Talk:Hydrocodone/Archive 2

Archive 1

Archive 2

Overdose Concerns

Just for future reference, "tramadal" is actually tramadol, and is not in any way considered a NSAID like sulindac. Although mixing different chemicals within the body may cause serious bodily harm or death, the accuracy of what one is to watch out for is of the highest importance. Ethersnipher (talk) 16:48, 10 February 2008 (UTC)

I don't think so!

"The presence of acetaminophen in hydrocodone-containing products deters many drug users from taking excessive amounts" I don't think someone realizes the extent of the addiciton associated with this medication. Weather its the Lortab or ES's with the different level of aceto neither one deters any addict from abusing the meds. Most dont use cold water extraction. I have done research and know of people taking in excess of 25 Vicodin ES's a day for long periods, some years. Addicts have no concept about ruining thier liver. NONE! Now maybe that will keep them from injecting it but certainly you don't hear an addict say "I can't take no more today, I have reached the 4g aceto limit" LOL yeah right. Lets keep it real. I also have a problem with this notion that Oxycontin is more addictive. No its not if you take it as prescribed and its less toxic. Its more addictive for addicts/abusers sure... They are taking more at higher doses... breaking that time release. Now if a Oxy abuser didnt have access to it and had only ES's they would take the same mg for mg not even concerned about the liver problems. in thats sense they are both equally as addictive. Ok, I got of base here a little. Just my thoughts... —Preceding unsigned comment added by 68.61.109.8 (talk) 11:24, 11 March 2008 (UTC)

Oxycodone is pharmacologically more potent than hydrocodone; this results in a higher potential for dependence. Even people who are prescribed to it are likely to become *dependent*; taking it as prescribed doesn't get rid of the potential for dependence. It is also not less toxic than hydrocodone; they are of a similar, pretty low toxicity by themselves. In combination with acetaminophen, of course, is an entirely different matter. Also, these people taking 25 pills a day for years...that's absolutely ludicrous. Acetaminophen overdose would be obvious and deadly unless treated after even one day of 25 hydrocodone/acetaminophen pills, as well as in the case of the guy trying to take an Oxycontin-equivalent dose of Vicodin. In addition, you are generalizing "addicts"; please don't do so unless you can show that *all* people addicted to hydrocodone don't understand the hepatotoxicity of acetaminophen. Anyway, from my own research I've found that most hydrocodone users really don't take it in the kind of heavy, heavy doses that other opiate users do. Admittedly, I'm drawing pretty heavily on erowid here, and the people on erowid tend to be more educated than your average drug user. Rarr (talk) 21:41, 11 March 2008 (UTC)

Cold Water Extraction Again

Since this was already removed twice after discussion (#Hydrocondone_Extraction, #Removal_of_.22Extraction.22_section), I'm going to go ahead and remove the latest re-insertion (still with no references!) of CWE. Please discuss here before adding it again. Bazzargh (talk) 15:23, 28 March 2008 (UTC)

Hearing loss associated with hydrocodone use.

Apparently opiates, in particular the -codones, can cause long term hearing loss in long periods of use. . Nagelfar (talk) 08:08, 7 September 2008 (UTC)

pharmacology, SAR of hydrocodone

A pharmacology section showing the special structural relationship to codeine might be worthwhile for this article. Something that goes into details like how the hydroxide group (position 6) on the codeine molecule is replaced by the more greatly oxidized carbonyl group, which first makes it codeinone, which by itself is actually only one third the potency of codeine. While a second process makes the double bond between positions 6 & 7 reduced to a single bond by catalytic hydrogenation which by itself results in making dihydrocodeine (DHC) which is only modestly more powerful by itself than codeine. These two structures alone have no great activity or increased potency, but the structures together (dihydrocodeine & codeinone) become dihydrocodeinone or Hydrocodone, which is significantly more potent than codeine, and unlike codeine which is a prodrug, it is active by itself. 4.255.55.241 (talk) 03:51, 13 November 2008 (UTC)

Tusscodin Retard?

