II. Indications

  1. Moderate pain not relieved with NSAIDs or Acetaminophen

III. Classification

  1. Hydrocodone was reclassified as FDA Schedule II Opioid in United States as of Spring 2013

IV. Preparations

  1. Hydrocodone (5, 7.5 or 10 mg) with Acetaminophen 300 mg (Vicodin)
    1. Vicodin reformulated as of January 2014 in United States to lower Acetaminophen doses per pill (maximum 300 mg)
  2. Hydrocodone (7.5 mg/15 ml) with Acetaminophen (500 mg/15 ml) Suspension (Lortab Elixir)
  3. Hydrocodone Alone (Zohydro ER)
  4. Benhydrocodone (4.08 mg, 6.12 mg or 8.16 mg) with Acetaminophen 325 mg (Apadaz)
    1. Benhydrocodone 4.08 mg, 6.12 mg and 8.16 mg is roughly equivalent to Hydrocodone 5, 7.5 and 10 mg
    2. Benhydrocodone is a prodrug enzymatically converted to Hydrocodone in gastrointestinal tract
      1. Submitted and declined by FDA as an Opioid Abuse Deterrent Agent
    3. Offers no benefit over other Opioids including Hydrocodone and not recommended
    4. (2020) Presc Lett 27(1):4

V. Dosing: Hydrocodone with Acetaminophen (Vicodin Tablets)

  1. Hydrocodone 5 with Acetaminophen 300 (Vicodin 5/300)
    1. Vicodin 5/300 take 1-2 every 4-6 hours as needed for moderate pain (up to 8 tabs/day)
  2. Hydrocodone 7.5 with Acetaminophen 300 (Vicodin ES 7.5/300)
    1. Vicodin ES 7.5/300 take 1-2 every 4-6 hours as needed for moderate pain (up to 5 tabs/day)
  3. Hydrocodone 10 with Acetaminophen 300 (Vicodin HP 10/300)
    1. Vicodin HP 10/300 take 1 every 4-6 hours as needed for moderate pain (up to 6 tabs/day)

VI. Dosing: Hydrocodone with Acetaminophen Suspension (Lortab Elixir)

  1. Components per 15 ml
    1. Hydrocodone 7.5 mg
    2. Acetaminophen 500 mg
  2. Dosing
    1. Age 2-3 years (12-15 kg or 27-34 lbs)
      1. Dose: 3.75 ml (0.75 tsp)
    2. Age 4-6 years (16-22 kg or 35-50 lbs)
      1. Dose: 5 ml (1 tsp)
    3. Age 7-9 years (23-31 kg or 51-69 lbs)
      1. Dose: 7.5 ml (1.5 tsp)
    4. Age 10-13 years (35-45 kg or 70-100 lbs)
      1. Dose: 10 ml (2.0 tsp)

VII. Dosing: Hydrocodone alone

  1. Hydrocodone extended release (Zohydro ER)
    1. CII agent due out in United States in March 2014
    2. Available in 10-50 mg capsules and taken twice daily for severe Chronic Pain
    3. Increased abuse risk at a high financial cost without unique benefit
      1. Not in tamper resistant packaging and risk of crushing of immediate high (and further potentiated by Alcohol)
      2. Twice the cost of Oxycontin and 7 times the cost of generic Morphine ER
      3. FDA approved despite FDA expert panel voting to not approve (11 to 2 decision)
      4. In Zohydro Overdose, consider Activated Charcoal and Whole Bowel Irrigation, in addition to Naloxone infusion
        1. See Opioid Overdose
    4. References
      1. Swadron and Nordt in Herbert (2014) EM:Rap 14(10):3
      2. (2014) Presc Lett 21(4): 21

VIII. References

  1. (2013) Presc Lett 20(12): 67

Images: Related links to external sites (from Bing)

