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View Full Version : Why is there no pure hydrocodone pill?


diggleblop
09-02-2006, 10:56 AM
For instance, there is Oxycontin, which is pure Oxycodone with no Tylenol in it. Why is there no Hydrocodone with no Tylenol or other binding agent? I take hydrocodone for pain and the Tylenol in it always worries me and anything stronger makes me too sleepy to function. I know there is Vicoprofin, but I mean pure hydrocodone.

Anyone, Bueller? Bueller?

WhyNot
09-02-2006, 11:08 AM
Tylenol potentiates the action of the hydrocodone, meaning you need far less hydrocodone if you take a bit of Tylenol with it. This, of course, lessons the unwanted effects of large doses of hydrocodone.

Ibuprofen, incidently, is also potentiated by Tylenol. Taking an Advil and a Tylenol together works better than two of either by itself. (Check with your doctor, avoid prolonged use of Tylenol unless under a doctor's care, do not drink alcohol with Tylenol on a regular basis, void in Lesser Zimbabwe.)

Bill Door
09-02-2006, 04:13 PM
The interesting thing about this is that toxicity in overdoses is generally not the fault of the hydrocodone, but the Tylenol. While the LD50 for Tylenol is around 7000 mg and the LD50 for hydrocodone only 800 mg, the normal dosage in a Vicodin or generic APAP/hydrocodone tablet is 500 mg acetaminophen/5 mg hydrocodone. It would take 160 tablets to reach the LD50 for hydrocodone and only 14 to reach the LD50 for Tylenol.

I have often suspected that the Tylenol is in there to prevent abuse. It's pretty cynical to assume the FDA would place poison in prescription drugs to prevent misuse, but there you have it. I guess it says something about my character.

Spectre of Pithecanthropus
09-02-2006, 04:34 PM
I've wondered about the OP's question myself. If you're trying to manage your pain with Tylenol or a similar drug, but need something stronger occasionally, then when you take the Vicodin, you've got a double dose of Tylenol. And too much of that can't be good.

Qadgop the Mercotan
09-02-2006, 05:28 PM
Oh, it's manufactured by itself. But then it's a schedule II drug, same as oxycodone with or without acetaminophen.

But first you have to find a doc to prescribe plain hydrocodone, and most probably won't be that eager to do so. If I've got a patient who needs more than 40 mg of hydrocodone a day (the max amount to take of the hydrocodone/APAP 5/500 mix, in terms of max APAP dose), perhaps there's another problem, or I should be using a stronger pain killer.

Then you'd have to find a pharmacy that stocks it. Not much call for it. Just another schedule II drug to keep an inventory on, and not much used.

So there you go.

diggleblop
09-02-2006, 06:19 PM
Qadgop, what would it be called? The name brand, that is?

edwino
09-02-2006, 10:21 PM
Qadgop, what would it be called? The name brand, that is?
It is just hydrocodone, as it is a generic. There are several trade names, including Hycodan. It is not a great pain reliever, that's why mostly it is used with acetaminophen. If you are needing greater pain relief, I'm not offering medical advice but what we use around here is a long acting opiod with a short acting one for PRN breakthrough (oxycontin + PRN oxycodone, for example). You should really seek advice from a qualified pain expert, though.

diggleblop
09-02-2006, 11:11 PM
Yeah, I've tried percocet, oxycontin and they just make me too sleepy. Hydrocodone is the only thing that doesn't make me crash out during the day. It sucks, too. I'll talk to my doc about compound hydrocodone, though. Thanks !

tygerbryght
09-03-2006, 07:22 PM
Ask your doctor for Oxycodone IR, and be prepared to discuss it with him/her. I have it for breakthrough pain. I can take or not take Tylenol with it, as seems appropriate at the time. I have liver worries, so I watch my Tylenol intake closely.

Theobroma
09-03-2006, 07:55 PM
Hycodan (hydrocodone without any Tylenol or ibuprofen) is usually prescribed for cough, not pain. It's not used that frequently; the hospital I work for doesn't carry it.

