Heh. I was trying to be discrete!
You were trying to be separate and distinct?
Discreet.
It seems to run counter to one of the basic principles of the scheduling system, which has usually scheduled multiple-ingredient opioid preparations less severely than single ingredient ones. And how can they put the lowest-strength acetominophen/hydrocodone in the same schedule as dilaudid, laudanum, and Fentanyl? Of course, I’m not expecting logic here.
With regard to Tylenol PM, though, for some reason it does seem to knock me out more than a Benadryl alone would. Although, come to think of it, it’s been quite a while since I’ve taken it, and with the meds I’m on now it might be that I wouldn’t experience the same effect.
Speaking of lacking logic, have you heard about hydro? It’s a time release single-entity powerful opioid. People within the FDA are shocked by its approval, as it is just begging to be abused. I heard about it last year, before news hit the internet, from an excited opioid abuser who had already lined up a purchase.
So it sounds like Oxycontin 2.0. Timed-release opioids do a lot of good for a lot of people I’m sure, and those people should be allowed to have them.
It’s my opinion that better tracking of purchases would go a long way towards discouraging doctor/pharmacist shopping. You have to swipe your driver’s license (in California) when you buy Sudafed or Primatene tablets (ephedrine/guafenesin); yet you can buy those without a prescription. By contrast, when filling actual controlled substance prescriptions, there is no such requirement. It’s not hard to see how a “patient” could go to several independent pharmacies in a couple of days, buying a month’s supply of an opioid each time.
I can’t speak for all states/pharmacies, but here in Ohio, since Vicodin 5/500 is no longer available, if a prescriber writes for “Vicodin”, we generally assume 5/300 now, and if they write “Vicodin ES”, it would be the 7.5/300, and “Vicodin HP” would be 10/300. If they actually specify the old strength, ie “Vicodin 5/500”, though, we have to call. Why the difference? The former would fall under a professional judgement call of the pharmacist as to what the prescriber meant, while the latter tells us explicitly what the prescriber wanted (even if it no longer exists). Stupid distinction, perhaps, but unfortunately, unless the law changes, it’s what we’re stuck with.
Correct, if you specify the wrong strength, at least in Ohio, we have to call, even if we know beyond a shadow of a doubt that you are going to change it to the available product. The rationale is that in theory, even though I’m 99% certain you are ok with a switch to 5/300, there exists that small chance that you actually wanted 5/325 and by substituting without calling you, I’m therefore extending my practice illegally into your scope of practice (essentially, rewriting your prescription without your authorization).
Yes, all hydrocodone products going schedule II is going to be a nightmare. I expect to get yelled at quite frequently by both patients and prescribers when/if that goes into effect, and frankly, I expect pharmacy robberies to go up, as well. So thanks in advance for that, HHS, FDA, and DEA Fuckwits!
coughLiver failure.cough
Technically, you’re ignoring Percocet (oxycodone/acetaminophen) in your argument, which is schedule II, just like Roxicodone (oxycodone IR) and Oxycontin (oxycodone ER). If anything, since hydrocodone by itself has always been schedule II (just not available in the states, until Zohydro), they are bringing hydrocodone/acetaminophen products in line with oxycodone/acetaminophen products. Further, when talking about pain meds, we compare one to another in Morphine Equivalence. Hydrocodone is 1:1 equivalent with Morphine, which is also schedule II.
Said abuser best dampen his enthusiasm, since the mutterings from a great many pharmacists I’ve interacted with, both within the company I work for and those who work for other companies, all agree that a great many pharmacies will NOT be carrying Zohydro precisely because it sets us up for exactly that scenario, as well as robberies similar to when Oxycontin wasn’t tamper resistant.
Most states DO track opiates, as well as other controlled medications, through the use of prescription monitoring programs (in Ohio, we call ours OARRS, and I feel something akin to grief whenever it goes down, so much do I love it). In addition, the company I work for has a policy requiring positive identification for all controlled substance pickups (driver’s license, state-issued ID, passport, military photo ID, or known individual), and we usually ID unknown individuals at drop off AND pickup (if the same employee doesn’t deal with them at both points), to be extra cautious. And, of course, because OARRS doesn’t update instantly, insurance companies, via Drug Utilization Review messages, often can tell us if an individual has gotten a narcotic somewhere else recently. Trust me, it’s being tracked, and yes, it does discourage (but not eliminate) doctor shopping if used (of course, sadly, many of the area docs apparently don’t do so regularly, in my experience).
I don’t understand this.
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Why does the FDA care about whether a drug* could* be abused? Why is the hypothetical future misuse of a product within their remit?
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Since someone out there in the world will attempt to abuse any substance, even glue or paint or canned air, I suppose it is wrong to say that it is in any way hypothetical. If it can be ingested, it WILL be abused by someone. So where do they draw the line between a “good” drug and a “bad” one? (And please don’t let this devolve into an argument over coke or pot or heroin… I’m making a good-faith effort to understand medicine here.)
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This speaks to a larger trend in our society of asking the government and the judicial system to legislate products beyond even the potential, hypothetical misuse of that product. This has implications for everything from Sudafed to cars to guns to whatever other product you can name. How is it the manufacturer’s responsibility, or the government’s responsibility, to “protect” consumers from deliberate and willfull misuse of a product, instead of just calling it chlorine in the gene pool and letting nature take its course?
