁰ It is interesting to note that in the study of abuse risk of different opioids cited earlier, when adjusted for volume of prescriptions, immediate-release oxycodone had one of the lowest abuse risks, and extended-release oxycodone had one of the highest.⁷

A long-acting formulation of hydrocodone and acetaminophen, Vicodin CR (Abbott Laboratories, Abbott Park, IL), was studied in 2006 to 2008 but was not approved by the FDA. Currently, four pharmaceutical firms are developing long-acting formulations of hydrocodone. Of these, Zogenix Inc (San Diego, CA) completed Phase III trials on Zohydro ER™ and submitted a New Drug Consideration in May 2012. Zohydro ER is an extended-release formulation of pure hydrocodone that uses patented Spheroidal Oral Drug Absorption System (SODAS^®) technology.

The SODAS technology is achieved by the extended-release beads that are prepared using sugar and starch spheres, upon which a drug excipient layer is coated, followed by an ammonio-methacrylate copolymer coating. After rapid dissolution of the hard gelatin capsule shell, the permeability of the ammonio-methacrylate copolymer coating allows gastrointestinal fluid to enter the beads and solubilize the drug. After dissolving, the active medication may then diffuse out of the beads at a predetermined rate. This entire process prolongs the in vivo dissolution of the drug and extends its absorption into the body. This allows for both immediate-release and time-release of hydrocodone for twice daily dosing.¹¹ The SODAS technology is not-tamper resistant. The dose strengths studied range from 10 mg to 50 mg tablets. Phase III efficacy and safety studies have been completed. A 12-month follow-up safety study has also been completed.

Teva Pharmaceuticals (North Wales, PA) has also announced a long-acting hydrocodone tablet given twice daily called TD hydrocodone, which is currently undergoing trials; the “TD” in the name refers to “tamper deterrent”, according to the company. ¹² Anticipated dosing ranges from 15 mg to 45 mg per tablet. Phase III safety and efficacy studies have been completed¹³ and a 12-month follow-up safety trial is ongoing. According to the company, a study of the abuse potential of the 45 mg strength tablet, crushed or intact, has also been completed.¹³

Purdue Pharma LP (Stamford, CT), the manufacturers of OxyContin^®, and Egalet (Malvern, PA), are also developing long-acting hydrocodone products. The Purdue Pharma product is being targeted as a once-daily formulation. The Egalet product would feature a tablet that is “impossible” to crush, chew, or dissolve.¹⁴ All such pure forms of long-acting hydrocodone will be Class II drugs and will require risk evaluation and mitigation strategy training for prescribers and dispensers.

In reviewing the literature for temper-resistant solutions, there are only patented products that are not available for clinical use at this time. A prodrug form of hydrocodone has been suggested by forming covalent bonds between the drug and different chemical moieties such as amino acids, peptides, and carbohydrates. When compared with hydrocodone itself, the various prodrug compounds are formulated to produce lower bioavailability if injected or snorted. At higher doses, saturation of the biological conversion process is believed to occur, preventing the “rush” abusers seek from opioids like hydrocodone.¹⁵ Unfortunately, none of these options are being utilized in the proposed products, although there is no evidence that any of the proposed deterrents actually prevent abuse.

Hydrocodone is a well established semisynthetic opioid, which has been used for acute and chronic pain for decades. The availability of long-acting, higher-dose hydrocodone formulations would be expected to provide an additional option for patients who cannot tolerate morphine or oxycodone, and another option for opioid rotation strategies.

A long-acting formulation containing hydrocodone without added acetaminophen would reduce the risk of liver damage that has been observed in patients taking prolonged high doses of analgesics containing acetaminophen. While the evidence is scanty, many pain providers hold that long-acting, regularly scheduled opioids are more effective and less prone to abuse than short-acting opioids for chronic pain. For patients who are prone to chronic headaches or central sensitization conditions such as fibromyalgia, less frequent dosing may reduce the risk of rebound, which theoretically could lead to worsening of such conditions.¹⁶