I have had Hycodan prescribed for me some years ago when I had a severe bronchitis with a cough that kept me up all night. It worked pretty well, especially at night, when sleepiness wasn't a real issue. The Tylenol is useless for cough, so the manufacturer (Dupont, I think) left it out.

Theobroma, R.Ph.

Qadgop the Mercotan
09-03-2006, 09:05 PM
One thing to remember about hycodan: Homatropine methylbromide is included in a subtherapeutic amount to discourage deliberate overdosage. Take a lot of homatropine and it will discourage you from doing so again.

That's how hycodan can get away with being schedule III, not schedule II.

Hydrocodone is an extremely popular drug of abuse, with a stronger euphoriant effect than codeine for the typical individual.

diggleblop
09-03-2006, 09:09 PM
Out of curiousity, what are the effects of Homatropine methylbromide. I guess I could google, but I'm super lazy right now.

gabriela
09-04-2006, 07:58 PM
The interesting thing about this is that toxicity in overdoses is generally not the fault of the hydrocodone, but the Tylenol. While the LD50 for Tylenol is around 7000 mg and the LD50 for hydrocodone only 800 mg, the normal dosage in a Vicodin or generic APAP/hydrocodone tablet is 500 mg acetaminophen/5 mg hydrocodone. It would take 160 tablets to reach the LD50 for hydrocodone and only 14 to reach the LD50 for Tylenol.

I have often suspected that the Tylenol is in there to prevent abuse. It's pretty cynical to assume the FDA would place poison in prescription drugs to prevent misuse, but there you have it. I guess it says something about my character.

Sorry to chime in so late, and this is a slight hijack since the OP's had his question answered by Whynot and Qadgop the Mercotan, but I had to go to work to look up the answer I wanted to this question.

I was a little puzzled by Bill Door's statement above about the toxicity in OD's. Because I sign the death certificates on maybe three hydrocodone deaths a month, and one acetaminophen death a year. So why do his sources say so much of the toxicity is due to acetaminophen?

Then it hit me. He's probably talking about living people who OD'd but survived. Since as is well known, acetaminophen toxicity (this is acute overdoses we're talking about, not chronic toxicity) comes on about a day or two after you attempt suicide on that handful of pills. You don't really watch your liver die for four to ten days.

Whereas, if you die from hydrocodone overdose, you die within hours of use. You go into a very deep sleep in which your breathing is so shallow that you don't get enough oxygen to your heart or your brain. Any condition which lowers the threshold for your heart to go into an arrhythmia will bring on your death faster such as enlarged heart, cardiomyopathy, diabetes with small vessel disease of the myocardium, or concomitant use of cocaine, amphetamiines, or alcohol.

(Not everyone knows that alcohol decreases the ventricular threshold for arrhythmias just as it decreases the brain threshold for seizures. And benzoylecgonine is also a fairly strong arrhythmogen, though not as strong as the mother compound cocaine.)

I got the following data from the Red Book, formally known as Baselt's Disposition of Toxic Drugs and Chemicals in Man, third edition.

Hydrocodone. One dose. Peaks two hours later at 0.011 mg/L (that's drug level in the bloodstream). One high dose. Peaks two hours later at 0.024 mg/L. Fatal doses. 11 people in 6 studies died from levels varying between 0.13 (that's about eleven pills!) and 7.0 (that one was a suicide who emptied the bottle down her throat); in eight of them, the fatal blood level ranged from 0.013 to 0.60.

Tylenol. One dose (one standard pill, 325 mg). Blood level maximum, 4.2 mg/L.
Tylenol. One dose of 1000 mg. Blood level maxes out at 9 mg/L.
Tylenol. One dose of 1300 mg (four standard pills). Blood level, 4.8 to 13 mg/L.
Tylenol. One dose of 1800 mg. Blood level, 5.6 to 52 mg, mean 26.

