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hydrocodone; dihydrocodeinone (Zohydro ER, Hysingla ER)

Prior to 2014, DEA-controlled substance: class 3. All hydrocodone combinations to became class 2 Oct 6, 2014. [4,5,7] Indications: - treatment of pain (acute pain & chronic pain) - cough Dosage: - 5 mg PO every 4-6 hours Extended-release: - Zohydro ER: 50 mg - Hysingla ER (abuse-deterrent): 20,30,40,60,80,100,120 mg [6] Pharmacokinetics: 1) well absorbed orally 2) onset of action 15-60 minutes 3) duration 4-8 hours 4) metabolized in the liver by cytochrome CYP2D6 into hydromorphone & by CYP3A4 into norhydrocodone 5) excreted by kidney Adverse effects: 1) common (> 10%) - lightheadedness, dizziness, sedation, drowsiness, weakness, tiredness, hypotension 2) less common (1-10%) - shortness of breath, troubled breathing, confusion, diminished urination, nausea/vomiting, bradycardia, tachycardia 3) uncommon (< 1%) - hallucinations, hypertension, double vision, dry mouth, anorexia, miosis, biliary spasm, urinary spasm, histamine release, hot & dry skin, impaired GI motility, mydriasis, blurred vision 4) other - rash - blood dyscrasias - nephrotoxicity with chronic use - hepatotoxicity - respiratory depression is dose & tolerance-related - tolerance & dependence - constipation Drug interactions: 1) any pharmaceutical agent that inhibits cyt P450 2D6 may increase levels of hydrocodone 2) see opiate Laboratory: - hydrocodone in specimen - hydrocodone in hair - hydrocodone in gastric fluid - hydrocodone in meconium - hydrocodone in saliva - hydrocodone in serum/plasma - hydrocodone in urine - hydrocodone free in blood - hydrocodone free in serum/plasma - hydrocodone free in stool - hydrocodone free in urine - hydrocodone free in vitreous fluid Mechanism of action: 1) alters perception of pain at the level of the spinal cord & higher levels of the CNS 2) alters emotional response to pain 3) cough suppressant effects are due to direct action on the cough centers of the medulla

Interactions

drug adverse effects of antitussive agent(s)

Related

cytochrome P450 2D6 (cytochrome P450 2D, cytochrome P450 DB1, debrisoquine-4-hydroxylase, CYP2D6) norhydrocodone

General

antitussive agent opiate

Properties

MISC-INFO: elimination route LIVER 1/2life 4 HOURS pregnancy-category C safety in lactation ?

Database Correlations

PUBCHEM correlations

References

  1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
  2. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998 - not on National VA formulary
  3. FDA New Release: Oct. 25, 2013 FDA approves extended-release, single-entity hydrocodone product. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm372287.htm
  4. Food and Drug Administration (FDA). Oct 24, 2013 Statement on Proposed Hydrocodone Reclassification from Janet Woodcock, M.D., Director, Center for Drug Evaluation and Research. http://www.fda.gov/drugs/drugsafety/ucm372089.htm
  5. Prescriber's Letter 21(9): 2014 PDF: DEA Update on Rescheduling of Hydrocodone Combination Products (August 21, 2014) CHART: Equianalgesic Dosing of Opioids for Pain Management LETTER: A Note from Your Pharmacist: Hydrocodone Combinations are Moving from Schedule III to Schedule II PATIENT EDUCATION HANDOUT: Changes for Hydrocodone Combinations Detail-Document#: 300943 (subscription needed) http://www.prescribersletter.com
  6. FDA News Release. November 20, 2014 FDA approves extended-release, single-entity hydrocodone product with abuse-deterrent properties http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm423977.htm
  7. Habbouche J, Lee J, Steiger R et al Association of Hydrocodone Schedule Change With Opioid Prescriptions Following Surgery. JAMA Surg. Published online August 22, 2018 PMID: 30140896 https://jamanetwork.com/journals/jamasurgery/article-abstract/2696622
  8. Barakat NH, Atayee RS, Best BM, Ma JD Urinary Hydrocodone and Metabolite Distributions in Pain Patients Journal of Analytical Toxicology. 2014 38(7):404-409 September PMID: 2483689 https://academic.oup.com/jat/article/38/7/404/2797996

Component-of

acetaminophen/caffeine/chlorpheniramine/hydrocodone/phenylephrine acetaminophen/hydrocodone (Anexsia, Lorcet, Lortab, Vicodin, Norco) aspirin/hydrocodone brompheniramine/guaifenesin/hydrocodone brompheniramine/hydrocodone/phenylephrine brompheniramine/hydrocodone/pseudoephedrine carbinoxamine/hydrocodone/phenylephrine carbinoxamine/hydrocodone/pseudoephedrine chlorpheniramine/guaifenesin/hydrocodone/pseudoephedrine chlorpheniramine/hydrocodone (Tussionex) chlorpheniramine/hydrocodone/phenylephrine chlorpheniramine/hydrocodone/phenylephrine/pyrilamine chlorpheniramine/hydrocodone/pseudoephedrine dexbrompheniramine/hydrocodone/phenylephrine dexchlorpheniramine/hydrocodone/phenylephrine diphenhydramine/huntingtin/hydrocodone/phenylephrine diphenhydramine/hydrocodone/phenylephrine guaiacolsulfonate/hydrocodone guaiacolsulfonate/hydrocodone/pseudoephedrine guaifenesin/hydrocodone guaifenesin/hydrocodone/phenylephrine guaifenesin/hydrocodone/pseudoephedrine homatropine/hydrocodone (Hycodan) hydrocodone/ibuprofen (Vicoprofen) hydrocodone/pheniramine/phenylephrine/phenylpropanolamine/pyrilamine hydrocodone/phenylephrine hydrocodone/phenylephrine/pyrilamine hydrocodone/phenylpropanolamine (Hycomine, Codamine) hydrocodone/pseudoephedrine hydrocodone/pseudoephedrine/triprolidine