Article: Hydrocodone

It has been suggested that Vicodin be merged into this article or section. (Discuss)

Hydrocodone
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
Bioavailability	?
Metabolism	Hepatic
Half life	4-8 hours
Excretion	?
Therapeutic considerations
Pregnancy cat.	Category C (USA)
Legal status	Class A (UK), Schedule II/III (USA)
Routes	Oral

Hydrocodone or dihydrocodeinone (marketed as Vicodin, Anexsia, Dicodid, Hycodan, Hycomine, Lorcet, Lortab, Norco, Hydroco, Tussionex, Vicoprofen) is an opioid derived from either of the naturally occurring opiates codeine or 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. 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.

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 miligrams (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 miligrams 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, it clearly states in the 2006 PDR (Physicians Desk Reference) that Norco 10, containing 10 miligrams of hydrocodone and 325 miligrams of APAP (viz., acetaminophen or paracetamol), can be taken at a dosage of up to twelve tablets per day (120 miligrams 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 miligrams 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, like alcohol, 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.

Pills containing Hydrocodone

The following is a list of hydrocodone pills primarily manufactured by Watson Laboratories, Inc., as they provided the list. Some other manufacturers are included. (i.e. Zydone is made by ENDO) This is a relatively complete listing of the various combinations/strengths of hydrocodone/Apap preparations available in tablet form. Other drug combinations such as Vicoprofen, Hycomine and Hycodan, which include drugs other than Apap are not listed. It is, however, not a complete listing of all the different pill markings being used today by far. There are several other manufacturers of generic hydrocodone tablets, of all strengths, supplying the growing demand for this drug, whether obtained through licit or illicit means.

Vicodin and popular culture

Hydrocodone is possibly known best by the trademark name Vicodin™ (pronounced 'VIKE-o-din'). Like Quaalude and Valium in the 1970s, Vicodin has become not just a drug but a symbol, and its presence in a lyric or a screenplay can be seen as a comment on the obsessions of the early twenty-first century. Some of the places where the brand name has appeared in popular culture include:

• In the television series House, Gregory House (played by Hugh Laurie) is a brilliant but difficult doctor who takes massive amounts of Vicodin to manage chronic pain.
• In the short-lived, controversial television series The Book of Daniel, Aidan Quinn plays an Episcopal priest who is hooked on Vicodin.
• The song "Company" by Third Eye Blind features the lyric "Mix it up with Vicodin, Cause anything's better than this."
• In the Jack's Mannequin song, "Last Straw", singer Andrew McMahon laments "I stayed home, took a vicodin".
• The metalcore band Atreyu have a song called "Five Vicodin Chased with a Shot of Clarity."
• Terra Naomi, the singer-songwriter, recorded a "Vicodin Song" which includes the lyric "I've got Vicodin, do you want to come over?"
• Several songs by Eminem mention Vicodin.
• In the song "Feel Good Hit of the Summer" by Queens of the Stone Age, the phrase "Nicotine, Valium, Vicodin, marijuana, ecstasy and alcohol. Cocaine..." is repeated over the song.
• The song "Diary Of A San Fernando Sexx Star" by Butch Walker has the lyric "So you popped a Vicodin and ran away from everyone, and everything you thought you knew."
• Bill Engvall has a joke called 'Vicodinland'. An amusing account of his time on Vicodin after his hernia.
• In the television series Six Feet Under, Ruth's sister, Sarah, experiences withdrawal symptoms while trying to break her Vicodin addiction.
• During Season 2 of the television series Rescue Me, Franco gets hooked on Vicodin.
• ECW wrestlers Rob Van Dam and Sabu were both arrested for possession of the drug without a prescription.
• In Chuck Palanuik's "Invisible Monsters," Vicodin is mentioned throughout the novel with multiple characters addicted to the drug.
• Actor Matthew Perry (of Friends fame) voluntarily checked himself into a drug rehabilitation facility after he admitted to the press that he had been addicted to Vicodin for several years.[3]
• Comedian George Carlin checked himself into a rehabilitation facility in 2004 after he became addicted to Vicodin.[4]
• Several Alkaline Trio songs make reference to Vicodin.

See also

• Hydrocodone compound