One hundred and thirty-nine people who died from a combined overdosage of acetaminophen and at least one other drug, any other drug. Acetaminophen blood levels ranged from 90 to 300 mg/L, mean 170. Six people who died from acetaminophen alone, range 160 to 367 mg/L, average 248.

Obligatory reference to the Rumack nomogram (http://www.emedicine.com/ped/topic7.htm).

So you got a little more room to make mistakes with Tylenol. Your wiggle room with hydrocodone is measured in hundredths of a mg per liter. Your wiggle room with acetaminophen is in tens of grams.


gabriela

gabriela
09-04-2006, 08:01 PM
the fatal blood level ranged from 0.013 to 0.60.


Typo. The fatal blood level ranged from 0.13 to 0.60.

Oops!

Hirundo82
09-04-2006, 11:40 PM
Not everyone knows that alcohol decreases the ventricular threshold for arrhythmias just as it decreases the brain threshold for seizures. And benzoylecgonine is also a fairly strong arrhythmogen, though not as strong as the mother compound cocaine.Definitely a hijack here, but the part about alcohol lowering the seizure threshold caught my eye. Why would it decrease the seizure threshold?

If I recall correctly, EtOH has a very similar mechanism to barbiturates--ie it binds to and increases conductance through the GABA-Cl ion channel, resulting in hyperpolarization of the neuronal membrane. If this is correct, why wouldn't EtOH raise the seizure threshold the same way that barbiturates do? Or is there another effect of EtOH that I am not considering?

Joey P
09-05-2006, 12:43 AM
Out of curiousity, what are the effects of Homatropine methylbromide. I guess I could google, but I'm super lazy right now.
I have NO IDEA at all if this is what QtM was referring to, but back in the experimental college days, when I was doing reseach on robotripping (I always did reseach before trying something) I read something about bromide poisoning. That may or maynot be what Qadgop was talking about. I don't remember how much you had to injest to do it or any of the complications though.

edwino
09-05-2006, 01:40 AM
I have NO IDEA at all if this is what QtM was referring to, but back in the experimental college days, when I was doing reseach on robotripping (I always did reseach before trying something) I read something about bromide poisoning. That may or maynot be what Qadgop was talking about. I don't remember how much you had to injest to do it or any of the complications though.
No, homatropine is an anti-muscarinic:
Mad as a hatter
Red as a beet
Dry as a bone
Hot as a hare
Blind as a bat
Bowel and bladder lose their tone
And the heart runs alone

It is quite an unpleasant toxicity -- CNS disturbance, hyperthermia, dry mouth, hyperthermia, miosis, urinary retention, gastric ileus, tachyarrhythmias.

gabriela
09-05-2006, 03:39 AM
Definitely a hijack here, but the part about alcohol lowering the seizure threshold caught my eye. Why would it decrease the seizure threshold?

If I recall correctly, EtOH has a very similar mechanism to barbiturates--ie it binds to and increases conductance through the GABA-Cl ion channel, resulting in hyperpolarization of the neuronal membrane. If this is correct, why wouldn't EtOH raise the seizure threshold the same way that barbiturates do? Or is there another effect of EtOH that I am not considering?

I'm sorry to say I don't know why, Hirundo82. I only know that it does.

I can try to find out for you. One reason may be the difference between neuronal and myocardial membranes. Myocytes have some extremely specific calcium and other ion channels. As you no doubt know well.

As a consideration: The myocardium lives chiefly off short-chain and medium-chain fatty acids. EtOH as a very short-chain fatty acid interferes with the mechanism of production of energy in heart mitochondria. I read that in the NEJM about fifteen years ago.

It would seem likely to me that it's from interference with the use of fatty acids as food rather than from any direct neuron-like effect.

KP
09-05-2006, 09:14 AM
I haven't followed this subject in a decade, but isn't EtOH also believed to operate by mass-effect random disruption of the lipid bilayer in susceptible cell types? I realize that this seems a crude mechanism, but it's to be expected: not too many substances (much less drugs) are routinely ingested in such large quantities.