The brand name of nicocodeine hydrochloride is really Tusscodin Retard? 4.242.192.128 (talk) 22:17, 13 November 2008 (UTC)

FDA DESI Hydrocodone Cough Preparation Review

The recently added section to this article is very poorly written. I did some work on it, but it needs more. It sounds like it was written by somebody who was very unhappy that they could not get the medication they wanted - hardly the NPOV style appropriate for encyclopedia entry. It is in dire need of citations. Anybody else have thoughts on this? Bhimaji (talk) 04:29, 24 November 2008 (UTC)

Hydrocodone an American drug?

It would be helpful if a suitable expert editor could comment on hydrocodone use internationally. I know it's widely used in the US, but I've never known anybody have it prescribed here in the UK, and it seems rarely used generally outside America. Oxycodone is another stranger here. I'm not a health professional, but AFAIK people in Britain are given codeine / dihydrocodeine / morphine depending on the level of analgesia required, sometimes in combination with non-opioid analgesics. --80.176.142.11 (talk) 23:25, 18 May 2009 (UTC)

My Dr today tried to tell me Hydrocodone is called Dihydrocodeine in the UK, I told him and gave him information to proove him wrong since Dihydrocodeine is roughly 4.5times weaker than Hydrocodone.

Hydrocodone is a Class A drug under the Misuse of Drugs Act 1971 and is Schdule II under the regulations meaning it is a legally prescribable drug. However, it is very rear they use it, just like in the United States they use Demerol often in the UK that drug is only used by women in labor.

Oxycodone is a legal drug in the UK all Dr's and GP's can prescribe it. It comes in the form of Oxycontin (Slow/ Modified Release) or Oxynorm (Immediate Release). They just dont like to prescribe what they called next level opiates (those stronger than Dihydrocodeine and Tramadol).

Tramadol Hydrochloride is branded Ultram in the United States. (Upadated July 10th 2009, Chronic Pain sufferer from Rheumatoid Arthritis and former London NHS employee)

You are quite correct that hydrocodone and dihydrocodeine are different drugs, though like all the opiods they are related. If your doctor was a pain specialist and didn't understand the difference between them that is rather worrying. Dihydrocodeine doesn't seem widely used in the US and this may explain (though not excuse) the ignorance if the doctor was American. --Ef80 (talk) 15:15, 9 October 2009 (UTC)

Big typo and poor quality link

Under the pharmacology section there is this: "However other studies have shown hydrocodone to be anywhere from half as potent to oxycodone (1.5× the potency of morphine) to only 66.6~% the potency of oxycodone (equipotent to morphine)" It says oxycodone twice and gives different information, also it says From 50% to only 66%. WTF? I think someone was editing while partaking in the article's topic. Also the link for that info goes to a forum where there is only two posts and they do not cover the data in any way. This should be removed. —Preceding unsigned comment added by 12.166.11.143 (talk) 02:05, 7 October 2009 (UTC)

It's not Wikipedia's business to carry water for the U.S. War on Drugs, is it?

Almost every paragraph references hydrocodone's similarities with morphine, its potential for misuse, the danger of the side effects (with not even vague mention of the ODDS of any side effect, e.g. "common" or "rare") and various ways it is regulated. All of these subjects are mentioned several times each, which is redundant -- but the more disturbing implication is that the redundancy of these particular facts seems deliberate.

To be more blunt -- dude, I GET IT. Do the various ways to say "ZOMG IT'S A DANGEROUS DRUG R BAD" need to be mentioned so often? Of course not. I was prescribed hydrocodone so I came here to learn about it and the information is certainly useful, but the article is annoyingly political. Is it really necessary in a general reference article to mention that, "in tests conducted on rhesus monkeys, the analgesic potency of hydrocodone was actually found to be higher than that of morphine"?? There are plenty of useful facts in the article and I don't suggest removing the "it's a dangerous recreational drug" bits entirely, but as formatted it reads like FDA propaganda, especially compared to Wiki articles on medications that aren't so politically feared. All mention of its recreational use, control, etc. could be stripped out of non-related sections and compiled into a single section.

Thanks for your consideration, Wiki staff

24.95.90.102 (talk) 19:47, 18 February 2011 (UTC)

For the most part I agree with you. A LOT of opioid and benzodiazepine pages in particular seem to have this problem of spending way too much time on the potential for misuse, to the point where it seems to dominate some otherwise valuable articles.--Metalhead94 ^{T C} 00:35, 20 October 2011 (UTC)

either or both?

