Hydrocodone

DESCRIPTION / DEFINITIONS: Hydrocodone (hydrocodone bitartrate) is the active ingredient in approximately 25 different brand names of prescription painkillers. It is usually combined with other drugs, including acetaminophen and ibuprofen, and is available in several different forms – tablets, oral solution, immediate or extended release, and so on. It is packaged or repackaged by dozens of different companies. See more information below.

ABUSE: Hydrocodone has high potential for abuse similar to other opioids including fentanyl, oxycodone, hydromorphone, methadone, morphine, oxymorphone.

ADDICTION / DEPENDENCE: Becoming addicted to or dependant on hydrocodone is possible even if taken as directed by your doctor and with no abuse or misuse. The drug label warns that hydrocodone “expose patients and other users to the risks of opioid addiction, abuse, and misuse, which can lead to overdose and death.It’s best to take it for the shortest period of time possible, and at the lowest dosage.

SIDE EFFECTS:  Hydrocodone side effects include nausea, headaches, dizziness, chest pain, dangerously low blood pressure upon standing, erectile dysfunction, infertility, immune system suppression and more.  See more complete list below.

WITHDRAWAL SYMPTOMS: Common withdrawal symptoms include: abdominal cramping, pain, anxiety, diarrhea, shaking, high blood pressure and increased heartbeat.  See more complete list below.

TREATMENT: Quitting hydrocodone on your own can be painful and dangerous. Medical detox is the most comfortable and safest way to stop taking hydrocodone. Call us to talk to a Detox Advisor.

 

DESCRIPTION / DEFINITIONS

Hydrocodonen (hydrocodone bitartrate) is a prescription painkiller. It is available by itself, but is usually formulated with other drugs such as acetaminophen, ibuprofen, antihistamines, decongestants, medications for respiratory symptoms associated with a cold or allergy, medications that treat ulcers or intestine problems, or GABA (gamma-aminobutric acid), an amino acid prescribed for anxiety, improving mood, reducing symptoms of premenstrual syndrome (PMS), and treating attention deficit-hyperactivity disorder (ADHD).

Hydrocodone is sold under several brand names, including:

  • Anexsia (Hydrocodone Bitartrate and Acetomenaphin)
  • Ceta Plus (Hydrocodone Bitartrate and Acetomenaphin)
  • Co-Gesic (Hydrocodone Bitartrate and Acetomenaphin)
  • Dolorex Forte (Hydrocodone Bitartrate and Acetomenaphin)
  • Flowtuss (hydrocodone bitartrate and Guaifenesin – an expectorant used in cough syrups and sometimes for pain relief from fibromyalgia)
  • Hycet (Hydrocodone Bitartrate and Acetomenaphin)
  • Hydrocodone Bitartrate and Chlorpheniramine Maleate (an antihistamine) solution
  • Hydrocodone Bitartrate and Homatropine Methylbromide (used to treat duodenal or stomach ulcers or intestine problems) oral solution
  • Hydrocodone Bitartrate and Ibuprofen tablet
  • Hydrocodone Bitartrate, Chlorpheniramine Maleate and pseudoephedrine hydrochloride (an antihistamine and decongestant used to treat or prevent symptoms of allergies) solution
  • Hydrocodone polistirex (used as a cough suppressant and to treat cough and respiratory symptoms associated with a cold or allergy) and chlorpheniramine polistirex (also used to treat cough and respiratory symptoms associated with a cold or allergy)
  • Liquicet (Hydrocodone Bitartrate and Acetomenaphin)
  • Lorcet (Hydrocodone Bitartrate and Acetomenaphin)
  • Lortab (Hydrocodone Bitartrate and Acetomenaphin)
  • Maxidone (Hydrocodone Bitartrate and Acetomenaphin)
  • Norco (Hydrocodone Bitartrate and Acetomenaphin)
  • Obredon (Hydrocodone Bitartrate and Guaifenesin solution)
  • Reprexain (Hydrocodone and Ibuprofen)
  • Theracodophen-325 (Hydrocodone Bitartrate and Acetomenaphin and gamma-aminobutric acid – GABA, a amino acid that is taken to relieve anxiety, improve mood, reduce symptoms of premenstrual syndrome (PMS), and treat attention deficit-hyperactivity disorder (ADHD))
  • Tussicaps (hydrocodone polistirex and chlorpheniramine polistirex cap)
  • Tussigon (Hydrocodone Bitartrate and homatropine methylbromide tab)
  • Tussionex Pennkinetic (Hydrocodone Bitartrate and chlorpheniramine) suspension or (TUSSIONEX Pennkinetic Extended-Release Suspension (Hydrocodone Bitartrate and chlorpheniramine)
  • Verdrocet (Hydrocodone Bitartrate and Acetomenaphin)
  • Vicodin (Hydrocodone Bitartrate and Acetomenaphin)
  • Xodol (Hydrocodone Bitartrate and Acetomenaphin )
  • Zamicet (Hydrocodone Bitartrate and Acetomenaphin)
  • Zydone (Hydrocodone Bitartrate and Acetomenaphin )