(While there is no real "standard" dose, I've seen .both 75 g/kg and a single US beer [~10 grams EtOH] cited as "standard" in recent studies. Three beers has as much alcohol as the acetominophen in 100 tablets. At that dose range, raw physico-chemical effects can be quite significant, compared to the more specific biochemical effects. Of course, for a lot of people, 3 beers (or equivalent) is a daily thing, and much higher doses are not uncommon]

KP
09-05-2006, 09:23 AM
er - make that "not may single chemicals" (not substances) "are routinely ingested in such large doses" (not quantities).

You might consume 10-30g of sucrose in a sitting, or perhaps some proteins or starches in a given meal, but the list tails off rapidly. Take table salt, ubiquitous in most of our diets: while many people ignore the federal RDA of under 2400mg/day of sodium, You'd have to eat 10 lbs of potato chips to get 30g.

DrDeth
09-05-2006, 10:04 AM
Well, this is only my own personal opinion, it's because hydrocodone is crap as a pain reliver- most of the pain relief work is being done by the acetaminophen. The Hydrocodone just (IMHO) makes you drowsy so you can sleep off the pain and injury.


gabriela you may indeed see more deaths from hydrocodone, but liver failure or hepatic injury, or systemic inflammatory response syndrome (SIRS) from overdoses of acetaminophen is fairly common and very dangerous, even if you survive.


http://content.nejm.org/cgi/content/abstract/337/16/1112

http://www.aemj.org/cgi/content/abstract/6/11/1115

http://www3.interscience.wiley.com/cgi-bin/abstract/106596965/ABSTRACT?CRETRY=1&SRETRY=0

http://www3.interscience.wiley.com/cgi-bin/abstract/106592869/ABSTRACT
Abstract
Little information is available on acute liver failure (ALF) in the United States. We gathered demographic data retrospectively for a 2-year period from July 1994 to June 1996 on all cases of ALF from 13 hospitals (12 liver transplant centers). Data on the patients included age, hepatic coma grade on admission, presumed cause, transplantation, and outcome. Among 295 patients, 74 (25%) survived spontaneously, 121 (41%) underwent transplantation, and 99 (34%) died without undergoing transplantation. Ninety-two of 121 patients (76%) survived 1 year after transplantation. Acetaminophen overdose was the most frequent cause (60 patients; 20%), followed by cryptogenic/non A non B non C (NANBNC; 15%), idiosyncratic drug reactions (12%), hepatitis B (10%), and hepatitis A (7%). Spontaneous survival rates were highest for patients with acetaminophen overdose (57%) and hepatitis A (40%) and lowest for those with Wilson's disease (no survivors of 18 patients). The transplantation rate was highest for Wilson's disease (17 of 18 patients; 94%) and lowest for autoimmune hepatitis (29%) and acetaminophen overdose (12%). Age did not differ between survivors and nonsurvivors, perhaps reflecting a selection bias for patients transferred to liver transplant centers. Coma grade on admission was not a significant determinant of outcome, but showed a trend toward affecting both survival and transplantation rate. These findings on retrospectively studied patients from the United States differ from those previously gathered in the United Kingdom and France, highlighting the need for further study of trends in each country.

It seems here that ibruprofen & hydrocodone is better anyway.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10945514&dopt=Citation
CONCLUSIONS: The results of this study suggest that 2-tablet doses of combination hydrocodone 7.5 mg and ibuprofen 200 mg may be more effective than either 1-tablet doses of this combination or 2-tablet doses of combination codeine 30 mg and acetaminophen 300 mg. Moreover, 1-tablet doses of combination hydrocodone 7.5 mg and ibuprofen 200 mg may be as effective as 2-tablet doses of combination codeine 30 mg and acetaminophen 300 mg.

Harmonious Discord
09-05-2006, 04:56 PM
Hydrocodone comes in tablets with less Tylenol and more codine. I used those instead of the more common ones, to lesson the chance of liver damage. They were also strickly a quick fix, when the other pain medicines needed a short term help. They would likely be in a different classification of drugs if they were made differently. Once the classification type changed it would be hard for a person to get something short term for a tooth problem or back strain. Most people that need short term fixes for pain would not have a medicine that a doctor would prescribe them without hydrocodine available.