"Hydrocodone or dihydrocodeinone is a semi-synthetic opioid derived from either of two naturally occurring opiates—codeine and thebaine."Serialjoepsycho (talk) 07:20, 23 April 2011 (UTC)

Controversy regarding paracetemol hybrid.

I recall there was a big backlash in the medical community about including paracetemol to discourage recreational use by causing liver damage if people took too much; it was compared to putting cyanide in beer as a means to make sure people don't get drunk. Sadly, I cannot find my old notes on this issue for sources, but I'd really encourage editors of this page to seek that information and add it. I'd do it myself, but having been a user since year 0 I no longer contribute figuratively to wikipedia due to ethical issues with the management (power tripping admins). So please, from an academic point of view, I do actively encourage editors to bring that element to light. Pmorphsab (talk) 04:21, 2 August 2011 (UTC)

Availability in Germany and Belgium

Hello there.. I think hydrocodone preparations are (no longer) available in both Belgium and Germany. The Belgian and German equivalents to the American PDR do not list any drugs containing hydrocodone, neither as a stand-alone ingredient nor as a combination with a second analgesic drug (paracetamol, ibuprofen,...). Unless someone protests, I would modify the sections on hydrocodone availability in these countries. C.d.rose (talk) 19:24, 10 August 2011 (UTC)

Oops, I edited the part about availability in Belgium, but I forgot to log in before. So, the last edit changing the section on Regulation was done by me. C.d.rose (talk) 21:15, 11 August 2011 (UTC)

Needs qualified attention: "100-200 µg/L in abusers and 0.1-2.0 mg/L in cases of acute fatal overdosage"

100-200 micrograms *IS* 0.1-0.2 mg, so... Someone who knows which of the two figures is wrong please edit. PS and yeah, while it's well-known that abusers often tolerate far over opiate-naive patients' fatal overdose levels, it's highly unlikely that non-abusers would fatally overdose, plus abusers' blood levels are somewhat limited by the combination NSAIDs, which can cause fatal overdoses on their own and at lower levels. — Preceding unsigned comment added by 208.127.80.59 (talk) 22:38, 11 August 2011 (UTC)

Testosterone??

I've never heard of this, and the claims are awfully specific to be left uncited. I think this section should be removed, if no sources from the primary literature are added. — Preceding unsigned comment added by 98.194.207.248 (talk) 21:52, 19 May 2012 (UTC)

I moved it here until I or someone else can find a reference. I looked at the guidelines for unsourced material and this was just sensationalist enough that I couldn't decide whether or not it could cause someone harm.98.194.207.248 (talk) 22:09, 19 May 2012 (UTC)

Extended content

Hydrocodone, along with most other opioids, may also severely decrease testosterone levels in men and may cause menstrual irregularities in women. Short-term use of opioids will usually result in a decrease in testosterone with a subsequent rebound post-cessation. However, chronic use is much more dangerous. In a study on cancer survivors using opioids for chronic pain relief, 90% of the subjects had hypogonadal levels of testosterone.

This may occur due to both a negative feedback at both the hypothalamus-pituitary and at the gonadal (testicular) level. This is known as "central hypogonadism". Patients using opioid therapy should be screened for such endocrinological problems periodically through blood tests and inquiry of symptoms, which include loss of libido, erectile dysfunction, anxiety, fatigue, loss of muscle mass, and infertility. Treatment should first consist of opioid rotation. If that does not work, then testosterone replacement should commence.

Vicoprofen

It may be worth noting that hydrocodone (I don't know how much; probably the typical therapeutic dose) is paired with 200 mg of ibuprofen under the name "Vicoprofen."

