Acetaminophen with hydrocodone

Vicodin—A pain-relief drug that combines acetaminophen with hydrocodone, which can be habit-forming. 

Inadequate analgesia with hydrocodone-acetaminophen ibuprofen ... 

The opioid analgesics of choice for use in the elderly are listed in Box 7-3. For treatment of moderate to severe pain, an effective opioid regimen consists of a combination of acetaminophen with 15 to 60 mg codeine or acetaminophen with 5 to 30 mg oxycodone. Acetaminophen combinations with hydrocodone are also frequently used. If pain persists, an alternative opioid analgesic should be selected. Adjuvants such as caffeine may enhance the analgesic activity of the opioid. 

CNS depression is the most frequently reported clinical effect. The typical overdose patient may present with extreme somnolence that may progress to frank coma. Miosis is usually present unless the individual is acidotic or has suffered hypoxic brain injury. Respiratory depression can occur and may progress to respiratory arrest. Pulmonary edema may be seen. Bradycardia, hypotension, and hyperthermia can develop. Hydrocodone is often combined in products with acetaminophen therefore, patients should be evaluated for hepatotoxicity secondary to acetaminophen overdose. Available opiate immunoassays cross-react unreliably with hydrocodone. Peak therapeutic serum levels are 0.024 mg 1 toxic levels have been reported to reach 0.1-1.3 pgml , but are of little prognostic or therapeutic value. 

Friedman RA, House JW, Luxford WM, et al. Profound hearing loss associated with hydrocodone/acetaminophen abuse. Am J Otol 2000 21 188-9. 

Cardiovascular A case report of a 23-year-old man who presented with sinus bradycardia and second degree Mobiz Type I AV block after ingestion of 42 alprazolam tables, risperidone, acetaminophen and hydrocodone [1 ]. The exact quantity, dose and ingestion times were unknown. The AV block resolved 5 h after his presentation, he refused further follow-up. This case suggests the possibility of potential arrhythmogenicity associated with benzodiazepine exposure. 

Severe pain should be treated with an opioid such as morphine, hydromorphone, methadone, or fentanyl. Moderate pain can be treated effectively in most cases with a weak opioid such as codeine or hydrocodone, usually in combination with acetaminophen. Meperidine should be avoided owing to its relatively short analgesic effect and its toxic metabolite, normeperidine. Normeperidine may accumulate with repeated dosing and can lead to central nervous system side effects including seizures. 

Catalytic reduction of codeine gives dihydrocodeine and Oppenauer oxidation (a ketone such as acetone and an aluminum alkoxide, the ketone being reduced to an alcohol) gives hydrocodone. Hydrocodone can also be prepared directly from codeine with a metal catalyst, which isomerizes the allylic alcohol to a ketone. Codeine is prepared by methylation of morphine, which is isolated from the opium poppy. Hydrocodone is more potent than codeine. Acetaminophen is a mild analgesic and is discussed in Section 8. 

Unlike hydrocodone, it is used as an analgesic in combination with other drugs, such as aspirin or acetaminophen. Oxycodone is similar to morphine in terms of durational efficacy and is intended for oral use. Synonyms for this drug are roxicodone, proladone, per-ketan, eutagen, oxycon, and many others. 

Acute pain is managed with either nonopioids such as acetaminophen, NSAIDs, or, when severe, opioids such as meperidine, morphine, methadone, hydromor-phone, fentanyl, or sufentanil (Golianu et ah, 2000). The latter are generally used parenterally, and when the patient is converted to oral analgesics, agents such as codeine, oxycodone, and hydrocodone are often used. 

Hydrocodone is a semisynthetic opioid derived from codeine.18It is utilized as an analgesic and antitussive available for oral administration, often in combination with acetaminophen or ibuprofen. As a rule, potent analgesics containing a methoxyl group at position 3 (e.g., hydrocodone, K, = 19.8 nM) bind the mu receptor relatively weakly, but their O-demethylated metabolites (such as hydromorphone, Kt = 0.6 nM) bind more strangely. As with oxycodone, the possibility exists that some of their ability to relieve pain may actually derive from their active metabolites 48... 

Hydrocodone None when used alone 5-10 mg every 4-6 hours Most often combined with acetaminophen (Anexsia , Azolone, Damason , Lorcet , Lortab , Vicodin , Zydone ) or ibu profen (Vico profen )... 

SCHEDULE II Certain barbiturates, cocaine, codeine, codeine + acetaminophen (depends on dose and formulation), fentanyl (depends on dose), hydrocodone, hydromorphone, meperidine, methadone, morphine (depends on combination with other pain relievers), oxycodone, propoxyphene... 

Hydrocodone, another codeine congener, is approximately six times more potent than codeine. This agent appears to cause less constipation and less sedation than codeine. It has been suggested that hydrocodone may produce more euphoria than codeine, but this effect has not been substantiated in clinical studies. Hydrocodone is also available in combination with aspirin, acetaminophen, or ibuprofen. 

