Hydrocodone a semi-synthetic drug is a member of the opioid analgesics which produces pharmacological properties as an analgesic and cough suppressant. Like all the other opioids the exact mechanism of action is not fully known but does exert affect on the opioid receptors of the central nervous system. It produces many of the similar characteristics of codeine, such as drowsiness, mood changes and reduced mental acuity.

The drug should be given with extreme caution in a controlled setting to those with a possible allergy to any of the opioids especially other codeine like derivatives. It can produce dose-related respiratory depression by direct action on the brain stem center producing irregular and periodical breathing and shallow breaths. Hydrocodone may increase CSF, (cerebral spinal fluid) so its use in head trauma should be monitored closely along with any acute abdominal conditions as it can mask serious progressing gastrointestinal disorders.

The use of the drug in debilitated, elderly, or hepatic (liver disease) or renal (kidney disease) patients, hypothyroid, or patients with urinary retention due to anatomical conditions (stricture-narrowing of urethra) should be cautiously administered. As a potent cough suppressant it may suppress the cough reflex which could be a threat to the post-operative patient recovering from anesthesia or in patients with advanced pulmonary diseases.

Alcohol and other central nervous system suppressants may enhance the sedative effects of hydrocodone and should be avoided when driving; operating any type of machinery when full mentally alert capacity is required. For those patients whose conditions dictate long term usage, appropriate blood laboratory tests should be performed including liver function, complete blood counts and renal function tests.

Concomitant drugs may interact with hydrocodone products such as other narcotics, antihistamines (for allergic symptoms), anti-anxiety, anti-depressants or anti-psychotic medications, and alcoholic beverages.

Hydrocodone when possible, should be avoided in the pregnant patient due to its capacity to reduce respiration and as with all opioids possible because physical dependency by the fetus the same is true of the nursing mother as the drug is excreted in human milk. Hydrocodone compounds are not indicated in pediatric use with a possible reduction in doses to the geriatric population on an individual basis considering co-morbidities (i.e. liver, kidney, and thyroid) and other diseased states with the smallest dose that may produce the desired analgesia as possible.

Hydrocodone compounds affect various organ states in the body. Central nervous system effects may include drowsiness, mental confusion and lethargy (fatigue), anxiety, fear, mood changes, and impaired physical performance.

Prolonged use may produce constipation with reduced gastrointestinal motility and digestive disturbances. The senses including hearing may sustain injury or impairment with prolonged excessive high does usage. Skin rashes and itching may result.

Hydrocodone overdose will manifest with decreased respiration and cyanosis, deep sleep(somnolence) progressing to stupor or coma with a cold clammy skin and skeletal muscle flaccidity(weakness) bradycardia (slow heart rate) and hypotension and eventually blood circulatory collapse, followed by cardiac arrest and death.

Various products are available containing hydrocodone for use as an analgesic or cough suppressant (anti-tussive). Those also containing acetaminophen (APAP) for pain relief have been or will be reformulated with a reduction in the amount of acetaminophen as per FDA (Food & Drug Administration) guidelines. One such company is Abbott Pharmaceuticals for their product Vicodin. As of May 2012, Abbott voluntarily has changed formulations from a combination of hydrocodone which remains at 5mg, 7.5mg or 10mg with a reduced APAP combination of 500mg to 300mg, 750mg to 300mg and 660mg to 300mg respectively. Other companies with this combination of medicine, though perhaps not in the same amounts , will also be lowering their APAP content as per the new FDA daily recommendation of APAP( i.e. Tylenol) OTC (over the counter) and prescription strength.

The drug combination of hydrocodone/APAP in the range from 2.5 or 5mg/300 for mild to moderate pain is 1-2 tablets every 4-6 hours as needed, while the higher doss of 7.5 or 10/300 is usually 1 tablet every 4-6 hours for pain. The response is carefully monitored and the dosage adjusted. As mentioned various pharmaceutical companies manufacture this combination drug ands some of the products most commonly prescribed are LorTab, Lorcet, Vicodin, Hycodan and Hycomine Compound (also available in liquid as a cough suppressant) and Vicoprofen (a combination of hydrocodone and ibuprofen) - a good product with analgesia of the hydrocodone strength is needed along with an anti-inflammatory.

REFERENCES

PDR 59 Physicians’ Desk Reference 2005

MPR 2011 Edition, Monthly Prescribing Reference Pain Management Reference Issue

In my personal practice, I have found this particular drug useful for mild to moderated pain following trauma to the foot or ankle, Generally, I have found these combinations to be well tolerated with a minimum of significant drowsiness. In trauma my type of practice usually is not faced with the complication of drug dependence/abuse, as the dose is usually very short term as the etiology of pain is addressed and corrected through healing the bone or soft tissue injury or surgical intervention.

ADDITIONAL REFERENCES

Drugs.com

Mayo Clinic

MedlinePlus

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