Hydrocodone and Acetaminophen

Drug Class: Hydrocodone And Acetaminophen > Hydrocodone > Semi Synthetic Opioid > Opioids > Opioid Agonist > Analgesic.

Uses

Use hydrocodone and acetaminophen preparations to relieve moderate to severe pain.

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Other, off label uses for this medicine

Hydrocodone and acetaminophen may be prescribed to treat a dry cough. Hydrocodone works directly on the part of the brain responsible for the cough reflex; it makes the brain unaware of the need to cough. Acetaminophen also reduces fever.

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Administration/Dosage

Hydrocodone and acetaminophen polydrugs are available as a tablet, oral liquid or oral elixir. Hydrocodone and acetaminophen are sold under various brand names including Anexsia, Dolorex Forte, Hycet, Liquicet, Lorcet, Lortab, Maxidone, Norco, Polygesic, Stagesic, Vicodin, Xodol, Zamicet and Zydone.

The usual adult dose for hydrocodone and acetaminophen tablets to treat pain is one tablet every six hours as needed for pain. These tablets typically contain 500 mg of acetaminophen and 5 mg of hydrocodone. Oral elixirs and oral solutions usually contain 300 mg to 500 mg of acetaminophen and 5 mg to 10 mg of hydrocodone per 5 ml dose. Many different commercial combinations of hydrocodone and acetaminophen exist. In general, the usual prescription for polydrugs containing 5 mg of hydrocodone call for one to two doses every 4 to 6 hours, not to exceed 8 doses in one day. Preparations containing 7.5 mg or 10 mg of hydrocodone are typically taken once every four to six hours with a maximum of 5 or 6 doses per day, depending on the total daily intake of acetaminophen.

Older adults may be more sensitive to hydrocodone and acetaminophen. Doctors should observe elderly patients closely while on hydrocodone and acetaminophen, especially during initial doses. Lower initial doses are prudent in older patients.

Physicians typically prescribe hydrocodone and acetaminophen to be taken as needed to control pain rather than on a regular schedule so there is no need to worry about missed doses. If your doctor has recommended you take this medication on a schedule and you miss a dose, take the missed dose as soon as possible. If it is almost time to take another dose and you can tolerate the pain, skip the missed dose and resume your normal schedule. Never double up on doses in an effort to make up for missed doses.

Measure the liquid form of hydrocodone and acetaminophen with a medical measuring device rather than a household spoon to ensure adequate dosage and avoid lethal overdose. You can purchase an accurate measuring device from your local pharmacy.

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Action

Trauma or illness injures the cells of your body. Injured cells release a protein known as a COX enzyme. COX enzymes produce prostaglandins. Prostaglandins serve many functions in the human body, including causing pain, inflammation and fever. Prostaglandins bind with pain receptors in nerve endings, sending specific information about the severity and location of the injury to your brain. Your brain responds by perceiving pain and taking action, like raising the body temperature. Hydrocodone and acetaminophen work in two different ways to provide more complete pain relief than either medicine could achieve by itself. Acetaminophen blocks the production of prostaglandins to reduce pain and works directly on the part of the brain responsible for temperature regulation to reduce fever. Hydrocodone binds directly to opioid receptors in the nervous system to send messages of euphoria to the brain. Additionally, hydrocodone acts directly on the part of the brain responsible for the cough reflex, making your brain unaware of the need to cough.

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Precautions

An allergic reaction is a serious medical emergency. Seek immediate help at the first sign of an allergic reaction as a patient's condition may deteriorate rapidly and without warning during an allergic reaction. Symptoms of an allergic reaction include hives, difficulty breathing and swelling of the face, lips, tongue and throat.

If you have a history of certain medical conditions, your physician may prescribe a different pain medication, alter the dosage or order laboratory tests. Hydrocodone and acetaminophen may worsen these medical conditions or interfere with treatment. Alternately, your medical condition or treatment for that condition may change the way hydrocodone and acetaminophen works in your body.

Tell your physician about any significant illnesses or conditions, including:

  • Asthma, COPD, Sleep Apnea or Other Breathing Disorders.
  • Liver or Kidney Disease.
  • Head Injury or Brain Tumor.
  • Low Blood Pressure.
  • Stomach or Intestinal Disorder.
  • Underactive Thyroid.
  • Addison's Disease or Other Adrenal Gland Disorder.
  • Curvature of the Spine.
  • Mental Illness.
  • A History of Drug or Alcohol Addiction.