Case Conclusion In the ED, the patient was given IV morphine with adequate pain control. After an overnight hospital stay for observation and easting of the left leg, LG was discharged to home with a prescription for hydrocodone/ acetaminophen tablets, to be taken as needed for pain. 

The AHCPR guidelines recommend using the WHO three-step method for managing cancer pain. Patients should be started on a nonopioid pain medication, such as acetaminophen or a nonsteroidal antiinflammatory agent. If this does not relieve their pain, proceed to the next level of a weak opioid agent, such as codeine or hydrocodone, with or without a nonopioid. If this does not relieve their pain, proceed to the final level of a strong opioid, such as morphine, with or without a nonopioid. 

Many analgesic effectiveness studies involving combination drug formulations (an opioid combined with a nonopioid) have been reported. For example, in the treatment of moderate to severe postoperative obstetric or gynecologic pain, 2-tablet dose of hydrocodone 7.5 mg with ibuprofen 200 mg was comparable in efficacy to the 2-tablet dose of oxycodone 5 mg and acetaminophen 325 mg. Obviously both of these treatments were superior to the placebo [23]. In contrast, for treatment of chronic pain, the 2-tablet dose of hydrocodone 7.5 mg and ibuprofen 200 mg was more effective than either the 1 -tablet dose of this combination or the 2-tablet dose of codeine 30 mg and acetaminophen 300 mg combination [24]. In a double-blind, randomized controlled trial involving 118 patients with chronic cancer pain, the combination formulation of hydrocodone (25 mg/d) and acetaminophen (2500 mg/d) was effective in relieving pain in 56.5% of the patients [25]. 

Hydrocodone PO 5-10 mg q 3-6 h Use in moderate/severe pain Most effective when used with NSAIDs or aspirin or acetaminophen... 

Hydrocodone Bitartrate (Lortab, Vicodin in Combinations with Acetaminophen)... 

The client with a brain tumor is complaining of headache that is a 5 on a scale of 1-10. The client s Medication Administration Record (MAR) has acetaminophen (Tylenol) 2 po PRN pain, hydrocodone (Vicodin) 2 po PRN pain, morphine 4 mg IVP PRN pain, and lorazepam (Ativan) 1 mg fVP PRN. Which medication should the nurse prepare to administer ... 

Which discharge instructions should the nurse provide for the client diagnosed with cancer who is taking hydrocodone with acetaminophen (Vicodin) PRN for pain ... 

The term opioids refers to these and other derivatives of naturally occurring opium (eg, morphine, heroin, codeine, and hydrocodone) as well as new, totally synthetic opiate anaiogs (eg, fentanyl, butorphanol, meperidine, and methadone Table 11-43). A wide variety of prescription medications contain opioids, often in combination with aspirin or acetaminophen. Dextromethorphan (see p 183) is an opioid derivative with potent antitussive but no analgesic or addictive properties. Tramadol (Ultram )... 

Hydrocodone (trade name in Germany Dicoditfl, though marketing approval has been withdrawn due to addiction risk) is an opioid as well, with a pharmacology that is comparable to codeine. Particularly pronounced is its antitussive activity. Hydrocodone has higher potency than codeine, and is therefore used for moderate to severe pain. It is formed by palladium- or platinum-catalysed double bond isomerisation of codeine. Hydrocodone production has seen an almost constant upward trend over the past 20 years, teaching 56 tonnes in 2011. It is exclusively manufactured in the United States, where it is used in combination products, e.g. with acetaminophen in Vicodin . [82]... 

Addiction to Vicodin (hydrocodone with acetaminophen) can result in complete deafness. 

While primarily employed as an analgesic, hydromor-phone is an excellent cough suppressant and is associated with less histamine release and pruritus than codeine. Hydrocodone is only available for oral administration, as either a tablet, capsule, or syrup formulation, and is usually combined with acetaminophen or ibuprofen. Standard immediate-release tablets provide 4-6 h of analgesia for patients with... 

Hydrocodone/acetaminophen may be used to treat moderate to moderately severe pain with greater convenience and possibly better patient compliance since it is dosed twice a day (ql 2 hours) instead of the usual 3-6 hours. The long-term efficacy of extended-release hydrocodone/acetaminophen was evaluated for osteo-arthritic pain management [7]. Pain and quality of life were assessed using Brief Pain Inventory (BPI), Work Productivity and Activity Impairment (WPAI), and SF-36 questionnaires that occurred at baseline. 

P< 0.01 vs. placebo, V< 0.01 vs. one tablet. With permission from- DesJardins P, Diamond E, Clark F. Treatment of acute pain with 12-hour controlled-release hydrocodone-acetaminophen tablets following bunionectomy a randomized, double-blind, placebo-controlled study. The American Academy of Pain Medicine Annual Meeting, 23rd Annual Meeting, February 7-10,2007, New Orleans, LA. 

Absolute history of previous severe allergic reaction to hydrocodone or acetaminophen. Relative head injury, increased intracranial pressure, elderly patient, severe liver or renal impairment, acute abdominal conditions, hypothyroidism, Addison s disease, prostatic hypertrophy, urethral stricture, history of drug abuse, and patients with respiratory depression [8]. 

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