Hydrocodone is dangerous and has a very high potential for abuse, addiction, misuse, and dependency.

In addition to the side effects section below, the Hydrocodone Bitartate and Acetomenaphin label summarizes the numerous potential problems with this drug:

WARNING: ADDICTION, ABUSE, AND MISUSE; RISK EVALUATION AND MITIGATION STRATEGY (REMS); LIFE-THREATENING RESPIRATORY DEPRESSION; ACCIDENTAL INGESTION; NEONATAL OPIOID WITHDRAWAL SYNDROME; CYTOCHROME P450 3A4 INTERACTION; HEPATOTOXICITY; AND RISKS FROM CONCOMITANT USE WITH BENZODIAZEPINES OR OTHER CNS DEPRESSANTS

Addiction, Abuse, and Misuse

Hydrocodone Bitartrate and Acetaminophen Tablets expose patients and other users to the risks of opioid addiction, abuse, and misuse, which can lead to overdose and death. Assess each patient’s risk prior to prescribing Hydrocodone Bitartrate and Acetaminophen Tablets, and monitor all patients regularly for the development of these behaviors and conditions.

Opioid Analgesic Risk Evaluation and Mitigation Strategy (REMS)

To ensure that the benefits of opioid analgesics outweigh the risks of addiction, abuse, and misuse, the Food and Drug Administration (FDA) has required a REMS for these products. Under the requirements of the REMS, drug companies with approved opioid analgesic products must make REMS-compliant education programs available to healthcare providers. Healthcare providers are strongly encouraged to

  • complete a REMS-compliant education program,
  • counsel patients and/or their caregivers, with every prescription, on safe use, serious risks, storage, and disposal of these products,
  • emphasize to patients and their caregivers the importance of reading the Medication Guide every time it is provided by their pharmacist, and
  • consider other tools to improve patient, household, and community safety.

Life-Threatening Respiratory Depression

Serious, life-threatening, or fatal respiratory depression may occur with use of Hydrocodone Bitartrate and Acetaminophen Tablets. Monitor for respiratory depression, especially during initiation of Hydrocodone Bitartrate and Acetaminophen Tablets or following a dose increase.

Accidental Ingestion

Accidental ingestion of Hydrocodone Bitartrate and Acetaminophen Tablets, especially by children, can result in a fatal overdose of Hydrocodone Bitartrate and Acetaminophen Tablets.

Neonatal Opioid Withdrawal Syndrome

Prolonged use of Hydrocodone Bitartrate and Acetaminophen Tablets during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated, and requires management according to protocols developed by neonatology experts. If opioid use is required for a prolonged period in a pregnant woman, advise the patient of the risk of neonatal opioid withdrawal syndrome and ensure that appropriate treatment will be available.

Cytochrome P450 3A4 Interaction

The concomitant use of Hydrocodone Bitartrate and Acetaminophen Tablets with all Cytochrome P450 3A4 inhibitors may result in an increase in hydrocodone plasma concentrations, which could increase or prolong adverse reactions and may cause potentially fatal respiratory depression. In addition, discontinuation of a concomitantly used Cytochrome P450 3A4 inducer may result in an increase in hydrocodone plasma concentrations. Monitor patients receiving Hydrocodone Bitartrate and Acetaminophen Tablets and any Cytochrome P450 3A4 inhibitor or inducer for signs of respiratory depression or sedation.

Hepatotoxicity

Acetaminophen has been associated with cases of acute liver failure, at times resulting in liver transplant and death. Most of the cases of liver injury are associated with the use of acetaminophen at doses that exceed 4,000 milligrams per day, and often involve more than one acetaminophen-containing product.

Risks From Concomitant Use With Benzodiazepines Or Other CNS Depressants

Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death.

