However, when combined with acetaminophen, hydrocodone combinations have become a common cause of acetaminophen acute liver injury. Hydrocodone is a controlled substances and classified as a Schedule III drug, indicating that it has medical usefulness, but also a potential for physical and psychological dependency and abuse.ĭespite wide scale use for many decades, hydrocodone by itself has not been convincingly linked to instances of clinically apparent acute liver injury. Severe adverse events include life-threatening respiratory depression, addiction, abuse, opioid withdrawal, serotonin syndrome (when used with serotonergic agents) and adrenal insufficiency. Side effects of hydrocodone include sedation, respiratory depression, mental clouding, euphoria, agitation, constipation, diarrhea, abdominal bloating, nausea, vomiting, headache and dizziness. The FDA, however, has recommended that physicians not use opioid combinations with concentrations of acetaminophen of more than 325 mg per unit dose. Importantly, the dose of acetaminophen in hydrocodone combinations varies from 300 to 1000 mg per tablet. The preparations are generally taken every 4 to 6 hours. Hydrocodone is available in multiple formulations (tablets, capsules, syrup) combined with other analgesics, antihistamines or anticholinergics in concentrations of 2.5, 5, 7.5 and 10 mg generically and (with acetaminophen) under brand names such as Vicodin, Norco, Lortab and Co-Gesic, among others. It is currently one of the most commonly prescribed drugs in medical practice. Current indications are for treatment of moderate-to-moderately severe pain (combinations with acetaminophen or ibuprofen) or alleviation of cough and symptoms of upper respiratory tract infections (combined with chlorpheniramine or homatropine). Hydrocodone has been in use since shortly after its initial synthesis in the 1920’s, but was formally approved for use in combination with acetaminophen in the United States in 1998. The combination of hydrocodone with acetaminophen or other products helps to prevent its recreational use and administration by injection. The combination of hydrocodone with acetaminophen is effective in ameliorating moderate-to-moderately severe pain and is widely used for temporary as well as chronic management of pain states. It is well absorbed orally and has moderate opiate activity (approximately 6 times that of codeine), acting an agonist of the µ opiate receptor. Hydrocodone (hye” droe koe’ done) is a semisynthetic derivative of codeine or thebaine, natural alkaloids derived from the resin of poppy seeds (Papaver somniferum).
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