Antitussives hydrocodone

Hydromorphone [466-99-9] (31) and hydrocodone [125-29-1] (32) are isomers of morphine and codeine, respectively. Hydromorphone can be prepared by catalytic rearrangement of morphine (49) or by oxidation of the aliphatic hydroxyl group of dihydromorphine (50). Hydrocodone can be similarly prepared. As an antitussive, hydromorphone is several times more active than morphine and hydrocodone is slightly more active than codeine. Hydromorphone has a much higher addiction potential than hydrocodone. 

Catalytic reduction of codeine (2) affords the analgesic dihydrocodeine (7) Oxidation of the alcohol at 6 by means of the Oppenauer reaction gives hydrocodone (9)an agent once used extensively as an antitussive. It is of note that treatment of codeine under strongly acidic conditions similarly affords hydrocodone by a very unusual rearrangement of an allyl alcohol to the corresponding enol, followed by ketonization. 

Hydromorphone (I) and hydrocodone (II) belong to the morphine group of drugs and are used invariably in combination with other ingredients in a number of proprietory antitussive and analgesic antipyretic mixtures. However, interest in the pharmacokinetics of hydromorphone and hydrocodone in human subjects required an adequate assay for drug levels in plasma. 

Hydrocodone is an opium analgesic (pain reliever) and antitussive (cough suppressant). It is related in structure to other alkaloids used as drugs, such as morphine and codeine (see Section 8). It increased 20% in number of prescriptions for one year. Its synthesis from codeine is by simple reactions. 

Codeine occurs naturally in opium but the amount is too small to be useful. It is prepared from morphine by methylating the phenolic hydroxyl group with diazomethane, dimethyl sulfate, or methyl iodide. Codeine does not possess the same degree of analgesic potency as morphine but is used as an antitussive, a cough suppressant. Hydrocodone was discussed in Section 3.4. It is made from codeine. 

Hydrocodone exhibits expressed analgesic and antitussive properties, which make up its primary clinical use. It may cause dependence and addiction. Synonyms for this medication are dicodid, detussin, vicodin, and others. 

Each teaspoonful (5 mL) of TUSSIONEX Pennkinetic extended-release suspension contains hydrocodone polistirex equivalent to 10 mg of hydrocodone bitartrate and chlorpheniramine polistirex equivalent to 8 mg of chlorpheniramine maleate. TUSSIONEX Pennkinetic extended-release suspension provides up to 12-hour relief per dose. Hydrocodone is a centrally acting narcotic antitussive. Chlorpheniramine is an antihistamine. TUSSIONEX Pennkinetic extended-release suspension is for oral use only. Hydrocodone polistirex sulfonated styrene-divinylbenzene copolymer complex with... 

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 is used in small animal veterinary practice for the management of pain and for its antitussive properties. Hydrocodone should be used with... 

Codeine, hydrocodone, and hydromorphone are used in combination products as antitussives. "M be beneficial in vascular headaches. 

Hydrocodone bitartrate/homatropine methylbromide is an antitussive combination. Hydrocodone suppresses the cough reflex stimulates opiate receptors iu the CNS and peripherally blocks pain impulse geueratiou. Atropine inhibits action of acetylcholine or other cholinergic stimuli at postgauglionic cholinergic receptors. They are used for symptomatic relief of cough. 

Homatropine methylbromide is the quaternary derivative of homatropine. It is less potent than atropine in antimuscarinic activity, but it is four times more potent as a ganglionic blocking agent. It is available in combination with hydrocodone as an antitussive combination (hycodan) and has been used for relief of GI spasms and as an adjunct in peptic ulcer disease. 

Hydrocodone bitartrate is approximately threefold more effective on a weight basis as an oral antitussive medication compared to codeine. Hydrocodone also has greater analgesic activity and abuse potential than codeine. Hydrocodone is only available as a Schedule III prescription agent in combination formulations for cough suppression. 

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]... 

First produced in 1920, hydrocodone is a semisynthetic hydrogenated ketone related to the phen-anthrene derivative codeine. It is only available as an enteral agent in oral preparations. Hydrocodone bitartrate is cmrently approved in the USA only for use in fixed combinations with non-opioid medications as an analgesic or antitussive agent Another preparation, hydrocodone polistirex, is used as an antitussive agent, again only in combination with nonopioid medications. Hydrocodone bitartrate forms a water-soluble crystalline powder it is sensitive to light and typically stored at room temperature in a... 

Hydrocodone bitartrate is absolutely contraindicated in patients with known hypersensitivity reactions to hydrocodone. Commercial preparations may also contain sulfite compounds that can produce allergic reactions, including bronchospasm and anaphylaxis, in certain susceptible individuals, particularly asthmatic patients. In addition, the dye tartrazine is present in one preparation of hydrocodone bitartrate, combined with chlorpheniramine maleate and phenylephrine hydrochloride, that is used as an antitussive and expectorant agent (Vanex). Also known as FD C yellow No. 5, tartrazine can cause asthmatic and other allergic reactions in some susceptible patients, especially those with aspirin sensitivities. 

For the symptomatic relief of moderate to moderately severe pain, hydrocodone should be administered in the smallest dose as infrequently as possible to achieve the desired treatment effect and minimize the development of tolerance and dependence. The usual adult dosage is 5 to 10 mg PO every 4 to 6 hours as necessary, with manufacturer recommendations on maximum daily total doses of 60 mg when combined with acetominophen and 37.5 mg when combined with ibuprofen. Unlike when used as an antitussive, where the recommended dose for children 6 to 12 years of age is 2.5 mg PO every 4 to 6 hours as necessary with a daily maximum of 15 mg, there is no consensus pediatric recommendation for the use of hydrocodone bitartrate as an analgesic agent. Additionally, in both cases, there are no data on the efficacy and safety of its use in children under 6 years of age. However, some authors and clinicians recommend an analgesic pediatric starting dose, based on the hydrocodone component of various preparations, of 0.1 mg/kg every 4 to 6 hours as needed, similar to the pediatric dose of oxycodone. 

Opiates, narcotic compounds extracted or derived from opium, are a remarkable source of lead compounds for their potent pharmaceutical effects such as analgesics, antitussives and ataractics, and of which many synthetic derivatives have been prepared [8, 72], Apomorphine (28), a dopamine agonist derivative from morphine (5) but without analgesic properties like morphine, was recently approved as a therapy for Parkinson s disease [73], Hydrocodone (30) is a narcotic agent derived from thebaine (29) and is commonly combined with other analgesics such as acetaminophen and ibuprofen as drugs to relieve pain. [74]. Naloxone (31) and naltrexone (32) are both opioid receptor antagonists. Naloxone is used as a treatment for opioid... 

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