Trials of intravenous opioid administration in opioid abusers have estimated roughly equivalent abuse potential between morphine, oxycodone, and hydrocodone.¹⁷ A similar study found the abuse potentials of oral oxycodone, hydrocodone, and hydromorphone to be similar, despite the lower estimated potency of hydrocodone.¹⁸ Previous medical experience with immediate-release oxycodone and long-acting formulations such as OxyContin suggest that long-acting formulations of potent opioids may be perceived and used very differently than their short-acting counterparts. OxyContin was reported to be widely used by drug abusers, who would crush or dissolve the tablets to release the oxycodone all at once; the medication was reformulated in 2010 to resist this form of tampering. Abuse behavior is not unique to OxyContin but indeed dates back to the beginning of the 20th century, and has been a consistent response to the availability of potent opioids.¹⁹

Time-based administration of chronic opioid therapy has been shown, in at least one study, to result in increased overall opioid dosages and also in higher rates of patient concern about control over their opioid consumption.²⁰ The higher-end dosage of extended-release hydrocodone, expected to be 45 mg or 50 mg per day, would result in a morphine equivalent of 90 mg or 100 mg per day, which is the level that has been found to be associated with a jump in opioid-related morbidity and mortality.²¹ The daily dosage would go significantly higher if prescribers write for patients to take more than one tablet at a time, or to take long-acting hydrocodone more frequently than every 12 hours, as has been commonly done with long-acting oxycodone preparations.

Despite the fact that hydrocodone has been available for clinical use in the US since 1943,²² its metabolism and kinetics are not entirely understood. Its primary metabolites are norhydrocodone (via cytochrome P450 [CYP]3A4) and hydromorphone (via CYP2D6). Hydromorphone is more potent and also much more tightly bound to the μ-opioid receptor than hydrocodone, and probably represents the active metabolite of hydrocodone. Therefore, patients who are ultrarapid CYP2D6 metabolizers may convert significantly more hydrocodone into hydromorphone, and there is a case report of an ultrarapid metabolizer developing unpleasant side effects after a single dose of a hydrocodone-containing analgesic following minor surgery.²³ With greater numbers of patients taking larger doses of hydrocodone, the rate of such adverse events will likely go up. Conversely, a poor CYP2D6 metabolizer would not expect to obtain analgesia except with higher hydrocodone doses.

Another rare side effect of hydrocodone administration is sensorineural hearing loss, which has been reported in patients taking hydrocodone, especially at high doses. ^24,25 In these cases, the hearing loss did not respond to discontinuation of hydrocodone or to corticosteroid therapy. With higher doses of hydrocodone, this could become a significant risk.

The pending availability of long-acting oral hydrocodone medications will add another type of long-acting opioid medication to the chronic pain armamentarium. Despite education requirements including risk evaluation and mitigation strategy and safety features such as tamper-resistance, the benefits and liabilities of long-acting hydrocodone will ultimately need to be determined by the individual physician and the individual pain patient. Prudence and adherence to best practices in opioid prescribing will be essential to allow patients to benefit from pain-relieving properties of these medications without being harmed by their potential for abuse. Given the medical community’s recent experience with chronic opioid therapy and potent opioids, it is incumbent on every prescriber to recognize the risks of abuse and diversion associated with these types of medications and to prescribe only for suitable patients with appropriate indications, while taking appropriate steps to monitor compliance and patient safety. Important stakeholders in society have already made it clear that they will be observing the impact of these new medications. For example, Senator Charles Schumer of New York wrote a letter to the FDA chairman in January, 2012, expressing his concern about the abuse potential of long-acting hydrocodone medications and asking whether the agency was doing enough to combat the prescription drug epidemic.²⁶

On a broader level, it is clear that adding one more opioid medication, long-acting or not, tamper-resistant or not, will not solve chronic pain issues. The pharmacogenetics of pain go far beyond metabolism, and include the role of catecholamine O-methyl transferase polymorphisms in opioid response and abuse and opioid receptor subtypes and polymorphism.²⁷ In addition, the epigenetics of pain is a new and largely undefined field of research which may help explain why some pain becomes chronic and how pain medications can help or worsen pain conditions.²⁸ Until research is able to help doctors distinguish patients who are likely to respond well to chronic opioid therapy from those who are prone to develop worsening pain or addictive behaviors, it is important to offer pain patients a multidisciplinary treatment approach which maximizes outcomes while minimizing the risks and harms associated with pain treatment. Some patients are predisposed to bad outcomes due to genetic and other factors. Some pain conditions tend to worsen with opioid treatment. These patients should not be started on chronic opioid therapy. There is no evidence that chronic opioid therapy is helpful for these patients. For patients in whom we decide that chronic opioid therapy, as part of their multidisciplinary therapy, is a good choice because the benefits outweigh the risk, long-acting opioids are a good choice. The main goal for these patients is to increase their function. There is currently no safe chronic opioid option.