Hydrocodone and acetaminophen can make you dizzy or drowsy. It can also impair your ability to make decisions. Do not operate heavy machinery, drive a car or participate in activities that require you to make quick decisions until you know how this drug affects you.

Tell the prescribing physician if you drink more than three alcoholic beverages each day or if you have ever had cirrhosis, commonly known as alcoholic liver disease. You may not be able to take medications containing acetaminophen. Your healthcare provider may prescribe a different medication to treat your pain.

Hydrocodone can be habit-forming. Stop using this medication when recommended by your doctor. Never give hydrocodone and acetaminophen to another person, especially if they have a history of drug abuse.

Hydrocodone and acetaminophen may cause constipation. Drink six to eight full glasses of water each day while taking this medication. Discuss ways to increase your dietary fiber with your doctor or nutritionist; dietary fiber is associated with bowel regularity. Do not take laxatives unless directed to do so by the prescribing physician.

Hydrocodone and acetaminophen may alter results of laboratory urine tests. Tell the ordering physician, laboratory receptionist or lab technician accepting your urine sample that you have been using hydrocodone and acetaminophen.

Tell any doctor or dentist who treats you that you are using hydrocodone and acetaminophen, especially before you have any procedures, treatments or operations. You may need to stop using this medication for a short time before the procedure.

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Warnings

The FDA classifies hydrocodone and acetaminophen preparations as pregnancy category C. This medication may be harmful to an unborn baby and cause withdrawal symptoms and breathing problems in a newborn. Tell the prescribing physician if you are pregnant or plan to become pregnant while taking hydrocodone and acetaminophen. Notify your physician immediately if you become pregnant while using this drug. Do not breastfeed a baby while using hydrocodone and acetaminophen; components of this drug pass into breast milk and may harm a nursing infant.

Do not stop taking hydrocodone and acetaminophen preparations suddenly unless directed to do so by a doctor. Stopping suddenly may cause unpleasant withdrawal symptoms. When it is time to quit taking hydrocodone and acetaminophen, take increasingly smaller doses further apart to wean yourself from the drug without experiencing withdrawal symptoms.

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Drug Interactions

Hydrocodone and acetaminophen may interact with other drugs in unfavorable or dangerous ways. Give the prescribing physician and pharmacist filling the prescription with a list of all your medications, including prescriptions, over-the-counter drugs and herbal preparations. Do not stop, start or change the way you take any medication without first consulting a physician.

Tell the prescribing physician if you take antidepressants such as brand names Elavil, Etrafon, Anafranil, Janimine, Tofranil. Do not take hydrocodone and acetaminophen polydrugs if you have taken an MAO inhibitor in the past 14 days; taking hydrocodone and acetaminophen while an MAO inhibitor is in your system can cause a dangerous drug interaction. Tell your doctor and pharmacist if you take Donnatal, Cogentin, Dramamine, Robinul, Cantil, Pamine or Transderm-Scop. You may not be able to use hydrocodone and acetaminophen if you are using certain bladder or urinary medications such as Enablex, Ditropan, Oxytrol, Detrol or Vesicare, among others. Tell your healthcare provider if you use a bronchodilator such as Atrovent or Spiriva, or if you are taking irritable bowel medications. Do not use any cough, cold, pain medication or allergy drugs while taking hydrocodone and acetaminophen.

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Side effects

Some patients have reported side effects while taking hydrocodone and acetaminophen. Most of these side effects are not serious and go away on their own, but some side effects can be life-threatening. Talk with the prescribing physician if your common side effects become intolerable or do not go away on their own.

Common side effects include:

  • Feeling Anxious, Dizzy, or Drowsy.
  • Mild Nausea or Vomiting.
  • Upset Stomach.
  • Constipation.
  • Headache, Mood Changes.
  • Blurred Vision.
  • Ringing In Your Ears. or
  • Dry Mouth.

Some side effects can be serious. Seek immediate medical assistance if you experience any one of the following side effects while taking hydrocodone and acetaminophen.

