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Hydrocodone
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| Systematic (IUPAC) name | |
| 4,5a-Epoxy-3-methoxy-17-methylmorphinan-6-one tartrate (1:1) hydrate (2:5) | |
| Identifiers | |
| CAS number | 125-29-1 |
| ATC code | R05DA03 |
| PubChem | 5284569 |
| DrugBank | APRD00591 |
| Chemical data | |
| Formula | C18H21NO3 |
| Mol. weight | 299.368 |
| Pharmacokinetic data | |
| Metabolism | Hepatic |
| Half life | 4-8 hours |
| Therapeutic considerations | |
| Pregnancy cat. | Category C (USA) |
| Legal status | Class A (UK), Schedule III (USA) |
| Routes | Oral |
Hydrocodone or dihydrocodeinone (marketed as Vicodin, Anexsia, Dicodid, Hycodan, Hycomine, Lorcet, Lortab, Norco, Novahistex, Hydroco, Tussionex, Vicoprofen) 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.
Acetaminophen 650mg
As a narcotic, hydrocodone relieves pain by binding to opioid receptors in the brain and spinal cord. It may be taken with or without food. 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 can be habit-forming, and can lead to physical and psychological addiction. 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.
Contents |
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. Tolerance to this drug can increase very rapidly if abused. Because of this, addicts often overdose from taking handfulls of pills, in pursuit of the high they experienced very early on in their hydrocodone use. 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. This fact is often neither known nor given credence as it does not stop people from mixing them due to the feeling of euphoria it provides.
Commercial medications containing hydrocodone
When sold commercially, hydrocodone often is 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).
Below are some of the commercially available medications containing hydrocodone, listed by manufacturer.
Abbott Laboratories [2]
| Dosage | Appearance | Trademark Name |
| 5mg (500mg acetaminophen) |
White tablets bisected on one side and debossed "VICODIN" on the other side |
Vicodin |
| 7.5mg (750mg acetaminophen) |
White tablets with tapered edges bisected on one
side and debossed "VICODIN ES" on the other side |
Vicodin ES |
| 10mg (660mg acetaminophen) |
White tablets bisected on one side and debossed "VICODIN HP" on the other side |
Vicodin HP |
| 7.5mg (200mg 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 [3]
| Dosage | Appearance | Trademark Name |
| 2.5mg (500mg acetaminophen) |
White tablets with red specs bisected and
debossed "901" on one side and debossed "UCB" on the other side |
Lortab |
| 5mg (500mg acetaminophen) |
White tablets with blue specs bisected and
debossed "902" on one side and debossed "UCB" on the other side |
Lortab |
| 7.5mg (500mg acetaminophen) |
White tablets with green specs bisected and
debossed "903" on one side and debossed "UCB" on the other side |
Lortab |
| 10mg (500mg acetaminophen) |
Pink tablets bisected and debossed "910" on one
side and debossed "UCB" on the other side |
Lortab |
| 5mg (500mg aspirin) |
Red tablets mottled with white and debossed
"500" on one side and (possibly?) debossed "UCB" on the other side |
Lortab ASA |
| 7.5mg per 15mL (500mg acetaminophen) |
Yellow, tropical-punch flavored liquid with 7% alcohol | Lortab Elixir |
Watson Pharmaceuticals, Inc. [4]
(NOTE: Watson manufactures under its own Trademarks and generic Trademark Equivalents)
| Dosage | Appearance | Trademark Name |
| 10mg (750mg acetaminophen) |
Yellow Capule-shaped bisected on one side and debossed "Maxidone 634" on the other side |
Maxidone® |
| 5mg (325mg acetaminophen) |
White tablets with orange specks bisected and
debossed "Watson" on one side and "Watson 913" on the other side |
Norco® 5/325 |
| 7.5mg (325mg acetaminophen) |
Light orange oblong tablets bisected on one side and debossed "NORCO 729" on the other side |
Norco® 7.5/325 |
| 10mg (325mg acetaminophen) |
Yellow tablets bisected on one side and debossed "NORCO 539" on the other side |
Norco® |
| Dosage | Appearance | Trademark Equivalent |
| 2.5mg (500mg acetaminophen) |
White tablets bisected on one side and debossed "WATSON 388" on the other side |
Lortab® |
| 5mg (325mg acetaminophen) |
White tablets with orange specks bisected and
debossed "Watson" on one side and "3202" on the other side |
Norco® 5/325 |
| 5mg (500mg acetaminophen) |
White oblong tablets bisected on one side and debossed "WATSON 349" on the other side |
Vicodin® |
| 7.5mg (325mg acetaminophen) |
Light orange oblong tablets bisected on one side and debossed "WATSON 3203" on the other side |
Norco® 7.5/325 |
| 7.5mg (500mg acetaminophen) |
White tablets bisected on one side and debossed "WATSON 385" on the other side |
Lortab® |
| 7.5mg (650mg acetaminophen) |
Pink tablets bisected on one side and debossed "WATSON 502" on the other side |
Lorcet Plus® |
| 7.5mg (750mg acetaminophen) |
White tablets bisected on one side and debossed "WATSON 387" on the other side |
Vicodin ES® |
| 10mg (325mg acetaminophen) |
Yellow tablets bisected on one side and debossed "WATSON 853" on the other side |
Norco® |
| 10mg (500mg acetaminophen) |
Blueish/purple tablets bisected on one side and debossed "WATSON 540" on the other. |
Lortab® |
| 10mg (650mg acetaminophen) |
Light green tablets bisected on one side and debossed "WATSON 503" on the other side |
Lorcet 10/650® |
| 10mg (660mg acetaminophen) |
White tablets bisected on one side and debossed "WATSON 517" on the other side |
Generic |
| 10mg (750mg acetaminophen) |
Yellow tablets bisected on one side and debossed "WATSON 3228" on the other side |
Maxidone® |
Mallinckrodt Pharmaceuticals [5]
| Dosage | Appearance | Trademark Name |
| 5mg (325mg acetaminophen) |
White tablets bisected on one side and debossed "M365" on the other side |
Generic |
| 5mg (500mg acetaminophen) |
White tablets bisected on one side and debossed "M357" on the other side |
Generic |
| 7.5mg (325mg acetaminophen) |
White tablets bisected on one side and debossed "M366" on the other side |
Generic |
| 7.5mg (500mg acetaminophen) |
White tablets bisected on one side and debossed "M358" on the other side |
Generic |
| 7.5mg (650mg acetaminophen) |
White tablets bisected on one side and debossed "M359" on the other side |
Generic |
| 7.5mg (750mg acetaminophen) |
White tablets bisected on one side and debossed "M360" on the other side |
Generic |
| 10mg (325mg acetaminophen) |
White tablets bisected on one side and debossed "M367" on the other side |
Generic |
| 10mg (500mg acetaminophen) |
White tablets bisected on one side and debossed "M363" on the other side |
Generic |
| 10mg (650mg acetaminophen) |
Blue tablets bisected on one side and debossed "M361" on the other side |
Generic |
| 10mg (660mg acetaminophen) |
White tablets bisected on one side and debossed "M362" on the other side |
Generic |
| 10mg (750mg acetaminophen) |
White tablets bisected on one side and debossed "M364" on the other side |
Generic |