When considering patients for long-acting hydrocodone, the authors would advise to follow clear negative prognostic factors that have been established for chronic opioid treatment and include patients in an unstable or abusive living situation or with inadequate support, patients with poorly defined pain complaints with limited response to moderate opioid dosages, or those with somatoform disorders. Multidisciplinary pain medicine treatment appears to enhance adherence and decrease adverse events.²⁹

Disclosure

The authors report no conflicts of interest in this work.

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Articles from Journal of Pain Research are provided here courtesy of Dove Press

Side effects, dosage, uses and more

1. Acetaminophen-hydrocodone oral tablet is available as a generic drug and a brand-name drug. Brand names: Norco.
2. Acetaminophen-hydrocodone comes as an oral tablet and an oral solution.
3. Acetaminophen-hydrocodone oral tablet is used to treat moderate to severe pain that other treatments have not been able to relieve.

Other warnings

• Severe allergic reaction warning: This medication may cause a severe, potentially life-threatening allergic reaction. The reaction can occur very quickly. Symptoms may include:
  • trouble breathing
  • swelling of your face, throat, and mouth
  • rash
  • itching
  • vomiting

If this occurs, stop taking this medication and call your doctor right away or get emergency medical help.

• Adrenal gland problems warning: This medication may cause your adrenal glands to not work as well. Symptoms may include:
  • nausea
  • vomiting
  • loss of appetite
  • tiredness
  • weakness
  • dizziness
  • lightheadedness

If you have these symptoms, talk to your doctor. You may need to stop taking this medication or have some tests done.

Acetaminophen-hydrocodone is a prescription medication. As an opioid, it’s a controlled substance. It comes as an oral tablet and an oral solution.

Acetaminophen-hydrocodone oral tablet is available as the brand-name drug Norco. It’s also available in its generic form. Generic drugs usually cost less than brand-name drugs. In some cases, they may not be available in every strength or form as the brand-name version.

This medication is a combination of two drugs in a single form. It’s important to know about both of the drugs in the combination because each drug may affect you in a different way.

Why it’s used

Acetaminophen-hydrocodone oral tablet is used to treat moderate to severe pain that other treatments have not been able to relieve.

How it works

This medication is a combination of hydrocodone and acetaminophen. Hydrocodone is an opioid (narcotic), and acetaminophen is an analgesic (pain reliever). Both drugs are used to reduce pain.

These drugs work in your brain to block pain signals. They decrease your ability to feel pain.

Acetaminophen-hydrocodone oral tablet may make you feel sleepy, dizzy, or lightheaded. Avoid driving a car or using machinery until you know how your body reacts to this medication.

This drug can also cause other side effects.

More common side effects

The more common side effects that can occur with acetaminophen-hydrocodone include:

• sleepiness or drowsiness
• feeling dizzy or lightheaded
• nausea
• vomiting
• constipation

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

• Skin rash
• Swelling of your face, throat, and mouth
• Trouble breathing
• Drug dependence
• Liver problems, including liver failure. Symptoms may include:
  • yellowing of your skin and the whites of your eyes
  • pain in the upper right part of your stomach area
  • swelling of your stomach area
  • itchiness
  • confusion
  • feeling tired
  • lack of appetite

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

Acetaminophen-hydrocodone oral tablet can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Examples of drugs that can cause interactions with acetaminophen-hydrocodone are listed below.

Drugs that cause drowsiness

Taking certain drugs with acetaminophen-hydrocodone increases your risk of drowsiness, dizziness, tiredness, and reduced physical and mental function. If you need to use one of these drugs with acetaminophen-hydrocodone, the dosage of one or both drugs should be reduced.