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They (ultimately) don’t, which is why Zohydro was approved. Many professional organizations, as well as individual practitioners, are aghast at it’s approval, including myself, because we remember what happened when Oxycontin wasn’t tamper resistant, and I know many pharmacists who are stating that they are likely going to refuse to carry it.
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We have already seen the results of something like this with Oxycontin. Yes, determined individuals will abuse anything (and seriously, your examples are the tip of the iceberg to what people will abuse, both prescription an non-prescription. More sordid areas of the internet are both informative and hair-raising in what people will misuse or abuse to get high), but that doesn’t mean we should make it as easy as crushing the pill/capsular-contents and taking the resultant powder with a beer, which is the case with Zohydro.
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The difference here is that individuals who misuse or abuse this product are not just a danger to themselves, but to society at large. Do you seriously want to be on the road with someone who just chased 40mg of hydrocodone with a beer and/or a joint? Do you not think that the availability of a non-tamper-resistant form of a highly misused/abused narcotic in high doses will lead to increased robberies (and by proxy, increased injuries and deaths to innocent individuals) and that, hey, maybe the government (Federal and State) should do something to limit this/prevent this from happening?
One poster mentioned APAP making them tired, so it could be that. Also, if you’re in pain, getting out of pain will make it easier to fall asleep. So, if you have a headache/backache etc, Tylenol PM will be better then the PM alone.
Vicodin…High Power?
That sounds way better then whatever HP probably stands for.
Hard Poop.
I have a friend who lost her 23 year old son to a mix of “it should have been safe” medications for a cold, some alcohol, and his prescription anti-anxiety meds. Drug interactions can be BAD.
Does ibuprufn interact with hydrocodone the same way acetominephen does? I take Vicodin when my back goes out, but I prefer ibuprufn for ordinary headaches and routine pains like that. I was thinking of asking if there is such a thing as a combination of hydrocodone and iburprufn the next time my back starts acting up.
Usually I get Tylenol-3 for during the day, and Vicodin for the night. I am hoping for better pain relief if I get the equivalent of Ibuprufn-3 if such a thing exists, and the Vicodin-except-with-ibuprufn for night.
Unless asking for a specific drug will get me labelled as a drug seeker, which I have heard sometimes happens. Although I doubt it - my back only gets bad enough to see the doctor every couple of years.
Regards,
Shodan
Yes, it’s sold under the brand names Ibudone, Reprexain and Vicoprofen. And yet I hardly ever see it prescribed. I think I’ve seen it once in 2.5 years of home nursing disabled and elderly patients with lots of pain meds. I have no idea why it’s not more widely prescribed.
WhyNot, I was just now unsuccessfully looking for information of names that a hydrocodone/ibuprofen compound might be sold under, so thanks for that.
Do you know if hydrocodone is ever compounded with naproxen (Aleve)? And if so, under what name(s)?
That one I have not seen as a single pill. Got lots of people on naproxen three times a day with Norco or Vicodin for breakthrough pain as needed, though. So they can be mixed, but I don’t know of anyone making the hydrocodone naproxen combo. Holy cats, that would be awesome. (Naproxen is the otc one that works best for me, personally. Everyone’s system is a little different, so while they’re roughly equivalent in studies of lots of people, individuals often find better relief with a particular one. This is where group averages mask superior results on an individual level.)
Based on what we were taught in Pharm school, HP = High Potency, unless I’m badly misremembering.
That is awful. I’m sorry for your friend’s loss. 
As WhyNot has already said, there is a hydrocodone/ibuprofen combination (7.5mg hydrocodone/200mg ibuprofen), though there isn’t one with codeine. If you have a good relationship with your doctor, I would hope asking honestly wouldn’t get you labelled as a drug seeker, but sadly way too many prescribers and pharmacists still have inaccurate views on addiction/drug seeking, at least in my experience.
I’d suspect it’s a combination of reasons. One, many elderly are on medications for hypertension, and while hydrocodone (and the other opioids) can in the short term cause hypotension, ibuprofen and other NSAIDs can do the opposite. This is particularly important if they happen to be on ACE inhibitors (the combination can rarely lead to bilateral renal arterial stenosis) or have poor kidney function, as most of the opioids are eliminated renally to one degree or another. Two, ibuprofen and hydrocodone each can cause nausea and lead to vomiting. Putting the two together adds to the probability of one or both occurring, which is very often why, when asked, we counsel our patients to take with food (slightly delays the time to max concentration, yes, but also makes it way more tolerable). Three, many elderly patients are already on another NSAID, so prescribing Vicodin or Norco may make more sense than prescribing Vicoprofen, although now we’re starting to trend into liver damage territory, since all three agents can have a negative effect in a compromised hepatic environment.
Nope, no combination with naproxen that I’m aware of. My experience has been that ibuprofen can be rough on the stomach, but naproxen can be outright wicked. Combine it with hydrocodone or oxycodone and you’re looking at potentially nasty GI intolerances (and, like you, naproxen is the NSAID that works best for me).
Is hydrocodone available by itself? It seems like it should be easy for a patient to take hydrocodone along with ibuprofen, naproxen or whatever other pain reliever he or she finds most effective. Why must the two drugs be combined in a single pill?
Not yet, but soonish, in the form of Zohydro, an extended release capsule. Of course, the problem with Zohydro, as already mentioned, is that there aren’t any mechanisms of tamper resistance involved. Someone can easily take the capsules, open them up, crush the contents, then take them for instant release high dose hydrocodone. It’s a recipe for a massive upswing in overdose.