Hydrocodone

(Trade Names: Vicodin®, Lortab®, Lorcet-HD®, Hycodan®, Vicoprofen®)

Hydrocodone is a semi-synthetic opioid synthesized from codeine, one of the opioid alkaloids found in the opium poppy. It is a narcotic analgesic used orally as an antitussive/cough suppressant, but also commonly taken orally for relief of moderate to severe pain. Hydrocodone is prescribed predominantly within the United States, with the International Narcotics Control Board reporting that 99% of the worldwide supply in 2007 was consumed in the United States. The Administrative Controlled Substances Code Number for hydrocodone is 9193 and the aggregate production quota for 2014 is 99,625 kilograms in the U.S.

Hydrocodone, sold under the brand name Hysingla among others, is an opioid used to treat severe pain of a prolonged duration, if other measures are not sufficient. It is also used as a cough suppressant in adults. It is taken by mouth. Wikipedia

Onset of action: 10–20 minutes

Other names: Dihydrocodeinone, hydrocodone bitartrate

Duration of action: 4–8 hours

Elimination half-life: Average: 3.8 hours; Range: 3.3–4.4 hours

Metabolism: Liver: CYP3A4 (major), CYP2D6 (minor)

Bioavailability: By mouth: 70%

Compound Summary

2D Structure (source)

3D Conformer (source)

Hydrocodone Synonyms - MeSH Entry Terms

  • Codinovo
  • Dicodid
  • Dihydrocodeinone
  • Hycodan
  • Hycon
  • Hydrocodeinonebitartrate
  • Hydrocodon
  • Hydrocodone
  • Hydrocodone Bitartrate
  • Hydrocodone Tartrate (1:1), Hydrate (2:5)
  • Hydrocon
  • Robidone

(source)

Depositor-Supplied Synonyms

  • HYDROCODONE
  • Dihydrocodeinone
  • Hydrocodon
  • Hydrocone
  • Hydroconum
  • Codinovo
  • Dicodid
  • Multacodin
  • Bekadid
  • Idrocodone
  • Idrocodone [DCIT]
  • DICO
  • (-)-Dihydrocodeinone
  • hidrocodona
  • Hydrocodonum
  • Hydrocodonum [INN-Latin]
  • 125-29-1
  • Hidrocodona [INN-Spanish]
  • Codeinone, dihydro-
  • Hydrocodone [INN:BAN]
  • UNII-6YKS4Y3WQ7
  • 4,5-alpha-Epoxy-3-methoxy-17-methylmorphinan-6-one
  • 6-Oxo-3-methoxy-N-methyl-4,5-epoxymorphinan
  • 4,5alpha-Epoxy-3-methoxy-17-methylmorphinan-6-one
  • HSDB 3097
  • EINECS 204-733-9
  • NSC 19044
  • BRN 0094193
  • 6YKS4Y3WQ7
  • Zohydro
  • CHEBI:5779
  • DEA No. 9193
  • Hydrocon
  • (4R,4aR,7aR,12bS)-9-methoxy-3-methyl-1,2,4,4a,5,6,7a,13-octahydro-4,12-methanobenzofuro[3,2-e]isoquinoline-7-one
  • Hydrocodone polistirex
  • Morphinan-6-one, 4,5-alpha-epoxy-3-methoxy-17-methyl-
  • Hydrocodeinonebitartrate
  • 50678-79-0
  • Hydrocodone (INN)
  • NCGC00159317-02
  • 4,5.alpha.-Epoxy-3-methoxy-17-methylmorphinan-6-one
  • opioid1
  • SCHEMBL2987
  • CHEMBL1457
  • 4-27-00-03580 (Beilstein Handbook Reference)
  • 3-methoxy-17-methyl-4,5alpha-epoxymorphinan-6-one
  • Hydrocodone polistirex [USAN]
  • GTPL7081
  • DTXSID8023131
  • (5alpha)-17-methyl-3-(methyloxy)-4,5-epoxymorphinan-6-one
  • Hydrocodone 0.1 mg/ml in Methanol
  • Hydrocodone 1.0 mg/ml in Methanol
  • Morphinan-6-one, 4,5-epoxy-3-methoxy-17-methyl-, (5alpha)-
  • NSC19044
  • ZINC1280665
  • BDBM50386689
  • NSC-19044
  • DB00956
  • NCGC00159317-03
  • LS-92156
  • C08024
  • D08045
  • Q411441
  • 17-methyl-4,5alpha-epoxy-3-methoxymorphinan-6-one
  • 4,5alpha-epoxy-3-methoxy-17-methyl-morphinan-6-one
  • Morphinan-6-one,5.alpha.-epoxy-3-methoxy-17-methyl-
  • (5alpha)-3-Methoxy-17-methyl-4,5-epoxymorphinan-6-one
  • Morphinan-6-one, 4,5alpha-epoxy-3-methoxy-17-methyl-
  • Morphinan-6-one, 4,5alpha-epoxy-3-methoxy-17-methyl- (8CI)
  • Morphinan-6-one,5-epoxy-3-methoxy-17-methyl-, (5.alpha.)-
  • WLN: T B6566 B6/CO 4ABBC R BX FV HO PN GHT&&TTJ JO1 P1
  • hydrocodone;hydrocodone hydrogen tartrate;Hydrocodone hydrogen tartrate
  • Morphinan-6-one, 4,5-epoxy-3-methoxy-17-methyl-, (5alpha)- (9CI)
  • 4aH-8,5-bcd]furan-5-(6H)-one, 7,7a,8,9-tetrahydro-3-methoxy-12-methyl-
  • (1S,5R,13R,17R)-10-methoxy-4-methyl-12-oxa-4-azapentacyclo[9.6.1.0^{1,13}.0^{5,17}.0^{7,18}]octadeca-7(18),8,10-trien-14-one
  • 4,3,2-pq][2,6]benzodioxacyclooctadecine-13,2′-pyran]-7-yl 2,6-dideoxy-3-O-methyl-4-O-[2,4,6-trideoxy-3-O-methyl-4-(methylamino)-alpha-L-lyxo-hexopyranosyl]-alpha-L-arabino-hexopyranoside