Examples of these drugs include:

• other opioids (narcotics)
• antihistamines, which are used for allergies
• antipsychotics, which are used for bipolar disorder, schizophrenia, or depression
• benzodiazepines, which are used for anxiety

Drugs that increase serotonin

Taking this medication with drugs that increase the amount of a chemical called serotonin in your body can cause a serious problem. This problem, called serotonin syndrome, can be fatal. Tell your doctor if you are taking any of these medications:

• some antidepressants (selective serotonin reuptake inhibitors [SSRIs], selective serotonin and norepinephrine reuptake inhibitors [SNRIs], tricyclic antidepressants [TCAs], monoamine oxidase inhibitors [MAOIs], mirtazapine, trazodone)
• certain drugs for migraine (triptans)
• certain drugs for nausea, such as ondansetron
• tramadol, which is used for pain
• linezolid, which is an antibiotic

Drugs that inhibit activity of certain enzymes in the liver

Taking this medication with drugs that can inhibit activity of certain liver enzymes can increase the amount of hydrocodone in your body and cause more side effects. You may have increased breathing problems or drowsiness. Examples of these drugs include:

• erythromycin
• ketoconazole
• protease inhibitors used to treat HIV, such as ritonavir

Drugs that increase activity of certain enzymes in the liver

Taking this medication with drugs that can increase activity of certain liver enzymes can lower the amount of hydrocodone or acetaminophen in your body. You may need a higher dose of this medication to control your pain. Examples of these drugs include:

• rifampin
• carbamazepine
• phenytoin

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

This drug comes with several warnings.

Allergy warning

This drug can cause a severe allergic reaction. Symptoms may include:

• trouble breathing
• swelling of your throat or tongue
• hives
• rash
• itching

If you develop these symptoms, call 911 or go to the nearest emergency room.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

Alcohol interaction warning

You shouldn’t drink alcohol while taking acetaminophen-hydrocodone. Drinking alcohol while taking this medication may cause:

• slowed or stopped breathing
• drowsiness
• tiredness
• mental cloudiness
• physical and mental slowing

Combining alcohol with this drug also increases your risk for liver problems and liver damage.

Warnings for people with certain health conditions

For people with head injury: If you have a head injury, hydrocodone may cause increased pressure in your brain and cause breathing problems.

For people with stomach problems: Use caution taking this drug if you have intestinal obstruction, ulcerative colitis, or constipation. This medication may worsen your symptoms.

For people with severe kidney disease: This drug may build up in your body, which can cause trouble breathing and other side effects.

For people with lung disease: If you have lung disease, you might have trouble breathing if you take this medication.

For people with severe liver disease: If you have severe liver disease, your risk of liver failure is increased. Also, this drug may build up in your body, which can cause trouble breathing and other side effects.

For people with prostate enlargement: If you have an enlarged prostate, taking acetaminophen-hydrocodone may cause increased difficulty in urination.

For people with asthma: If you have severe or uncontrolled asthma, do not use this medication without talking to your doctor. You may have to take the first few doses in a monitored setting.

For pregnant women: This drug is a category C pregnancy drug. That means two things:

1. Research in animals has shown adverse effects to the fetus when the mother takes the drug.
2. There haven’t been enough studies done in humans to be certain how the drug might affect the fetus.

Tell your doctor if you’re pregnant or plan to become pregnant. Babies born to mothers who regularly take opioids such as hydrocodone may be born physically dependent on this drug. This can cause symptoms of withdrawal, or neonatal opioid withdrawal syndrome. Symptoms can include:

• excessive crying
• sneezing
• shaking
• rapid breathing
• increased bowel movements
• yawning
• vomiting
• fever

There’s also an increased chance that the baby may have trouble breathing if this medication is given to the mother shortly before giving birth.

For women who are breastfeeding: Acetaminophen is passed in small amounts in breast milk. Hydrocodone also passes into breast milk and may result in excessive tiredness and slowed breathing in a child who is breastfed.

Breastfeeding while taking this medication may come with risks. You and your doctor should decide whether you’ll take this medication or breastfeed.

For seniors: Older adults may have decreased kidney, liver, and heart function. If you’re a senior, your doctor may start you at a low dose of this medication.

All possible dosages and drug forms may not be included here. Your dosage, drug form, and how often you take the drug will depend on:

• your age
• the condition being treated
• the severity of your condition
• other medical conditions you have
• how you react to the first dose

Forms and strengths

Generic: Acetaminophen-hydrocodone

• Form: oral tablet
• Strengths:
  • hydrocodone 5 mg/acetaminophen 300 mg
  • hydrocodone 7.5 mg/acetaminophen 300 mg
  • hydrocodone 10 mg/acetaminophen 300 mg
  • hydrocodone 2.5 mg/acetaminophen 325 mg
  • hydrocodone 5 mg/acetaminophen 325 mg
  • hydrocodone 7.5 mg/acetaminophen 325 mg
  • hydrocodone 10 mg/acetaminophen 325 mg

