Hydrocodone/paracetamol (also known as hydrocodone/acetaminophen) is the combination of the pain medications hydrocodone (an opioid) and paracetamol (acetaminophen). It is used to treat moderate to severe pain. It is taken by mouth. Recreational use is common in the United States. Common side effects include dizziness, sleepiness, constipation, and vomiting. Serious side effects include addiction, decreased rate of breathing, low blood pressure, severe allergic reactions, and liver failure. Use during pregnancy may harm the fetus. Use with alcohol is not recommended. Hydrocodone works by binding to the mu-opioid receptor. How paracetamol works is unclear but may involve blocking the creation of prostaglandins. Hydrocodone/paracetamol was approved for medical use in the United States in 1982. In the United States, it is a schedule II controlled substance. In 2023, it was the 25th most commonly prescribed medication in the United States, with more than 21 million prescriptions. It is not available in the United Kingdom, though the combination codeine/paracetamol (co-codamol) is. It is sold under the brand names Vicodin and Norco among others.
Uses
Medical Hydrocodone/paracetamol is a fixed-dose combination consisting of the opioid hydrocodone and the non-opioid analgesic paracetamol. It is indicated for relief of moderate to severe pain of acute, chronic, or postoperative types. Hydrocodone/paracetamol comes in oral solution and tablet formulations; however strength of each component may vary. In October 2014, the Drug Enforcement Administration rescheduled hydrocodone combination drugs from schedule III, to schedule II due to its risk for misuse, abuse, and diversions.
Recreational Hydrocodone diversion and recreational use have escalated due to its opioid effects. In 2009 and 2010, hydrocodone was the second most frequently encountered opioid in the pharmaceutical industry. In-drug evidence was submitted to U.S. federal state and local forensic laboratories as reported by the Drug Enforcement Administration's National Forensic Laboratory Information System (NFLIS) and System to Retrieve Information from Drug Evidence (STRIDE).
Pregnancy and breastfeeding Prolonged use of hydrocodone/paracetamol during pregnancy can result in neonatal opioid withdrawal syndrome. Hydrocodone/paracetamol passes into breast milk and may harm the baby.
Kidney and liver impairment There is a possible risk of toxicity.
Side effects
Most common Lightheadedness Dizziness Sedation Nausea and vomiting Headaches
Less common Central nervous system: drowsiness, confusion, lethargy, anxiety, fear, unease, dependence, mood changes, impairment of mental and physical performance Gastrointestinal system: constipation Genitourinary system: inability to urinate, bladder spasms Respiratory depression: decreased rate and effort of breathing Hearing impairment, permanent hearing loss Dermatological: rash, itching
Boxed warning "Paracetamol 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 paracetamol at doses that exceed 4000 milligrams per day, and often involve more than one paracetamol-containing product." In the US, the label for hydrocodone/paracetamol contains a boxed warning about addiction, abuse, and misuse.
Overdose Hydrocodone: Respiratory depression, extreme somnolence progressing towards coma, muscle limpness, cold and clammy skin, slow heart rate, low blood pressure, abrupt loss of heart function, and death may occur. Paracetamol: Liver and kidney failure, low blood sugar, and coma may occur.
Interactions Hydrocodone may demonstrate an enhanced respiratory depressant effect when combined with other sedatives such as other opioids, benzodiazepines, nonbenzodiazepine sedatives, psychotropics, and anticonvulsants. Concurrent use of paracetamol with alcohol products may increase the risk of acute liver failure.
Pharmacology
Hydrocodone Mechanism of action: Hydrocodone acts primarily as an agonist at the mu-opioid receptors, but is also a weak agonist against the delta opioid and kappa opioid receptors. Absorption/distribution: The oral formulation can be absorbed from the gastrointestinal tract and remain 20–50% bound to plasma proteins. The onset of analgesia is about 20 to 30 minutes with a duration of 4 to 8 hours and t1/2 of 3 to 4 hours. Maximum serum levels are achieved at 1.3 hours. Metabolism/excretion: It is metabolized to norhydrocodone by cytochrome P450 3A4 and to hydromorphone, also biologically active, by cytochrome P450 2D6. For individuals who have a defect in the gene encoding CYP2D6, the clearance of the drug will be lower and less metabolite such as hydromorphone will be formed; however, the effect on analgesia remains unknown. Metabolites: Hydromorphone, the major active metabolite, has a 10-33-fold higher binding affinity for the mu-opioid receptor than hydrocodone. It may be up to >100-fold higher in some patients.
Paracetamol Mechanism of action: Paracetamol acts to inhibit COX enzyme, which is responsible for prostaglandin synthesis. Prostaglandins increase the perception of pain. Inhibition of prostaglandin production helps to alleviate pain. Absorption/distribution: The half-life of oral paracetamol is 1.25 to 3 hours and peak level is reached by 10–60 minutes after ingestion. Metabolism/excretion: Paracetamol is metabolized primarily in the liver via glucuronidation and sulfation to mostly non-toxic metabolites and some highly reactive metabolites, which is inactivated by glutathione. 85% of the oral dose is excreted via the kidneys. At high doses, the supply of glutathione cannot meet its demand, thus resulting in the accumulation of highly reactive compounds leading to liver damage.
Society and culture
… excerpt ends here. Continue reading the full article.