(source)

What is Hydrocodone?

Hydrocodone is an antitussive (cough suppressant) and narcotic analgesic agent for the treatment of moderate to moderately severe pain. Studies indicate that hydrocodone is as effective, or more effective, than codeine for cough suppression and nearly equipotent to morphine for pain relief. (source)

History


Hydrocodone was first synthesized in Germany in 1920 by Carl Mannich and Helene Löwenheim. It was approved by the Food and Drug Administration on 23 March 1943 for sale in the United States and approved by Health Canada for sale in Canada under the brand name Hycodan.

Hydrocodone was first marketed by Knoll as Dicodid, starting in February 1924 in Germany. This name is analogous to other products the company introduced or otherwise marketed: Dilaudid (hydromorphone, 1926), Dinarkon (oxycodone, 1917), Dihydrin (dihydrocodeine, 1911), and Dimorphan (dihydromorphine). Paramorfan is the trade name of dihydromorphine from another manufacturer, as is Paracodin, for dihydrocodeine.

The name Dicodid was registered in the United States and appears without a monograph as late as 1978 in the Physicians’ Desk Reference; Dicodid may have been marketed to one extent or another in North America in the 1920s and early 1930s. The drug was pure hydrocodone in small 5 and 10 mg tablets, physically similar to the Dilaudid tablets. It is no longer manufactured by Knoll in Germany, nor is a generic available. Hydrocodone was never as common in Europe as it is in North America—dihydrocodeine is used for its spectrum of indications. Germany was the number two consumer of hydrocodone until the manufacture of the drug was discontinued there. Now, the world outside the United States accounts for less than 1% of annual consumption. It was listed as a Suchtgift under the German Betäubungsmittelgesetz and regulated like morphine. It became available in the Schengen Area of the European Union as of 1 January 2002 under Title 76 of the Schengen Treaty.(source)

Why is this medication prescribed?

Hydrocodone is used to relieve severe pain. Hydrocodone is only used to treat people who are expected to need medication to relieve severe pain around-the-clock for a long time and who cannot be treated with other medications or treatments. Hydrocodone extended-release (long-acting) capsules or extended-release tablets should not be used to treat pain that can be controlled by medication that is taken as needed. Hydrocodone is in a class of medications called opiate (narcotic) analgesics. It works by changing the way the brain and nervous system respond to pain.

This monograph only includes information about the use of hydrocodone alone. If you are taking a hydrocodone combination product, be sure to read information about all the ingredients in the hydrocodone-combination monograph and ask your doctor or pharmacist for more information.

How should this medicine be used?


Hydrocodone comes as an extended-release (long-acting) capsule and an extended-release (long-acting) tablet to take by mouth. The extended-release capsule is usually taken once every 12 hours. The extended-release tablet is usually taken once daily. Take hydrocodone at around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take hydrocodone exactly as directed by your doctor.

Swallow the extended-release capsules or extended-release tablets one at a time with plenty of water. Swallow each capsule or tablet as soon as you put it in your mouth. Do not presoak, wet, or lick the extended-release tablets before you put them in your mouth.

Your doctor will probably start you on a low dose of hydrocodone and may gradually increase your dose, not more than once every 3 to 7 days if needed to control your pain. After your take hydrocodone for a period of time, your body may become used to the medication. If this happens, your doctor may increase your dose of hydrocodone or may prescribe a different medication to help control your pain. Talk to your doctor about how you are feeling during your treatment with hydrocodone.