Brand: Norco

• Form: oral tablet
• Strengths:
  • 2. 5 mg hydrocodone/325 mg acetaminophen
  • 5 mg hydrocodone/325 mg acetaminophen
  • 7.5 mg hydrocodone/325 mg acetaminophen
  • 10 mg hydrocodone/325 mg acetaminophen

Dosage for moderate to severe pain

Adult dosage (ages 18 years and older and weighing at least 101 pounds [46 kg])

• 5 mg or 2.5 mg hydrocodone / 300 mg or 325 mg acetaminophen: The typical dosage is 1–2 tablets taken every 4–6 hours as needed. The maximum dosage is 8 tablets per day.
• 7.5 mg or 10 mg hydrocodone / 300 mg or 325 mg acetaminophen: The typical dosage is 1 tablet taken 4–6 hours as needed. The maximum dosage is 6 tablets per day.

Child dosage (ages 0–17 years)

• Dosage for people younger than 18 years hasn’t been established.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always speak with your doctor or pharmacist about dosages that are right for you.

Acetaminophen-hydrocodone is used for short- or long-term treatment. It comes with risks if you don’t take it exactly as prescribed by your doctor.

If you stop taking the drug or don’t take it at all: Your pain will continue and might get worse.

If you miss doses or don’t take the drug on schedule: Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

What to do if you miss a dose: If you’re taking the medication regularly, take the missed dose as soon as you remember. Skip the missed dose if it’s almost time for your next scheduled dose.

Don’t use extra medication to make up the missed dose. This could result in dangerous side effects.

If you take too much: If you take too much, you can overdose on this medication. You may experience:

• nausea and vomiting
• sweating
• an overall feeling of fatigue
• slowed or stopped breathing
• slowed heart rate
• very low blood pressure
• possible coma
• liver damage or failure

If you think you’ve taken too much of this drug, call your doctor or seek guidance from the American Association of Poison Control Centers at 1-800-222-1222 or through their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.

How to tell if the drug is working: Your pain should decrease.

Keep these considerations in mind if your doctor prescribes acetaminophen-hydrocodone for you.

General

• Take with food to lower your risk of upset stomach.
• You can cut or crush the oral tablet.

Storage

• Store this drug at temperatures ranging from 68°F to 77°F (20°C to 25°C).
• Keep this drug in a container with a child-resistant closure.
• Keep this drug away from light.
• Keep this drug in a locked place and out of children’s reach.

Refills

A prescription for this medication is not refillable. You or your pharmacy will have to contact your doctor for a new prescription if you need this medication refilled.

Travel

When traveling with your medication:

• Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
• Don’t worry about airport X-ray machines. They can’t hurt your medication.
• You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled container with you.
• Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Clinical monitoring

Your doctor may do certain tests to check whether you have severe liver or kidney disease. These tests will check your:

• Kidney function. Your doctor may do kidney tests if you have kidney problems to make sure that this medication is safe for you and won’t cause breathing problems.
• Liver function. Your doctor may do liver tests if you have liver problems to make sure that this medication is safe for you and won’t cause breathing problems.

Prior authorization

Most insurance companies do not require a prior authorization for this drug.

There are other drugs available to treat your condition. Some may be more suitable for you than others. Talk to your doctor about other drug options that may work for you.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Hydrocodone (Vicodin) | Prozavisimost.rf

Home » Narcotics » Hydrocodone: a drug that heals and cripples

Hydrocodone is a powerful substance that helps fight the symptoms of colds, coughs, and also acts as a strong pain reliever. The composition of the drug contains paracetamol and opiates of plant origin – thebaine and codeine.

Dmitry Razorenkov

Psychologist

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Read more:

1. Signs of hydrocodone use
2. Consequences of using hydrocodone
3. Hydrocodone (Vicodin) treatment

Hydrocodone is known to many as Vicodin, a drug in tablet form that became especially popular after the airing of the TV series House M. D.

You cannot buy hydrocodone in a pharmacy. This substance may only be used on the advice of a physician, in low doses and by prescription. A big disadvantage of Vicodin treatment is the development of addiction, so doctors try to avoid this appointment and recommend safer analogues.

If your relative has become addicted to drugs and cannot stop, the help of drug addiction specialists is needed. Only they can make a correct diagnosis and prescribe the right therapy. In our center Prozavisimost.rf your loved one will be treated anonymously.

