Liquicet

Doctors prescribe Liquicet to relieve moderate to moderately severe pain.
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Other, off label uses for this medicine

Ingredients in Liquicet soothe a cough, and reduce fever and swelling.

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Administration/Dosage

Mallinckrodt, Inc. manufactures Liquicet in a red, raspberry flavored liquid form for oral administration. Every 15 ml dose of Liquicet contains 10 mg of hydrocodone bitartrate and 500 mg of acetaminophen. Liquicet is available in one pint bottles.

The usual adult dosage is one tablespoon every four to six hours as needed for pain, not to exceed 6 tablespoons in a 24-hour period.

A pediatrician will calculate the size of a pediatric dose based on the child's weight, usually administered every four to six hours as needed for pain. The usual pediatric dose is 0.27 ml of Liquicet for every kilogram of body weight. The total daily dose for children should not exceed 6 doses in a 24-hour period.

Consumers should use an approved measuring device when administering Liquicet. Household spoons are not accurate and could deliver an inadequate dose or overdose.

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Action

Hydrocodone

Hydrocodone is a semi-synthetic opioid drug, sometimes called a narcotic. Hydrocodone acts primarily on the nervous and digestive systems. Opioids work with the central nervous system, or CNS, to change the way the brain perceives pain. Hydrocodone also acts on the CNS to sedate, calm anxiety and produce euphoria.

Hydrocodone affects smooth muscles, like the bladder or intestinal muscles that propel food through the digestive tract. Hydrocodone increases tone, making these muscles stiff and less functional.

Opioids including the hydrocodone in Liquicet act on respiratory centers in the brain to slow breathing and depress the cough reflex.

Acetaminophen

Scientists have not yet established exactly how the acetaminophen in Liquicet works but think it reduces pain by inhibiting the production of prostaglandins, involved in sending pain messages to the brain. Acetaminophen also reduces fever by "turning down" the brain's thermostat, the hypothalamus.

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Warnings

Respiratory Depression

The hydrocodone works on the respiratory centers in the brain and brainstem to slow breathing and suppress cough; this action may result in respiratory depression, a dangerous and potentially fatal breathing problem. During respiratory depression, the lungs do not adequately exchange oxygen for carbon dioxide and other toxins, suffocating cells and causing buildup of toxic gases. Symptoms of respiratory depression include slow or shallow breathing and irregular breathing patterns along with a bluish tint around the victim's eyes, lips and fingertips.

Head Injury and Increased Intracranial Pressure

The hydrocodone in Liquicet may increase pressure around the brain and spinal cord. Head injuries, intracranial lesions and pre-existing high pressure around the brain may enhance the ability of hydrocodone to cause respiratory depression and increased intracranial pressure.
Additionally, hydrocodone produces adverse reactions that may obscure the diagnosis and progression of head injuries.

Acute Abdominal Conditions

Using Liquicet may obscure the diagnosis and progression of acute abdominal conditions.

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Precautions

Hydrocodone may impair the consumer's mental and physical capabilities, interfering with his ability to drive or operate heavy machinery.

Taking Liquicet with alcohol or other CNS depressants may enhance the depressive effect on the central nervous system.

The hydrocodone in Liquicet may be habit-forming. Taking high doses of Liquicet, consuming it frequently or using Liquicet for a long time increases this risk.

Special Risk Patients

Elderly and debilitated people should use Liquicet with caution, as should those with a history of serious liver or kidney problems, hypothyroidism, Addison's disease and some prostate and urinary problems.

Physicians should start geriatric consumers on the lowest dose of Liquicet and monitor the patient closely; older individuals may suffer slower kidney, liver and heart function that may change the way the body deals with Liquicet. Hydrocodone may cause confusion and over-sedation in older people.

The liver and kidneys are responsible for getting rid of hydrocodone and acetaminophen. Patients with impaired liver and kidney function face a greater risk for accumulating a toxic level of hydrocodone and acetaminophen in the blood. These individuals should submit to kidney and liver function tests while taking Liquicet.

The hydrocodone in Liquicet suppresses the cough reflex; it should be used with caution after surgery and by patients who have breathing problems.

Research has not yet established the effectiveness and safety of Liquicet in children younger than two years. Liquicet is effective in children two years of age and older.

Pregnancy and Breastfeeding

Pregnancy, Labor and Delivery

Liquicet is an FDA Pregnancy Category C, meaning there is not enough information about the effects of taking Liquicet during pregnancy, but that pregnant women should weigh the benefits against the potential risk to the unborn baby. 