Do not stop taking hydrocodone without talking to your doctor. If you suddenly stop taking hydrocodone, you may experience withdrawal symptoms such as restlessness, teary eyes, runny nose, yawning, sweating, chills, hair standing on end, muscle pain, widened pupils (black circles in the middle of the eyes), irritability, anxiety, back or joint pain, weakness, stomach cramps, difficulty falling asleep or staying asleep, nausea, loss of appetite, vomiting, diarrhea, fast breathing, or fast heartbeat. Your doctor will probably decrease your dose gradually.
(source)

Hydrocodone/acetaminophen

Hydrocodone/paracetamol, also known as hydrocodone/acetaminophen, is the combination of the pain medications hydrocodone and paracetamol. It is used to treat moderate to severe pain. It is taken by mouth. Recreational use is common in the United States. Wikipedia

  • Common brands: Vicodin, Hycet, Vicodin ES
  • Narcotic
  • It can treat pain.

Controlled substance

High risk for addiction and dependence. Can cause respiratory distress and death when taken in high doses or when combined with other substances, especially alcohol.

  • Brands: Vicodin, Hycet, Vicodin ES, Lortab Elixir, Lorcet Plus, Zamicet, Verdrocet, Xodol 5/300, Xodol 7.5/300, Xodol 10/300, and more
  • Availability: Prescription needed
  • Pregnancy: Consult a doctor
  • Alcohol: Avoid. Very serious interactions can occur
  • Drug class: Pain reliever and Analgesic

Hydrocodone/acetaminophen side effects and warnings


Nausea
vomitingconstipationlightheadednessdizziness, or drowsiness may occur. Some of these side effects may decrease after you have been using this medication for a while. If any of these effects persist or worsen, tell your doctor or pharmacist promptly. (source)

Hydrocodone/acetaminophen interactions


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. (source)

Black box warning


“Acetaminophen has been associated with cases of acute liver failure, at times resulting in liver transplant or death. Most of the cases of liver injury are associated with the use of acetaminophen at doses that exceed 4000 milligrams per day, and often involve more than one acetaminophen-containing product.”

Allergy warning


“Do not take hydrocodone bitartrate and acetaminophen tablets if you are allergic to any of its ingredients. If you develop signs of allergy such as a rash or difficulty breathing stop taking hydrocodone bitartrate and acetaminophen tablets and contact your healthcare provider immediately.”

Overdose


Hydrocodone: Respiratory depression, extreme somnolence progressing towards coma, muscle limpness, cold and clammy skin, slow heart rate, low blood pressure, abrupt loss of heart function, and death may occur.

Acetaminophen: Liver and kidney failure, low blood sugar coma may occur.
(source)

What should I know about storage and disposal of this medication?


Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). You must immediately dispose of any medication that is outdated or no longer needed through a medicine take-back program.. If you do not have a take-back program nearby or one that you can access promptly, flush any hydrocodone tablets or capsules that are outdated or no longer needed down the toilet. Talk to your pharmacist about the proper disposal of your medication.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

In case of emergency/overdose


In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at 
https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can’t be awakened, immediately call emergency services at 911.

While you are taking hydrocodone, you may be told to always have a rescue medication called naloxone available (e.g., home, office). Naloxone is used to reverse the life-threatening effects of an overdose. It works by blocking the effects of opiates to relieve dangerous symptoms caused by high levels of opiates in the blood. You will probably be unable to treat yourself if you experience an opiate overdose. You should make sure that your family members, caregivers, or the people who spend time with you know how to tell if you are experiencing an overdose, how to use naloxone, and what to do until emergency medical help arrives. Your doctor or pharmacist will show you and your family members how to use the medication. Ask your pharmacist for the instructions or visit the manufacturer’s website to get the instructions. If someone sees that you are experiencing symptoms of an overdose, he or she should give you your first dose of naloxone, call 911 immediately, and stay with you and watch you closely until emergency medical help arrives. Your symptoms may return within a few minutes after you receive naloxone. If your symptoms return, the person should give you another dose of naloxone. Additional doses may be given every 2 to 3 minutes, if symptoms return before medical help arrives.

Symptoms of overdose may include the following:

  • slowed breathing
  • sleepiness
  • muscle weakness
  • cold, clammy skin
  • narrowed or widened pupils
  • slowed heartbeat
  • coma
  • Death 
    (source)

Hydrocodone FAQ

Does Hydrocodone make you sleepy?
Taking hydrocodone can make you feel very tired and drowsy. At the same time, it can cause insomnia. The result may be completely disrupted sleep cycles and a lack of energy day and night. Some people who use hydrocodone also struggle with a condition known as nodding.Feb 24, 2020

How much hydrocodone is too much?
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.

What is hydrocodone used for?
This combination medication is used to relieve moderate to severe pain. It contains an opioid pain reliever (hydrocodone) and a non-opioid pain reliever (acetaminophen). Hydrocodone works in the brain to change how your body feels and responds to pain. Acetaminophen can also reduce a fever.

Does hydrocodone have codeine in it?
Hydrocodone is a semi-synthetic opioid drug, derived from the opiate codeine.

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