If you did not catch your loved one taking hydrocodone and did not see the name of the drug, it is unlikely that you will be able to understand from the symptoms that the addict is using it. But the main symptomatology, which manifests itself in dependence on a psychotropic substance, should alert you and become a reason for contacting a drug treatment center.

Main signs of use:

• frequent and unreasonable mood swings;
• the appearance of phantom pains that “force” the addict to take the drug again;
• severe weight loss;
• illogical thought process;
• drowsiness, yawning.

Often, addiction is detected when the drug is forced to stop, that is, when a person could not get himself another dose. During this period of time, there is a severe runny nose with liquid secretions, nausea and vomiting, abdominal cramps, watery eyes, chills, and increased sweating. The addict can’t find a place for himself and constantly thinks about a new dose of hydrocodone.

The body is tolerant to the active substances of this drug. This means that in order to get drugged from hydrocodone, a person will need to constantly increase the dosage. As a rule, the increase in tolerance stops only when doses dangerous to life and health are consumed.

The dose of a drug addict is several times higher than that of a person who was prescribed the drug by a specialist. But even with the smallest dosages, addiction can develop, which instead of benefit will cause harm.
Excessive use of hydrocodone is the cause of allergic reactions, seizures, decreased mental activity, lethargy and anxiety. Especially large dosages are ways to cause severe overdose, coma and death.

Dependence on hydrocodone (Vicodin) occurs both on a psychological and physiological level. In order for the therapy to be effective, specialists first prescribe medication that helps to cope with withdrawal symptoms, cleanse the body, and only after that they begin the rehabilitation course. Rehabilitation allows you to overcome psychological dependence, craving for drugs, restore a person’s confidence in himself and in the future, as well as the ability to enjoy life and enjoy it without the use of hazardous substances.

Comprehensive drug addiction treatment guarantees lifelong remission after drug use. Contact us, we will conduct therapy anonymously.

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its action and effect on the body

Hydrocodone is a strong narcotic substance characterized by analgesic properties. Secondly, it is an indispensable tool for cough therapy. More common is the name of the drug as Vicodin. It contains paracetamol, hydrocodone. Another name for it is dihydroxycodeinone. This is a semi-synthetic opioid based on tebein and codeine, natural opiates.

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90 002 The first recorded synthesis of paracetamol, which is a component of Vicodin, dates back to 1877. After that, in 1920, German scientists managed to obtain dihydroxycodeinone. In the early 2000s, the whole world became aware of Vicodin, thanks to the popular TV series about Dr. House, escaping from excruciating pain due to a leg injury with the help of this drug.

The use of hydrocodone as a drug became more and more popular in the 20th century, and then smoothly moved into our 21st century. Often, drug addicts buy Tussonex at a pharmacy and use it to get a slight euphoria. The drug is intended to combat cough, but it must be used strictly according to the doctor’s prescription and do not violate the prescribed dosage, do not arbitrarily extend the therapeutic course.

The use of hydrogodon is practiced for medical purposes to eliminate severe pain of various origins. It also copes with cough syndrome, facilitates the well-being of patients with its calming effect. The tool is paired with substances such as paracetamol, aspirin. This combination enhances its influence and anesthetic effect by 2 times. The medicine has a lot of contraindications, so you can not arbitrarily prescribe it to yourself. For example, the use of the drug during the bearing of a child can cause a miscarriage. Women who are breastfeeding are also prohibited from using hydrocodone due to the high risk of passing it through the milk to the baby.

Do not neglect the health and life of your loved one. The sooner you seek qualified help, the easier it will be to stop drinking alcohol later.

Narcologists and psychologists of the “First Narcological Clinic” jointly developed their own system of motivating addicts to voluntarily begin treatment. Its main feature is the creation in a person of his own reasoned desire to undergo treatment. Work is carried out with a psychologist who builds a conversation in such a way that the addict, in the end, himself comes to the decision to get rid of the addiction.

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Psychologists and therapists of the “First Narcological Clinic” developed and implemented an effective system of motivating addicts to decide to start treatment. A completely voluntary and non-coercive technique allows you to achieve good results 8 out of 10 addicts make an independent decision to start a recovery course.

