|Trade names||Hycet, Lorcet, Lorcet Plus, Lortab, Maxidone, Norco, Vicodin, Vicodin ES, Vicodin HP, Zamicet, and Zydone (possibly others)|
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|(what is this?)|
Hydrocodone/paracetamol, hydrocodone/acetaminophen, or hydrocodone/APAP (or under brand names such as Lortab, Norco and Vicodin) is a combination opioid narcotic analgesic drug consisting of hydrocodone and paracetamol (acetaminophen) used to relieve moderate to severe pain.
Hydrocodone/paracetamol is indicated for relief of moderate to moderately severe pain of acute, chronic or postoperative types.
Hydrocodone diversion and recreational use has escalated in recent years. In 2009 and 2010, hydrocodone was the second-most frequently encountered opioid pharmaceutical in drug evidence submitted to U.S. federal, state, and local forensic laboratories as reported by DEA’s National Forensic Laboratory Information System and System to Retrieve Information from Drug Evidence.
In 2007, 99% of hydrocodone was consumed in the United States. It was the most commonly prescribed opioid in the United States as of 2012. About 142 million prescriptions were dispensed in the US for hydrocodone-combination products, and the hydrocodone/acetaminophen combination was the most common of those.
Hydrocodone acts at μ-opioid receptors. It is metabolized to hydromorphone by the activity of cytochrome P450 2D6. Cytochrome 3A4 forms the substrate norhydrocodone. This conversion is only somewhat responsible for the effects of hydrocodone. Hydrocodone passes through the blood–brain barrier because of its modifications. The brain is typically where the analgesic effects are being carried out. Many of the side effects of this drug are caused because it so readily crosses the blood–brain barrier. The half-life of hydrocodone is around 3.8 hrs.
The major active metabolites of paracetamol are sulphates and glucuronide conjugates. Its main mode of action is to inhibit the activity of the enzyme cyclooxygenase (COX). COX enzymes are necessary for the production of prostaglandins. Prostaglandins are a form of hormone (although rarely classified as such) that are indicated to be mediators of pain, fever, and inflammation. The half-life of paracetamol may be measured either by salivary or by plasma counts. Both measurements give a varying half-life between 1 and 4 hours. Peak levels are reached 40–60 minutes after ingestion. It has been proposed that paracetamol aids in the reduction of pain by increasing serotonergic neurotransmissions.
Although hydrocodone-containing combination products containing up to 15 mg of hydrocodone per dosage unit had been classified as a Schedule III medications in the United States, all hydrocodone-containing products were moved to Schedule II on October 6, 2014.
Proposed U.S. ban
On June 30, 2009, a U.S. Food and Drug Administration (FDA) advisory panel voted by a narrow margin to advise the FDA to remove Vicodin and another painkiller, Percocet, from the market because of "a high likelihood of overdose from prescription narcotics and acetaminophen products". The panel cited concerns of liver damage from their acetaminophen component, which is also the main ingredient in commonly used nonprescription drugs such as Tylenol. Each year, acetaminophen overdose is linked to about 400 deaths and 42,000 hospitalizations.
In January 2011, the FDA asked manufacturers of prescription combination products that contain acetaminophen to limit the amount of acetaminophen to no more than 325 mg in each tablet or capsule. Manufacturers had three years to limit the amount of acetaminophen in their prescription drug products to 325 mg per dosage unit. The FDA also required manufacturers to update labels of all prescription combination acetaminophen products to warn of the potential risk for severe liver injury.
The opioid constituent hydrocodone has the same basic structure as morphine, but is metabolized by different enzymes. Hydrocodone, like oxycodone, is an intermediate-strength analgesic that has similar effects as morphine; hydrocodone is approximately twice as potent as morphine by mouth for acute use. The theory of using the mix comes from the idea that these drugs alleviate pain using different mechanisms and also that the adverse side effects of each separate drug are reduced by using reduced dosages of both drugs to get the same analgesic effect.
Both hydrocodone and paracetamol are white crystalline powders, which are then manufactured into tablet form. Manufacturers of hydrocodone include AbbVie Inc. (makers of trademark Vicodin), Amerisource Health Services Corp, Cardinal Health, Drx Pharmaceutical Consultants Inc, Eckerd Corp, Hospira Inc, Mallinckrodt Pharm. Quality Care, Pdrx Pharmaceuticals Inc, Physicians Total Care Inc, Rx Papoo s Packaging Inc, and Watson Pharmaceuticals.
In popular culture
In the television series House, the titular character Gregory House is addicted to Vicodin as a result of permanent pain in his leg. The theme of addiction is explored throughout the show, and House is often seen taking Vicodin.
Rap artist Eminem often spoke of Vicodin in his lyrics. The Slim Shady LP features a picture of a Vicodin pill on the disc.
English indie rock band The Wombats refer to Vicodin in their song "Give me a try" released April 2015.
The Metalcore band Atreyu performed a song on their album "The Curse" entitled "Five Vicodin Chased With a Shot of Clarity."
Queens of the Stone Age - Feel good song for the summer: 'Nicotine, Valium, Vicodin, Marijuana, Ecstasy and Alcohol'
The band Dope included Vicodin as a primary lyric in the line "She's like cocaine, heroin, alcohol and Vicodin" in their song "Addiction" (rel. 2009)
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- Mike McEvoy (June 12, 2008). "Hydrocodone/APAP: Drug Whys". EMS1. Archived from the original on 2012-07-10.
Popularity: First most commonly prescribed drug between 2002-2007 (U.S.)
- Vicodin U.S. DEA Drug Schedule
- Vicodin U.S. Federal Regulations
- U.S. National Library of Medicine: Drug Information Portal - Vicodin