Vicoprofen has 7.5 milligrams of hydrocodone it. This is the only dose of the drug currently available. 21:15, 3 September 2013 (UTC)

Popular Culture/House

Do we really need a detailed summary of the character House's battles with addiction? I would think it would be enough to just say he's battled with addiction (details should be on his own page). In fact, does this article really need a Popular Culture section? 42Yggdrasil (talk) 04:22, 25 June 2012 (UTC)

I agree. There is a great deal of plot line on a fictional character and only one line about a rapper making "frequent references" to Vicodin. One is a fictional character, uncertain what that truly does bring to the article other than to suggest abuse by a medical professional is tolerated when it is not and the latter isn't exceptionally noteworthy to any who do not listen to rap music. I'd recommend removal. Can we get consensus on this here?Wzrd1 (talk) 12:17, 21 September 2012 (UTC)

People may come to this article just to make sure they heard right, and to make sure they could spell the word correctly. The briefest of confirmations ought to suffice, but I think the mention is appropriate. It might explain the currency of the topic in conversations, and help people understand allusions in fiction and popular music. 172.56.27.137 (talk) 20:47, 22 May 2014 (UTC)

Routes of availability (incomplete?)

The only states ROA's for this narcotic are oral, intranasal, and rectal. I would be baffled to learn intravenous injection of hydrocodone is unviable as an ROA. Not to mention sublingual, and likely intramuscular ROA. Although hydrocodone has not been an IV/IM substance in the previous decades (presumptively due to low dose tablets being the primary source of the narcotic), this will likely change due to the new FDA approval of high dosage hydrocodone tablets similar to oxycodone & morphine. Such high dosage tablets will be (upon diversion) unnaturally over-priced ($1/1mg is not uncommon in California) which leads recreational or dependent users to pursue IV/IM administration as to not waste any of the narcotic to less effective ROA's. — Preceding unsigned comment added by 99.169.135.200 (talk) 15:15, 25 March 2013 (UTC)

Shouldn't that be "route of administration" and "presumably"? "The only states" should be "this only states that", right? Or is the "only" meant to refer to the restriction of routes of administration to the three mentioned? I, too, wonder whether injections are ruled out, for some reason. 172.56.27.18 (talk) 20:59, 22 May 2014 (UTC)

P450 vs. 450

Looking up "Cytochrome 450" causes a redirect to "Cytochrome P450". I suspect that the two refer to the same thing, but decided not to make any change. 172.56.26.10 (talk) 20:33, 22 May 2014 (UTC)

yes they are same thing. — Preceding unsigned comment added by 24.102.212.170 (talk) 16:37, 31 August 2014 (UTC)

PLEASE Read Before Editing This Article

There is a LOT of confusion regarding the rescheduling of all Hydrocodone products to Schedule II as of 6 Oct 2014. Mistakes and misconceptions are being edited into this article based on U.S. STATE law rather than DEA requirement or federal law under the Control Substances Act. Specifically, today an edit was posted stating that patients must see their prescribing physician once monthly to obtain their prescription; the DEA has stated specifically that they do not require this, but leave that decision up to physicians.

"Although the CSA prohibits refills of prescriptions for schedule II controlled substances, a practitioner may issue multiple schedule II prescriptions in order to provide up to a 90-day supply of medication in accordance with 21 CFR 1306.12. Furthermore, DEA regulations do not require patients to be seen monthly by their provider. Rather, practitioners must determine on their own, based on sound medical judgment, and in accordance with established medical standards how often to see their patients when prescribing controlled substances."

It is very easy to confuse what is required in a given region with what is actually law. So to prevent endless edits and re-edits, please read the DEA's actual ruling before posting something as if it applies to the entire U.S. when in fact it may not. We aim to clarify this very concerning subject, not confuse it further. Here is the ruling:

https://www.federalregister.gov/articles/2014/08/22/2014-19922/schedules-of-controlled-substances-rescheduling-of-hydrocodone-combination-products-from-schedule#h-27

I have also listed this under External Links in this article.

Thank you for double checking and posting responsible and factual edits. History Lunatic (talk) 02:23, 6 October 2014 (UTC)HistoryLunatic

U.S. Schedule. III vs II

As of right now, hydrocodone is still a Schedule III drug in the United States; it becomes a Schedule II drug on 6 Oct 2014. I don't know when the edit was made to list it as a Schedule II already, but this causes major confusion in the Pain community, among doctors and patients. This 8 more days may seem a moot point, but for these days a pain patient can still get prescribed hydrocodone products under rules and state laws affecting Schedule III drugs, which for most mean that the prescription can be called in instead of requiring an office visit and refills on a script issued before Oct 6 can be honored until April 8, 2015. I will edit it back to Schedule II until Oct 6, as per the DEA's ruling. If anyone has a concern, please discuss it here first before simply reverting the edit. Thank you. 69.42.36.181 (talk) 10:23, 30 September 2014 (UTC)History Lunatic

Edit completed by EDSandPOTSY. Thanks much! History Lunatic (talk) 04:39, 6 October 2014 (UTC)History Lunatic

Inside Narcotics

I can't find any book called "Inside Narcotics" on Worldcat. The refs below appear to be fake...

