Analgesic

Hydrocodone

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Hydrocodone, Hydrocodone Bitartrate, Hydrocodone with Acetaminophen, Vicodin, Norco, Lortab, Zohydro, Benhydrocodone, Apadaz

  • Indications
  1. Moderate pain not relieved with NSAIDs or Acetaminophen
  • Classification
  1. Hydrocodone was reclassified as FDA Schedule II Opioid in United States as of Spring 2013
  • Preparations
  1. Hydrocodone (5, 7.5 or 10 mg) with Acetaminophen 300 mg (Vicodin)
    1. Vicodin reformulated as of January 2014 in United States to lower Acetaminophen doses per pill (maximum 300 mg)
  2. Hydrocodone (7.5 mg/15 ml) with Acetaminophen (500 mg/15 ml) Suspension (Lortab Elixir)
  3. Hydrocodone Alone (Zohydro ER)
  4. Benhydrocodone (4.08 mg, 6.12 mg or 8.16 mg) with Acetaminophen 325 mg (Apadaz)
    1. Benhydrocodone 4.08 mg, 6.12 mg and 8.16 mg is roughly equivalent to Hydrocodone 5, 7.5 and 10 mg
    2. Benhydrocodone is a prodrug enzymatically converted to Hydrocodone in Gastrointestinal Tract
      1. Submitted and declined by FDA as an Opioid Abuse Deterrent Agent
    3. Offers no benefit over other Opioids including Hydrocodone and not recommended
    4. (2020) Presc Lett 27(1):4
  • Dosing
  • Hydrocodone with Acetaminophen (Vicodin Tablets)
  1. Hydrocodone 5 with Acetaminophen 300 (Vicodin 5/300)
    1. Vicodin 5/300 take 1-2 every 4-6 hours as needed for moderate pain (up to 8 tabs/day)
  2. Hydrocodone 7.5 with Acetaminophen 300 (Vicodin ES 7.5/300)
    1. Vicodin ES 7.5/300 take 1-2 every 4-6 hours as needed for moderate pain (up to 5 tabs/day)
  3. Hydrocodone 10 with Acetaminophen 300 (Vicodin HP 10/300)
    1. Vicodin HP 10/300 take 1 every 4-6 hours as needed for moderate pain (up to 6 tabs/day)
  • Dosing
  • Hydrocodone with Acetaminophen Suspension (Lortab Elixir)
  1. Components per 15 ml
    1. Hydrocodone 7.5 mg
    2. Acetaminophen 500 mg
  2. Dosing
    1. Age 2-3 years (12-15 kg or 27-34 lbs)
      1. Dose: 3.75 ml (0.75 tsp)
    2. Age 4-6 years (16-22 kg or 35-50 lbs)
      1. Dose: 5 ml (1 tsp)
    3. Age 7-9 years (23-31 kg or 51-69 lbs)
      1. Dose: 7.5 ml (1.5 tsp)
    4. Age 10-13 years (35-45 kg or 70-100 lbs)
      1. Dose: 10 ml (2.0 tsp)
  • Dosing
  • Hydrocodone alone
  1. Hydrocodone extended release (Zohydro ER)
    1. CII agent due out in United States in March 2014
    2. Available in 10-50 mg capsules and taken twice daily for severe Chronic Pain
    3. Increased abuse risk at a high financial cost without unique benefit
      1. Not in tamper resistant packaging and risk of crushing of immediate high (and further potentiated by Alcohol)
      2. Twice the cost of Oxycontin and 7 times the cost of generic Morphine ER
      3. FDA approved despite FDA expert panel voting to not approve (11 to 2 decision)
      4. In Zohydro Overdose, consider Activated Charcoal and Whole Bowel Irrigation, in addition to Naloxone infusion
        1. See Opioid Overdose
    4. References
      1. Swadron and Nordt in Herbert (2014) EM:Rap 14(10):3
      2. (2014) Presc Lett 21(4): 21
  • Resources
  1. Hydrocodone and Acetaminophen Tablet (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f1063950-b302-4898-81c2-b1626c9c16ef
  • References
  1. (2013) Presc Lett 20(12): 67