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Hydrocodone

Hydrocodone or dihydrocodeinone (marketed as Vicodin, Anexsia, Dicodid, Hycodan, Hycomine, Lorcet, Lortab, Norco, Tussionex, Vicoprofen) is an opioid derived from either of the naturally occurring opiates codeine or thebaine. Hydrocodone is an orally active narcotic analgesic and antitussive. The typical therapeutic dose of 5 to 10 mg is pharmacologically equivalent to 30 to 60 mg of oral codeine. more...

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Sales and production of this drug have increased significantly in recent years, as have diversion and illicit use. Hydrocodone is commonly available in tablet, capsule and syrup form.

As a narcotic, hydrocodone relieves pain by binding to opioid receptors in the brain and spinal cord. It may be taken with or without food, but should never be combined with alcohol. It may interact with monoamine oxidase inhibitors, as well as other drugs that cause drowsiness. It is in FDA pregnancy category C: its effect on an unborn embryo or fetus is not clearly known and pregnant women should consult their physicians before taking it. Common side effects include dizziness, lightheadedness, nausea, drowsiness, euphoria, vomiting, and constipation. Some less common side effects are allergic reaction, blood disorders, changes in mood, mental fogginess, anxiety, lethargy, difficulty urinating, spasm of the ureter, irregular or depressed respiration and rash.

Hydrocodone can be habit-forming, and can lead to physical and psychological addiction. In the U.S., pure hydrocodone and forms containing more than 15 mg per dosage unit are called hydrocodone compounds and are considered Schedule II drugs. Those containing less than 15 mg per dosage unit are Schedule III drugs. Hydrocodone is typically found in combination with other drugs such as paracetamol (acetaminophen), aspirin, ibuprofen and homatropine methylbromide. In the UK it is listed as a Class A drug under the Misuse of Drugs Act 1971.

The presence of acetaminophen in hydrocodone-containing products deters many drug users from taking excessive amounts. However, some users will get around this by extracting a portion of the acetaminophen using hot/cold water, taking advantage of the water-soluble element of the drug. It is not uncommon for addicts to have liver problems from taking excessive amounts of acetaminophen over a long period of time--taking 10–15 grams of acetaminophen in a period of 24 hours typically results in severe hepatotoxicity. It is this factor that leads many addicts to use only single entity opiates such as OxyContin.

Symptoms of hydrocodone overdosage include respiratory depression, extreme somnolence, coma, stupor, cold and/or clammy skin, sometimes bradycardia, and hypotension. A severe overdose may involve circulatory collapse, cardiac arrest and/or death.

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Notes

^ Tarascon Pocket Pharmacopoeia.

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Preemptive nerve block studied in vaginal surgery
From OB/GYN News, 11/1/05 by Sharon Worcester

ATLANTA -- Preemptive pudendal nerve blockade had no effect on postoperative pain or use of narcotic analgesia in a prospective randomized study of patients undergoing pelvic reconstructive surgery.

A total of 102 patients undergoing transvaginal pelvic reconstruction under general anesthesia induced by intravenous fentanyl and propofol were randomized in double-blind fashion to receive pudendal block with either bupivacaine 0.25% or normal saline as placebo just before surgery. Patient-reported pain intensity at six time points in the 24 hours after surgery was similar in both groups, as was consumption of patient-controlled hydromorphone at three time points after surgery, Yoram Abramov, M.D., reported at the annual meeting of the American Urogynecologic Society.

Although some clinical studies have suggested that preemptive analgesia may reduce postoperative pain and consumption of postoperative narcotics, no prior studies have evaluated its effects in patients undergoing vaginal surgery, said Dr. Abramov of Northwestern University, Chicago.

Although it is possible that the threshold for the type of pain experienced by women undergoing vaginal surgery was too low to elicit a statistically significant difference in this study, it may be that the preemptive approach simply does not work in this population, he said.

Mean postoperative pain scores in the treatment vs. placebo groups--as measured using a validated visual analog scale of 0-10 points--were 4.63 and 4.80 at 1 hour, 3.71 and 3.87 at 3 hours, 2.89 and 3.10 at 5 hours, 2.85 and 3.12 at 7 hours, 3.22 and 3.47 at 18 hours, and 3.23 and 3.12 at 24 hours. Consumption of patient-controlled hydromorphone in the treatment vs. placebo groups was 1.84 mg and 1.77 mg at 0-3 hours, 1.19 mg and 1.20 mg at 4-7 hours, and 2.89 mg and 2.35 mg at 8-18 hours.

The treatment and placebo groups were similar with regard to the percentage of patients requiring additional boluses of hydromorphone (18% in each group) or ketorolac (8% and 12%), and with regard to 24-hour mean oral hydrocodone consumption (10.6 mg and 12.7 mg) and mean ibuprofen consumption (630 mg and 762 mg).

There were no complications associated with the pudendal nerve block.

BY SHARON WORCESTER

Southeast Bureau

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