A simultaneous warming of the stomach and rest of the body with the possible sensation of pleasant cooling in the lungs and the whole body which can start with the tip of the nose is sometimes also reported, as well as morphine derivatives and a large percentage of the others, along with opium and hydromorphone Hydrocodone, like other codeine derivatives as, can have the sedative, analgesic, euphoriant, and other effects modulated when or potentiated if combined with antihistamines (some of which do the the same thing as grapefruit juice) sedatives, anticholinergics, stimulants, anti-spasmodics, and hypnotics. This synergy is used both by mainstream medicine and pharmacology and unsupervised users

References

-Jytdog (talk) 07:14, 15 February 2016 (UTC)

recreational use section

The section below has been unsourced/inappropriately sourced for three years, so I am moving it here until it can be appropriately sourced

Extended content

Recreational use

Many users of hydrocodone report a sense of satisfaction (euphoria), especially at higher doses. A number of users also report a warm or pleasant numbing sensation throughout the body, one of the best-known effects of narcotics.

Withdrawal symptoms are similar to those of morphine and other opioids. More specifically, the symptoms may include severe pain, pins-and-needles sensations throughout the body, sweating, extreme anxiety and restlessness, sneezing, watery eyes, fever, depression, stomach cramps, diarrhea, and extreme drug cravings. Furthermore, unlike a light codeine or meptazinol dependence, hydrocodone withdrawal can be expected to reach the worst categories of symptoms, resembling that of morphine or hydromorphone. In a very small number of severe cases withdrawal can be lethal unless undertaken under medical supervision, particularly for users with cardiac or pulmonary disease or those unable to treat the dehydration and resultant acid-base and electrolyte problems. Unlike alcohol, benzodiazepine, barbiturate, and sedative-hypnotic dependence, the abstinence syndrome technically does not kill directly and is in fact self-limiting in many respects.

Taking hydrocodone with grapefruit juice is believed to enhance its narcotic effect. It is hypothesized that the CYP3A4 inhibitors in grapefruit juice may interfere with the metabolism of hydrocodone, although there has been no research into this issue. Additionally, many medications are either substrates (competing for metabolism and exhausting available enzymes) or direct inhibitors of CYP3A4. Inhibition of another enzyme, CYP2D6, would also increase the duration of hydrocodone's elevated concentration in the blood, leading to exaggerated effects. Complete inhibition of both enzymes would theoretically inhibit 60% of the factors involved in hydrocodone metabolism. Inducing CYP2D6 with, for example, glutethimide or promethazine, also increases the hydrocodone-hydromorphone conversion in the liver, and promethazine is an opioid potentiator used with everything from codeine to alphaprodine in clinical settings, which may increase effects but also muddy the picture vis à vis serum levels at any given time.

References

- Jytdog (talk) 07:18, 15 February 2016 (UTC)

regulation section

I am moving this here, as this has been mostly unsourced for at least three years, and that is not OK.

This can be added back, bit by bit, as it is sourced

Extended content

Regulation

Australia

In Australia, hydrocodone is a Schedule 8 (S8) or Controlled Drug.

Austria

Hydrocodone is regulated in Austria in the same fashion as in Germany (see below) under the Austrian Suchtmittelgesetz; since 2002, it has been available in the form of German products and those produced elsewhere in the European Union under Article 76 of the Schengen Treaty—prior to this, no Austrian companies produced hydrocodone products, with dihydrocodeine, nicomorphine, and nicocodeine being more commonly used for the same levels of pain and the former and last for coughing. The latter two were Austrian inventions of the first years of the 20th century.

