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acetaminophen/hydrocodone (Anexsia, Lorcet, Lortab, Vicodin, Norco)

DEA-controlled substance: class 3. To be rescheduled to DEA class 2. Indications: - pain - combinations of acetaminophen & opiate no longer recommended due to risk of acetaminophen toxicity [3] Contraindications: pregnancy-category + safety in lactation - Caution: in patients with G6PD deficiency Dosage: 500 mg acetaminophen _ 2.5 mg hydrocodone (Lortab) - 1-2 tabs PO every 4-6 hours 500 mg acetaminophen + 5 mg hydrocodone - 1-2 tabs PO every 4-6 hours 500 mg acetaminophen + 7.5 mg hydrocodone (Lortab) - 1-2 tabs PO every 4-6 hours 650 mg acetaminophen + 7.5 mg hydrocodone - 1 tab PO every 4-6 hours 650 mg acetaminophen + 10 mg hydrocodone (Lorcet) - 1 tab PO every 4-6 hours. 325 mg acetaminophen + 10 mg hydrocodone - 1 tab PO every 4-6 hours. (Norco) Pharmacokinetics: elimination: liver > kidney Dosage adjustment in renal failure: creatinine clearance dosage 10-50 (mL/min) every 6 hours < 10 (mL/min) every 8 hours (metabolites may accumulate) Adverse effects: 1) rash 2) nausea/vomiting 3) blood dyscrasias 4) nephrotoxicity with chronic use 5) hepatotoxicity 6) drowsiness 7) respiratory depression is dose & tolerance-related 8) tolerance & dependence 9) constipation 10) acetaminophen toxicity Drug interactions: 1) agents that increase acetaminophen hepatotoxicity - carbamazepine, hydantoin, barbiturates, chronic alcohol use, rifampin 2) acetaminophen can elevate INR in patients takin warfarin 3) naloxone is a direct opiate antagonist Mechanism of action: 1) see acetaminophen 2) see hydrocodone Notes: - counterfeit Norco containing fentanyl & promethazine, led to several hospitalizations in the San Francisco Bay Area in 2016 [5]

Interactions

drug interactions drug adverse effects of opiates

General

narcotic combination

Database Correlations

PUBCHEM cid=3083537

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. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
  4. Department of Justice. Durg Enforcement Administration. 21 CFR Part 1308. [Docket No. DEA-389] Schedules of Controlled Substances: Rescheduling of Hydrocodone Combination Products from Schedule III to Schedule II. https://s3.amazonaws.com/public-inspection.federalregister.gov/2014-19922.pdf
  5. Vo KT et al Counterfeit Norco Poisoning Outbreak - San Francisco Bay Area, California, March 25-April 5, 2016 MMWR. Early Release / April 26, 2016 / 65 http://www.cdc.gov/mmwr/volumes/65/wr/mm6516e1.htm

Components

acetaminophen (Tylenol, Paracematol, Panadol, Tempra, Datril, APAP, non-Aspirin) hydrocodone; dihydrocodeinone (Zohydro ER, Hysingla ER)