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In addition to a sharp change in mood, lack of logic in actions and words, a patient taking the drug has the following symptoms:

• Constant tearing. One gets the impression that the addict is crying all the time;
• Discharge of mucus from the nose as from coryza from a cold;
• Appetite disappears, a person rapidly loses weight;
• The addict is haunted by incessant yawning;
• There is bloating and nausea;
• Excessive sweating accompanied by chills.

The most clearly listed symptoms make themselves felt during the period of substance withdrawal.

The anesthetic effect of Vicodin is due to its direct effect on the central nervous system. However, for your own safety, we must not forget that in combination with alcohol, the drug causes severe drowsiness. The same reaction is observed when hydrocodone is combined with synthetic substances.

The negative effect of high dosages on the body is the appearance of adverse reactions:

1. Dizziness as a response from the central nervous system;
2. Nausea and vomiting, problems with stools from the gastrointestinal tract;
3. Violation of the circulatory system and kidneys;
4. State of euphoria, emotional instability.

Common symptoms for Vicodin addicts are allergic reactions, convulsions, decreased mental activity, increased anxiety, lethargic sleep.

Hydrocodone, like most other drugs, is classified as a tolerant drug. This means that it is not enough for the body to receive the same dose to get euphoria. A portion of the substance needs a periodic increase. This process is different for everyone. An irreversible outcome will occur when the dose is incompatible with life. The drug provokes an addiction, which is almost impossible to overcome on your own. Patients have a psychological and physical attraction to the drug. This is facilitated by codeine, which is listed as part of the drug. The therapy provided at the “First Narcological Clinic” is identical to the program for combating addiction to drugs containing codeine.

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Prolonged use of the drug, as well as a strong deviation from the prescribed dosages, provokes irreversible changes inside the body. The latter lead to serious illness and even death.

Complications are:

• Violation of cardiac activity;
• Spasms of the respiratory organs;
• Failure of vital organs – liver, kidneys;
• Loss of memory and consciousness;
• Hepatitis, jaundice;
• Coma.

The most severe effects occur with the simultaneous use of Vicodin and alcohol or other drugs.

The therapeutic daily dose is a maximum of 60 mg for standard cases and 40 mg for patients with high sensitivity to the components of the drug. Drug addicts use it in amounts of more than 200 mg. An increase in the threshold occurs in the process of forming a persistent dependence.

Signs of critical intoxication are as follows:

• Respiratory arrest;
• Irresistible desire to sleep;
• State of stupor;
• Cold and clammy skin;
• Bradycardia;
• Severe hypotension;
• Coma.

To neutralize the symptoms of an overdose, resuscitation measures are carried out in the form of artificial ventilation of the lungs, chest massage.

Narcologists of the First Narcological Clinic will consult you over the phone regarding measures to eliminate poisoning while they are on the road to the patient. An important role is also played by moral support and stabilization of the psyche of the addict.

The advantage is an individual approach, which, with a high degree of guarantee, will make you interested in the treatment process. Comfortable living conditions, flexible and adaptive recovery programs, experienced and friendly staff will help you concentrate on the essentials and cope with alcoholism.

All employees of the First Narcological Clinic are certified specialists who regularly confirm and improve their qualifications.

Licenses and certificates authorizing this practice can be found below

With extensive experience in the treatment of severe addictive disorders such as alcoholism and drug addiction, the First Narcological Clinic works with addicts and their relatives according to the following model of recovery:

MOTIVATION OR INTERVENTION

With the help of motivational psychologists, the addict admits (primarily to himself) that he has a problem with alcohol.

DIAGNOSIS

Diagnosis is carried out, revealing the stage of the disease, the degree of damage to internal organs and the level of emotional dependence.

DETOXIFICATION

Withdrawal syndrome is removed, detoxification is performed and craving for alcohol is suppressed.

HOSPITAL

Therapeutic activities and work with a psychologist are carried out, which helps to form a negative attitude towards alcohol.

POST TREATMENT MAINTENANCE

Post-rehab period during which cravings may suddenly escalate. At this stage, control and timely support, including loved ones, is important.

While you or your loved ones drink alcohol, you are, without exaggeration, in mortal danger. Let me help you — the qualified staff of the First Narcological Clinic will help you achieve comfortable sobriety with the least damage to your health and will give you the tools to keep it.

Cooperating with the “First Narcological Clinic” you are guaranteed to receive a world-class high-class medical service, a treatment program using the most highly effective and progressive methods, as well as a guarantee of complete anonymity and confidentiality.