Nicocodeine, the nicotinoyl ester of codeine, is virtually identical in strength to hydrocodone. A third, nicodicodeine, the dihydrocodeine analogue of nicocodeine, and acetyldihydrocodeine and thebacon, acetyl esters of dihydrocodeine and hydrocodone respectively, were also used. Nicocodeine is known as Tusscodin, and abroad as Lyopect. Nicocodeine is a prodrug for nicomorphine in the same way hydrocodone is for hydromorphone; nicomorphine is a strong opioid of the 3,6 diester (heroin-nicomorphine-dibenzoylmorphine) type, which is also stronger than morphine, not quite the milligram strength of hydromorphone, but with a faster onset of action.

Belgium

In Belgium, hydrocodone is no longer available for medical use.

Canada

In Canada, hydrocodone is a Schedule I controlled substance and is available by prescription only. Hydrocodone is typically found in cough suppressant liquid mixtures and as a 5 mg tablet. It is not available in combination with other analgesics as it is in the United States. It is not generally used as pain reliever.

France

In France, hydrocodone is no longer available for medical use. Hydrocodone is a prohibited narcotic.

Germany

In Germany, hydrocodone is no longer available for medical use. Hydrocodone is listed under the Betäubungsmittelgesetz as a Suchtgift in the same category as morphine.

Luxembourg

In Luxembourg, hydrocodone is available by prescription under the name Biocodone. Prescriptions are more commonly given for use as a cough suppressant (antitussive) rather than for pain relief (analgesic).

The Netherlands

In the Netherlands, hydrocodone is not available for medical use and is classified as a List 1 drug under the Opium Law.

Sweden

Hydrocodone is no longer available for medical use in Sweden. The last remaining formula was deregistered in 1967.

United Kingdom

In the United Kingdom, hydrocodone is not available for medical use and is listed as a Class A drug under the Misuse of Drugs Act 1971. Various formulations of dihydrocodeine, a weaker opioid, are frequently used as an alternative for the aforementioned indications of hydrocodone use.

United States

Hydrocodone was usually not commercially available in pure form in the United States due to a separate regulation, and was typically sold with an NSAID, paracetamol (acetaminophen), antihistamine, expectorant, antibiotic or homatropine. In solid pill form, Zohydro ER contains only hydrocodone as its active ingredient in an extended release format. As of 6 October 2014 all hydrocodone products are listed as Schedule II Controlled substance. They will no longer be a Schedule III narcotic. Prescriptions can no longer have refills and a handwritten paper script must be obtained for each fill. In some states a Schedule II substance can be electronically prescribed if the doctor has the proper technology and an electronic signature license.

Prior to 6 October 2014, hydrocodone was listed as both a Schedule II and Schedule III substance, depending on the amount of hydrocodone and type and amount of additional ingredient it was compounded with:

• Schedule II lists hydrocodone in pure form and any formulations of combination products containing more than 15 mg hydrocodone per dosage unit. This shares the ACSCN of bulk hydrocodone (9193)
• Schedule III also lists hydrocodone in combinations products containing "Not more than 300 milligrams of dihydrocodeinone (hydrocodone) per 100 milliliters or not more than 15 milligrams per dosage unit, with a fourfold or greater quantity of an isoquinoline alkaloid of opium" as ACSCN 9805.
• Schedule III also lists hydrocodone in combinations products containing "Not more than 300 milligrams of dihydrocodeinone (hydrocodone) per 100 milliliters or not more than 15 milligrams per dosage unit, with one or more active nonnarcotic ingredients in recognized therapeutic amounts" as ACSCN 9806 (e.g. Norco, Vicodin, Lortab)

Prior to August 1990, formulations with at least three active ingredients which were less than one-ten thousandth hydrocodone base by weight were Schedule V, meaning a handful of hydrocodone syrups including a phenyltoloxamine-based, decongestant-containing version of Tussionex were available OTC (for those willing to sign a Narcotic Exempt Register) in about a dozen states.