  • Reserve concomitant prescribing of Hydrocodone Bitartrate and Acetaminophen Tablets and benzodiazepines or other CNS depressants for use in patients for whom alternative treatment options are inadequate.
  • Limit dosages and durations to the minimum required.
  • Follow patients for signs and symptoms of respiratory depression and sedation.

ABUSE

Hydrocodone is classed by the DEA as a Schedule II drug, which means:

A. The drug or substance has a high potential for abuse.

B. The drug or other substance has a currently accepted medical use in treatment in the United States or a currently accepted medical use with severe restrictions.

C. Abuse of the drug or other substances may lead to severe psychological or physical dependence.

Hydrocodone is one of the most commonly abused prescription painkillers and is one of the drugs featured in the current opioid epidemic.

One can abuse hydrocodone by taking it in higher doses, more frequently, or for longer than it was prescribed.

 

ADDiCTION / DEPENDENCE

Hydrocodone is highly addictive, and easy to become dependent upon. The body sometimes builds a tolerance to hydrocodone, as with other opioids, making it necessary to take more of the drug to get the same effect. Increasing the amount being taken makes the risk of dependence and addiction even worse – as does taking it for longer than absolutely necessary.

One of the worst parts of becoming dependent or addicted is trying to quit the drug. It is uncomfortable and painful, both mentally and physically. In fact, most people who try to quit hydrocodone start going through the withdrawal symptoms and are so uncomfortable that they break down and take more of the drug. After that, it’s less likely that the person will try again. They don’t want to go through the same thing.

The longer you take hydrocodone, the more difficult and dangerous it can become to take and to quit.

 

HALF LIFE AND METABOLISM

The biological half-life of a substance is the time it takes for a drug to lose half of its pharmacologic activity. This is significant because it affects how soon withdrawal symptoms may appear.

The half life of hydrocodone is approximately 3.8 hours. Acetaminophen is 1.25 to 3 hours.

The CYP2D6 enzyme is entirely responsible for the metabolism of hydrocodone.

The liver is the primary site in the body where acetaminophen is metabolized.

The CYP enzymes are the major enzymes involved in drug metabolism, and since many drugs may increase or decrease the activity of various CYP isozymes, this is a major source of adverse drug interactions, since changes in CYP enzyme activity may affect the metabolism and clearance of various drugs. For example, if one drug inhibits the CYP-mediated metabolism of another drug, the second drug may accumulate within the body to toxic levels, possibly causing an overdose.

OPIOID INDUCED HYPERALGESIA

There is increasing medical research showing that taking opioids like hydrocodone for longer than six months will create a condition called Opioid Induced Hyperalgesia. This is a condition where the opioids actually make the pain receptors more sensitive and, therefore, make the pain greater. A person with this condition is required to take more and more of the opioid to try to address the pain but finds that the pain actually increases.

 

SIDE EFFECTS

Some of the side effects of hydrocodone can be mild, but the drug can also be deadly:

  • abdominal pain
  • accidental ingestion, especially by children, may result in respiratory depression or death
  • acetaminophen can cause potentially fatal hepatic necrosis,  renal tubular necrosis, hypoglycemic coma, coagulation defects. Early symptoms following a potentially hepatotoxic overdose may include: nausea, vomiting, diaphoresis and general malaise. Clinical and laboratory evidence of hepatic toxicity may not be apparent until 48 to 72 hours post-ingestion.
  • addiction can occur at recommended dosages and if the drug is misused or abused
  • adrenal insufficiency, a potentially life-threatening condition that may be indicated if nausea, vomiting, anorexia, fatigue, weakness, dizziness, and low blood pressure occur
  • agitation
  • agranulocytosis – dangerously low white blood count.
  • allergic reactions.
  • amenorrhea – abnormal or no menstruation
  • anaphylaxis – an acute allergic reaction that prompts the immune system to respond. The symptoms can include: fainting, lightheadedness, low blood pressure, dizziness,  flushing, difficulty breathing, rapid breathing, shortness of breath,  wheezing, hives, swelling under the skin, blue skin from poor circulation, rashes, nausea,  vomiting, fast heart rate, feeling of impending doom, itching, tongue swelling, difficulty swallowing, facial swelling, mental confusion, nasal congestion, or impaired voice.
  • anxiety
  • chest pain
  • circulatory failure
  • CNS depression
  • combining hydrocodone/ acetaminophen with other opioids, benzodiazepines, alcohol, or other central nervous system depressants (including street drugs) can cause severe drowsiness, decreased awareness, breathing problems, coma, and death.
  • constipation
  • digestive problems
  • dizziness
  • drowsiness
  • dysphoria – a state of unease or generalized dissatisfaction with life
  • erectile dysfunction
  • even when taken as recommended, hydrocodone can result in addiction, abuse, and misuse, which can lead to overdose and death
  • extreme drowsiness
  • fast heartbeat
  • fear
  • feeling faint
  • flushing
  • headache
  • hearing impairment
  • high body temperature
  • hypogonadism – insufficient sex hormones, male or female. Symptoms can include: lack of menstruation, slow or absent breast growth, hot flashes, loss of body hair, low or absent sex drive, milky discharge from breasts, muscle loss, abnormal breast growth, reduced growth of penis and testicles, erectile dysfunction, osteoporosis (bones become brittle and fragile from loss of tissue), low or absent sex drive, infertility, fatigue, hot flashes, difficulty concentrating
  • impairment of mental and physical performance
  • impotence
  • Infertility – may or may not be reversible
  • lethargy
  • life-threatening respiratory depression, especially when just starting to take  the drug or when increasing the dosage
  • light-headedness
  • light-headedness when changing positions
  • low blood pressure
  • low libido – low sex drive
  • may impair the ability to perform potentially hazardous activities such as driving a car or operating heavy machinery
  • mental changes such as confusion
  • mental clouding
  • miosis – excessive constriction of the pupil of the eye, even in total darkness. (Marked mydriasis (dilation of the pupil of the eye) rather than miosis may be seen due to hypoxia (deficiency in the amount of oxygen reaching the tissues) in overdose situations.)
  • mood changes
  • nausea
  • orthostatic hypotension – dizziness and fainting upon standing up
  • permanent hearing loss – primarily in patients with chronic overdose
  • potentially fatal effects may occur if Hydrocodone Bitartrate and Acetaminophen Tablets are used with benzodiazepines and other CNS depressants, including alcohol
  • pruritus – severe itching of the skin
  • psychological dependence
  • rapid, shallow breathing.
  • red eyes
  • respiratory depression
  • sedation
  • Serotonin Syndrome – (when taken in combination with serotonergic drugs) -serotonin syndrome is a group of side effects that include high body temperature, agitation, increased reflexes, tremor, sweating, dilated pupils, and diarrhea, associated with serotonergic drugs. Serotonergic drugs are used to treat migraine. depression and other mood disorders.
  • severe constipation
  • shortness of breath
  • skin rash
  • sleepiness
  • Stevens-Johnson syndrome –  a rare, very serious disease that makes skin blister and peel off
  • stiff muscles
  • stomach spasm
  • suppression of the immune system
  • sweating
  • swelling of the face, tongue, or throat
  • syncope – temporary loss of consciousness caused by a fall in blood pressure
  • thrombocytopenia – low blood platelet count which can lead to difficulty with blood clotting. Symptoms may include: easy or excessive bruising, superficial bleeding into the skin that appears as a rash of pinpoint-sized reddish-purple spots usually on the lower legs, prolonged bleeding from cuts, bleeding from your gums or nose, blood in urine or stools, unusually heavy menstrual flows, fatigue, enlarged spleen, and jaundice.
  • tiredness
  • tolerance, leading to needing more of the drug
  • toxic epidermal necrolysis – a rare, life-threatening drug-induced skin disease that causes you to lose the outer layer of your skin. It has a mortality rate of approximately 30 percent.
  • trouble breathing
  • trouble walking
  • ureteral spasm – incontinence or overactive bladder, sometimes accompanied by cramping pain and sometimes as a burning
  • urinary retention
  • vomiting

 

WITHDRAWAL SYMPTOMS

The comfort and safety of withdrawal from hydrocodone depends on how long you’ve been taking the drug, at what dosage, and how you react to the drug and to withdrawal. It’s different for everyone. But, generally, these are the most common withdrawal symptoms:

  • abdominal cramping
  • aching
  • anxiety
  • bone pain
  • cold flashes
  • diarrhea
  • excessive sweating
  • fever
  • high blood pressure
  • increased heart beat
  • insomnia
  • irritability
  • muscle and joint pain
  • nausea
  • runny nose
  • shaking
  • stomach aches
  • vomiting
  • watery eyes

TREATMENT

Most people don’t succeed in quitting hydrocodone without medical supervision. Plus, it can be extremely dangerous medically. The best treatment is in a medical detox facility that can help relieve the pain and discomfort while keeping you safe. Call us to talk to a Detox Advisor.