Harmonious Discord
09-05-2006, 05:04 PM
I also agree that hydrocodone is a inefectual pain reliever in many cases.

diggleblop
09-05-2006, 07:06 PM
Hydrocodone comes in tablets with less Tylenol and more codine. I used those instead of the more common ones, to lesson the chance of liver damage. They were also strickly a quick fix, when the other pain medicines needed a short term help. They would likely be in a different classification of drugs if they were made differently. Once the classification type changed it would be hard for a person to get something short term for a tooth problem or back strain. Most people that need short term fixes for pain would not have a medicine that a doctor would prescribe them without hydrocodine available.


I use Norco 10, which is (as you probably know) Hydrocodone 10mg and 325 Acetominophen. Works, but sometimes I catch myself taking 8-10 a day, meaning, 2 at a time, 4-5 times a day, but my days are 16 hour days. So, I'm still taking 2500-3000 mg of tylenol daily.

I know they say don't go over 4000mg in 24 hour period though. But honestly, hydrocodone is the ONLY thing I can function on without falling asleep throughout the day.

I don't want to be borderline abusing the medication, but I just don't have anything else to take. I have lumbar disc tramma and I am also obese, so maybe being overweight actually helps me with my tylenol intake.

DrDeth
09-05-2006, 08:57 PM
I use Norco 10, which is (as you probably know) Hydrocodone 10mg and 325 Acetominophen. Works, but sometimes I catch myself taking 8-10 a day, meaning, 2 at a time, 4-5 times a day, but my days are 16 hour days. So, I'm still taking 2500-3000 mg of tylenol daily.

I know they say don't go over 4000mg in 24 hour period though. But honestly, hydrocodone is the ONLY thing I can function on without falling asleep throughout the day.

I don't want to be borderline abusing the medication, but I just don't have anything else to take. I have lumbar disc tramma and I am also obese, so maybe being overweight actually helps me with my tylenol intake.

Please talk to your MD about getting the ibruprofen with Hydrocodone formulae. That, varied with your rather large amount of Acetominophen +Hydrocodone, could cut your Acetominophen intake in half, or at least by a third. I am assuming your MD is watching your Hydrocodone intake carefully. But the dangers of Acetominophen are fairly newish and not fully known.

Watch your alcohol intake too, it can make Acetominophen twice as hard on the liver. Have your liver checked next visit, too.

Harmonious Discord
09-05-2006, 09:01 PM
Different brands made under different processes cam make a difference in how the medications woek. One may give you more of the diesired benefits thans another made by a different process.

The type your taking is the stronger one with less Tylenol. The effective duration is about four hours and you wait for it to take effect and you wait while it wears off before you take the next dose. It's not the best long term pain management plan. Oxycontine is a longer term medicinie that can last upto twelve hours. I was on a pain management routine that I took one dose every eight hours. You get better management with the least least medicine. I switched to Morphine Sulfate, which is close to Oxycontine, but was more effective for me. It was also cheaper, but at the time I needed the pain control more than the difference in price. It was the least tiring of the pain medicines. The also had been on a muscle relaxer to stop spasms and other problems. My hand, arm or leg would just jerk and send things flying accross the room into a wall. I woke up a few time suspended over the bed and falling back down. I would contract my leg and arm muscles and arch my back while sleeping. I broke the bed at least three times, when I crashed back down onto it. The combination of the small doses of the correct medicines did a lot better result than a large dose of one thing. I can tell you one goood thing about my illness. I have a higher threshold before I start doing vocal tics.

Harmonious Discord
09-05-2006, 09:07 PM
I had blood tests for liver problems every 3 months, if nothing new happened.

Being over weight increases the strain on the liver. It's filtering out the medicine that is a problem. The problem has nothing to do with concentrations through out the rest of your body.