  • Shallow Breathing.
  • Slow Heartbeat.
  • Feeling Light-Headed.
  • Fainting.
  • Confusion or Fear.
  • Unusual Thoughts or Behavior.
  • Seizure.
  • Problems Urinating.
  • Nausea.
  • Abdominal Pain.
  • Loss of Appetite.
  • Itching.
  • Dark Urine, Clay-Colored Stools, Jaundice.

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Overdose

Overdose is a serious and potentially fatal medical emergency. If you believe you or someone you know has taken an overdose of hydrocodone and acetaminophen or any other medication, contact poison control center at 1-800-222-1222 or go to the emergency room. You can overdose from either component of hydrocodone and acetaminophen drugs. Acetaminophen overdose can cause serious damage to your liver. Adults should not exceed 1000 mg of acetaminophen in a single dose or 4000 mg of acetaminophen per day. One single hydrocodone and acetaminophen pill can contain as much as 750 mg of acetaminophen. Acetaminophen is a common ingredient in prescription and over-the-counter remedies. Read the labels of all medications and calculate your acetaminophen intake while on this drug. Manufactures may list acetaminophen as APAP or by its brand name, Tylenol. Hydrocodone overdose symptoms include slow, shallow respiration, extreme drowsiness leading to stupor or coma, flaccid muscles, cold and clammy skin. Hear rate may slow and low blood pressure might drop. In severe overdose, breathing may stop, the circulatory system may collapse, the heart might stop and death could occur.

The most serious side effect of acetaminophen overdose is potentially fatal hepatic necrosis, or liver disease. Evidence of liver problems could take 24 to 48 hours to appear after ingestion. Acetaminophen overdose may also cause kidney problems, bleeding problems and coma resulting from very low blood sugar. Early symptoms of acetaminophen overdose include nausea, vomiting, profuse sweating and general malaise.

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Abuse

Prescription drug abuse is on the rise. Drug abuse means to use a medication for recreational purposes or outside the recommendations of a physician. Drug abuse can lead to physical and mental dependence to a substance. Abusers procure hydrocodone by visiting multiple doctors, sometimes under assumed names, by filing phony prescriptions at pharmacies or by stealing it from friends, family members or strangers. Hydrocodone is also widely available on the streets as a recreational drug.

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Withdrawal

Withdrawal is a normal, predictable physiological process and not necessarily an indication of illegal drug use. Dependence on a drug means your body needs that substance to feel normal. When levels of the drug decline, you feel very unpleasant, flu-like withdrawal symptoms. If you associate your withdrawal symptoms with the drug, you may begin to crave the substance and exhibit addictive behaviors. Powerful withdrawal symptoms may prevent you from quitting the drug. Consult with your doctor or professional rehabilitation specialist if your withdrawal symptoms pose an obstacle to your drug-free lifestyle.

Detox

Successful rehabilitation addresses each aspect of dependence on drugs. Detoxification is a multi-faceted process in which physicians and other specialists cleanse the substance from your body and reduce withdrawal symptoms. Some clinics offer additional social services such as counseling to help you sort out any family, social or legal issues associated with your substance abuse. Rapid detox is the most humane way to overcome the potent and miserable symptoms of withdrawal. During rapid detox, specially-trained physicians administer anesthesia and sedatives along with those cleansing and anti-withdrawal medications so that you sleep through the most unpleasant stages of detoxification and withdrawal. When you awaken, you will have no memory of the cleansing and withdrawal procedures. Learn More About Hydrocodone and Acetaminophen Detoxification Programs

Storage

Store hydrocodone and acetaminophen preparations at room temperature, away from excessive heat and moisture. Do not keep this medication in your bathroom. Keep this and all medications out of the reach of children and pets. Prevent adults from willfully or mistakenly taking this drug. Do not share this medication with others, even if they complain of symptoms similar to yours.

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Miscellaneous information

Hydrocodone is frequently diverted from prescription use for recreational purposes. According to the Centers for Disease Control and Prevention, the estimated number of emergency department visits for non-medical use of opioids increased 111 percent between the years 2004 and 2008. The highest numbers of these emergency department visits were for oxycodone, hydrocodone and methadone. Doctors prescribed hydrocodone 124 million times in 2008 and oxycodone nearly 24 million times. Miscellaneous Information About Hydrocodone and Acetaminophen