Babies born to women who regularly take opioids just before delivery will be born physically dependent on hydrocodone. These babies will suffer withdrawal symptoms in the first few days of life, including irritability and excessive crying, frequent bowel movements, hyperactive reflexes and tremors. Other neonatal withdrawal symptoms include rapid breathing, sneezing, yawning, vomiting and fever. The intensity of these symptoms does not always correlate with the dosage or frequency of Liquicet use.

The hydrocodone in Liquicet crosses the placental barrier between the mother and the unborn child. Taking Liquicet close to delivery may cause the newborn to experience respiratory depression; the closer to delivery and the larger the dose, the greater this risk becomes.

Breastfeeding

The acetaminophen in Liquicet passes into breast milk but scientists have not yet determined the significance of its effects on a nursing baby. Researchers are still working to learn if hydrocodone is excreted in human milk. A mother must weigh the benefits of Liquicet against the risk to her nursing child.

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Drug and Drug/Laboratory Interactions

Drug Interactions

Liquicet interacts with some other drugs in unsafe or unfavorable ways. Taking Liquicet with other narcotics, antihistamines, antipsychotics, drugs for anxiety or other drugs that depress the nervous system may enhance CNS depression. Using certain types of antidepressants like MAO inhibitors and tricyclic antidepressants can increase the effects of either the hydrocodone in Liquicet or the antidepressant.

Drug/Laboratory Test Interactions

Acetaminophen may produce false-positive test results for urinary 5- hydroxy-indoleacetic acid, sometimes referred to as a 24-hour 5-HIAA urine test, used to diagnose a particular type of cancer.

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Side effects

Liquicet, like any medication, may cause side effects for some consumers. The most commonly reported side effects associated with Liquicet are stomachache, dizziness, drowsiness, feeling light-headed or short of breath, unusual fatigue, nausea and vomiting.

Because of the CNS action of hydrocodone, Liquicet use may cause adverse reactions affecting the central nervous system. Some of the side effects are physiological while others are psychiatric. CNS side effects include dizziness, drowsiness, dysphoria, general malaise, impaired mental and physical performance, lethargy, light-headedness, mental clouding, sedation and extreme sleepiness that progresses to stupor or coma.

Psychiatric side effects include anxiety, fear, mood changes, psychological dependence, euphoria and emotional opposite of euphoria, dysphoria.

Liquicet acts on respiratory centers in the brain, potentially causing adverse breathing reactions including respiratory depression, shortness of breath, acute airway obstruction and stopped breathing.

The hydrocodone in Liquicet works on smooth muscle groups, like those in the digestive system. Using Liquicet may cause gastrointestinal effects, especially constipation. Other gastrointestinal adverse reactions include abdominal pain, heartburn, hepatitis, blood in the stool, stomach ulcer, nausea and vomiting. Liquicet use may cause liver cell death, a serious condition known as hepatic necrosis.

Liquicet use may cause cardiovascular side effects, such as slow or stopped heartbeat, low blood pressure and collapse of the circulatory system. Using this drug might result in low white cell counts, prolonged bleeding times and various types of anemia. Liquicet use may affect the endocrine system and cause a coma due to very low blood sugar. This medication may also cause urinary problems including urinary retention.

Liquicet may weak or flaccid muscles. This medication may cause cold and clammy skin, excessive sweating, itching and rash. Some consumers have reported hearing impairment or permanent loss; most of these cases were in patients who took toxic doses of Liquicet for a long time.

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Overdose

Someone can overdose on either the hydrocodone or the acetaminophen in Liquicet. Hydrocodone and acetaminophen overdoses present different symptoms and affect the body in different ways. Both types of poisonings are serious and potentially fatal, requiring immediate medical attention.

About 15,000 Americans die each year after overdose of prescription painkillers, including Liquicet. Acetaminophen overdose is one of the most common poisonings on earth, and is the leading cause of acute liver failure in the United States.

Hydrocodone overdose causes an "opioid triad" of loss of consciousness, pinpoint pupils and respiratory depression. The victim may have seizures.

The toxic dose of acetaminophen for an adult is 10 grams. Liver damage may rarely occur at doses less than 10 grams; death rarely occurs at doses less than 15 grams of acetaminophen.

