Hydrocodone

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 has multiple actions, mainly involving the CNS and smooth muscle. Peak serum concentrations after single therapeutic doses are typically less than 30 ng/ml and occur within 1.5 h after drug administration.25 The plasma half-life has been reported to range from 3.4 to 8.8 h with a volume of distribution of 3.3 to 4.7 L/kg.25 In humans, hydrocodone is metabolized by O-demethylation (by the action of CYP2D6) and N-demethy 1 ation (by the action of CYP3A4) and 

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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. 

Hydrochlorothiazide U 358 Hydrocodone 1, 288 Hydrocortisone U 190 Hydrocortisone acetate 1, 190 Hydroflumethiazide 3 5 8... 

Tussafed Syrup—dextromethorphan HBr, carbinoxam-ine maleate, pseudoephedrine HC1 Tussend Tablets—hydrocodone bitartrate, chlorpheniramine, pseudoephedrine HC1 Vanex HD Liquid—hydrocodone bitartrate, chloqihen-iramine, phenylephrine HC1... 

Atalis-D (Kanto-Isei) Hydrocodone Rorer as maleate)... 

The inifial sfeps in fhe mefabolism of morphine and codeine by Pseudomonas putida MIO involve oxidafion of fhe C-6 hydroxy group and subsequenf reducfion of fhe 7,8-olefinic bond, forming hydromorphone (dihydromorphinone) and hydrocodone (dihydrocodeinone), respectively (Scheme 4) [52], These products have important industrial appUcations hydromorphone is an analgesic some seven times more potent than morphine [53],... 

Codeine, hydrocodone, morphine, methadone, and oxycodone are substrates of the cytochrome P-450 isoenzyme CYP2D6.47 Inhibition of CYP2D6 results in decreased analgesia of codeine and hydrocodone due to decreased conversion to the active metabolites (e.g., morphine and hydromorphone, respectively) and increased effects of morphine, methadone, and oxycodone. Methadone is also a substrate of CYP3A4, and its metabolism is increased by phenytoin and decreased by cimetidine. CNS depressants may potentiate the sedative effects of opiates. 

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. 

Dose based on codeine—children 1 mg/kg per dose every 6 hours adult 30-60 mg/dose Hydrocodone + acetaminophen... 

Dose based on hydrocodone—children 0.2 mg/kg per dose every 6 hours adults 5-10 mg/dose Anti-inflammatory agents... 

Ibuprofen + hydrocodone Each tablet contains 200 mg ibuprofen and 7.5 mg hydrocodone per tablet only for older children who can swallow tablets... 

HYDROCODONE BITARTRATE AND ACETAMINOPHEN TABLETS 100 TABS/BOTTLE 5505011899903 BT 4.61 ... 

Vicodin ES (apap + hydrocodone bitartrate) 1-2 tabs q4-6h. pm pain... 

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