Products
Hydrocodone was commercially available in tablet form in many countries between 1971 and 2018 (Hydrocodone Streuli, off label). In the United States, it is available in combination with acetaminophen (Vicodin, generic).
Structure and properties
Hydrocodone (C18H21NO3, Mr = 299.4 g/mol) is present in drugs as hydrocodontartrate (- 2.5 H2O), a white crystalline powder that is soluble in water. It is a derivative of codeine, which occurs naturally in the milky sap of the opium poppy.
Effects
Hydrocodone (ATC R05DA03) is an antitussive and analgesic. The effects are due to binding the μ-opioid receptors. Because of the potential side effects, we believe it should be used cautiously and not as a 1st-line agent for cough.
Indications
Hydrocodone is approved in many countries exclusively for the treatment of irritable cough. In other countries, such as the United States, it is also registered for the treatment of pain.
Abuse
Like other opioids, hydrocodone can be abused as a euphoric intoxicant. TV doctor Dr. House is addicted to Vicodin.
Dosage
According to the drug label. Tablets are usually taken two to three times daily with or after meals.
Contraindications
- Hypersensitivity
- Respiratory failure
- Pregnancy and lactation
Full precautions can be found in the drug label.
Interactions
Hydrocodone is metabolized by CYP2D6 and CYP3A4 to the active metabolite hydromorphone (eg, Palladone) and norhydrocodone, respectively. Corresponding interactions should be considered. Other drug-drug interactions are possible with centrally depressant drugs, alcohol, expectorants, and MAO inhibitors.
Adverse effects
The most common possible adverse effects include fatigue, headache, drowsiness, somnolence, nausea, vomiting, constipation, and sphincter Oddi spasms. Like other opioids, hydrocodone can be addictive and can cause life-threatening respiratory depression, especially in overdose.