Early symptoms of an acetaminophen overdose substantial enough to cause liver damage include profuse sweating, extreme sleepiness, general malaise, nausea and vomiting. Evidence of a toxic acetaminophen overdose may not appear on examination or in laboratory tests for 48 to 72 hours after Liquicet consumption. A potential victim of acetaminophen overdose should seek help immediately, even if he does not feel ill.

Other signs and symptoms of Liquicet overdose include slow heartbeat, cold and clammy skin, extreme sleepiness that progresses to stupor or coma, coma caused by very low blood sugar levels, low blood pressure, kidney problems, flaccid muscles and bleeding disorders.

Symptoms of severe Liquicet overdose include stopped breathing or heartbeat, collapse of the circulatory system, hepatic necrosis and death.

Transport all suspected victims of Liquicet to the nearest hospital or contact poison control center at 1-800-222-1222. Nurses will induce vomiting then introduce charcoal into the stomach to absorb excess Liquicet. The patient may undergo kidney dialysis in cases of severe intoxication. Nurses will also establish an airway to help the patient breathe and start intravenous fluids to control blood pressure and electrolyte levels.

Emergency department physicians will administer naloxone to reverse respiratory depression caused by the hydrocodone in Liquicet. If the patient consumed an excessive amount of acetaminophen, the doctor will give him acetylcysteine.
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Abuse

The euphoria produced by hydrocodone makes Liquicet attractive to recreational drug users. The DEA ranks a drug according to its potential for abuse relative to other substances. For example, heroin is a class I narcotic because it readily gets the consumer high, whereas the cough suppressant Robitussin AC is a class V drug because the abuser would probably vomit before consuming enough to catch a buzz. The DEA classifies Liquicet as a class III narcotic, meaning it poses the same relative risk for abuse as anabolic steroids.

Abusing Liquicet for non-medical reasons increases the risk for developing dependence or addiction to hydrocodone. To use Liquicet non-medically means to take it to get high or to treat a condition other than the one the doctor had intended.
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Withdrawal

Using Liquicet for a long time to treat a chronic illness, or taking Liquicet for non-medical reasons, increases the risk the individual will develop physical dependence and feel withdrawal symptoms when he stops using this drug. Experiencing withdrawal symptoms is not necessarily a sign of criminal drug abuse; it is possible to become dependent on hydrocodone after using therapeutic doses of Liquicet as directed by a doctor.

Physical dependence is possible after using Liquicet continually for several weeks but some individuals experience a mild degree of dependence after using Liquicet for only a few days. The human body becomes accustomed to the long-term presence of some substances, like the hydrocodone in Liquicet. In time, the body becomes opioid-dependent - it relies on a certain level of hydrocodone to feel "normal." When hydrocodone levels fall abruptly, the opioid-dependent body struggles to regain chemical balance. Doctors refer to this as detoxification.

The opioid-dependent person feels this battle for detoxification through uncomfortable physical and psychological withdrawal symptoms. Opioid withdrawal symptoms typically occur in two waves, the first set appearing a few hours after the last Liquicet dose. Early symptoms of withdrawal include:

  • Agitation
  • Anxiety
  • Muscle aches
  • Increased tearing
  • Insomnia
  • Runny nose
  • Sweating
  • Yawning

Late symptoms of withdrawal include:

  • Abdominal cramping
  • Diarrhea
  • Dilated pupils
  • Goose bumps
  • Nausea
  • Vomiting

Opioid withdrawal usually lasts five days or longer, symptoms gradually worsening until about the fourth day when the most severe symptoms appear. Uninterrupted, withdrawal symptoms disappear in time and do not return unless the individual again becomes dependent on opioids.

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Detox

Many hospitals are now offering detoxification services to help individuals overcome physical dependence on opioids, including Liquicet. Detoxification involves drugs to lower hydrocodone levels and medications to ease withdrawal symptoms. While standard detoxification reduces withdrawal symptoms, it does not shorten the duration of the detoxification process.

Rapid detox is the most humane and effective way to overcome opioid-dependence. Board-certified anesthesiologists sedate and anesthetize rapid detox patients before administering the standard detoxification and withdrawal drugs. The rapid detox patient dozes in a comfortable "twilight sleep" during the grueling detoxification process.
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Storage

Keep Liquicet in a tightly closed container at room temperature, between 68 degrees Fahrenheit and 77 degrees Fahrenheit. Store Liquicet away from light.

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Miscellaneous information

According to the DEA, the hydrocodone in Liquicet is "the most frequently prescribed opioid in the United States and is associated with more drug abuse and diversion than any other licit or illicit opioid."

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Facts

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