As of 2006, hydrocodone was the active antitussive in more than 200 formulations of cough syrups and tablets sold in the United States. In late 2006, the U.S. Food and Drug Administration (FDA) began forcing the recall of many of these formulations due to reports of deaths in infants and children under the age of six. The legal status of drug formulations originally sold between 1938 and 1962—before FDA approval was required—was ambiguous. As a result of FDA enforcement action, by August 2010, 88% of the hydrocodone-containing medications had been removed from the market. As a result, doctors, pharmacists, and codeine-sensitive or allergic patients or sensitive to the amounts of histamine released by its metabolites had to choose among rapidly dwindling supplies of the Hycodan-Codiclear-Hydromet type syrups, Tussionex—an extended-release suspension similar to the European products Codipertussin (codeine hydrochloride), Paracodin suspension (dihydrocodeine hydroiodide), Tusscodin (nicocodeine hydrochloride) and others—and a handful of weak dihydrocodeine syrups. The low sales volume and Schedule II status of dilaudid cough syrup predictably leads to under-utilisation of the drug. There are several conflicting views concerning the US availability of cough preparations containing ethylmorphine (also called dionine or codethyline)—Feco Syrup and its equivalents were first marketed circa 1895 and still in common use in the 1940s and 1950s, and the main ingredient is treated like codeine under the Controlled Substances Act of 1970.

As of July 2010, the FDA was considering banning some hydrocodone and oxycodone fixed-combination proprietary prescription drugs—based on the paracetamol content and the widespread occurrence of liver damage. FDA action on this suggestion would ostensibly also affect codeine and dihydrocodeine products such as the Tylenol With Codeine and Panlor series of drugs. In 2010, it was the most prescribed drug in the USA, with 131.2 million prescriptions of hydrocodone (combined with acetaminophen) being written.

The rationale of combining hydrocodone with other pain-killers is that the combination may increase efficacy, and the adverse effects may be reduced as compared with an equally effective dose of a single agent. A combination of hydrocodone and ibuprofen was more effective than either of the drugs on their own in relieving postoperative pain. The overall effect of the combination could be presented as a sum of the effects of ibuprofen and hydrocodone, which is consistent with differing mechanisms of action of these drugs. Similar results were observed for hydrocodone-acetaminophen combination.

Four pharmaceutical companies (Purdue Pharma, Cephalon, Egalet and Zogenix) are developing extended-release formulations of hydrocodone by itself; the Zogenix product was approved by the US FDA on 25 October 2013 and was launched in the 1st Quarter of the Market in 2014. These formulations were designed to avoid the issue of hepatotoxicity precipitated by acetaminophen. These new extended-release preparations also offer lower abuse potential.

On 25 October 2013, with support from critics of hydrocodone use and the DEA, the U.S. Food & Drug Administration proposed tightening control of the drug by reclassifying the existing Schedule III formulations of hydrocodone as Schedule II. Critics of the change included pharmaceutical firms, medical professionals, and patients, particularly those undergoing pain management, who stressed that reclassification is unnecessary and would be counter-productive to effectively provide pain relief for those suffering. One issue regarding Class II drugs as compared to Class III drugs is that doctors cannot "call in" Class II medications to a pharmacy over the phone or fax: the prescription must be hand written and taken to the pharmacy by the patient. Another issue with Class II drugs is that the doctor can only prescribe a one-month supply at a time, which means the prescription cannot have any refills. Those opposed to reclassification also maintain that the existing protocol for prescribing opioids and the existing inclusion of acetaminophen along with other NSAIDs are effective measures in deterring misuse.

Effective 6 October 2014, 21 CFR 1308.13 was amended (at 79 FR 49661) to remove ACSCNs 9805 and 9806 from Schedule III, the result being that all hydrocodone-containing preparations are now Schedule II, regardless of amount of hydrocodone or additional components.

References

- Jytdog (talk) 18:44, 18 March 2016 (UTC)

US popularity

Although the article now correctly states that this drug is overwhelmingly used in the US and is rarely encountered elsewhere, it doesn't explain how this came to happen. Presumably this dates back to decisions made either by US regulators or the US medical establishment in the past. Some background on this would improve the article. --Ef80 (talk) 21:20, 29 July 2016 (UTC)

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In popular culture

There should be a section called: "In popular culture", where there should be stated that Doctor House, the character of the series of the same name played by Hugh Laurie, is addicted to Vicodine. — Preceding unsigned comment added by 176.83.70.198 (talk) 21:32, 1 November 2017 (UTC)

Do it! --91.201.74.58 (talk) 14:58, 26 February 2018 (UTC)

No, not here. Vicodin is hydrocodone/paracetamol and it's already mentioned there. -- Ed (Edgar181) 15:00, 26 February 2018 (UTC)