Related Studies

Cost: Medications

hydrocodone (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
HYDROCODONE-ACETAMINOPHEN 10-300 MG TABLET Generic $1.41 each
HYDROCODONE-ACETAMINOPHEN 10-325 MG TABLET Generic $0.17 each
HYDROCODONE-ACETAMINOPHEN 10-325 TABLET Generic $0.17 each
HYDROCODONE-ACETAMINOPHEN 2.5-325 MG TABLET Generic $0.55 each
HYDROCODONE-ACETAMINOPHEN 5-300 MG TABLET Generic $0.96 each
HYDROCODONE-ACETAMINOPHEN 5-325 MG TABLET Generic $0.12 each
HYDROCODONE-ACETAMINOPHEN 5-325 TABLET Generic $0.12 each
HYDROCODONE-ACETAMINOPHEN 7.5 MG-325 MG/15 ML SOLUTION Generic $0.15 per ml
HYDROCODONE-ACETAMINOPHEN 7.5-300 MG TABLET Generic $1.11 each
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG TABLET Generic $0.18 each
HYDROCODONE-ACETAMINOPHEN 7.5-325 TAB Generic $0.18 each
HYDROCODONE-CHLORPHEN ER SUSP Generic $0.43 per ml
HYDROCODONE-HOMATROPINE 5-1.5 MG TABLET Generic $0.75 each
HYDROCODONE-HOMATROPINE SYRUP Generic $0.10 per ml
HYDROCODONE-IBUPROFEN 10-200 Generic $2.91 each
HYDROCODONE-IBUPROFEN 5-200 MG Generic $2.01 each
HYDROCODONE-IBUPROFEN 7.5-200 Generic $0.31 each
vicodin (on 3/22/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
VICODIN 5-300 MG TABLET Generic $0.96 each
VICODIN ES 7.5-300 MG TABLET Generic $1.11 each
lortab (on 12/21/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
LORTAB 10 MG-300 MG/15 ML ELXR $0.37 per ml
zohydro (on 3/22/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
ZOHYDRO ER 10 MG CAPSULE $7.61 each
ZOHYDRO ER 15 MG CAPSULE $8.19 each
ZOHYDRO ER 20 MG CAPSULE $8.38 each
ZOHYDRO ER 30 MG CAPSULE $8.62 each
ZOHYDRO ER 40 MG CAPSULE $8.93 each
ZOHYDRO ER 50 MG CAPSULE $9.30 each

Ontology: Hydrocodone (C0020264)

Definition (CHV) a kind of pain relieving drug
Definition (CHV) a kind of pain relieving drug
Definition (NCI) A semisynthetic hydrogenated codeine derivative and opioid agonist with analgesic and antitussive effects. Hydrocodone primarily binds to and activates the mu-opioid receptor in the central nervous system (CNS). This leads to analgesia, euphoria, respiratory depression, miosis, decreased gastrointestinal motility, cough suppression and physical dependence. Hydrocodone is converted to hydromorphone by the cytochrome P450 enzyme CYP2D6.
Definition (MSH) Narcotic analgesic related to CODEINE, but more potent and more addicting by weight. It is used also as cough suppressant.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D006853
SnomedCT 20320002, 372671002
LNC LP16161-9, MTHU003226
English Dihydrocodeinone, Hydrocodon, Hydrocodone, Morphinan-6-one, 4,5-epoxy-3-methoxy-17-methyl-, (5alpha)-, Hydrocodone [Chemical/Ingredient], HYDROCODONE, dihydrocodeinone, HYDROcodone, hydrocodone, Hydrocodone (product), Hydrocodone (substance)
Swedish Hydrokodon
Czech hydrokodon
Finnish Hydrokodoni
Russian DIKODID, GIDROKODON, GIDROKODONA FOSFAT, ГИДРОКОДОН, ГИДРОКОДОНА ФОСФАТ, ДИКОДИД
Japanese ヒドロコドン, ヒドロコン, 酒石酸水素ジヒドロコデイノン, ジヒドロコデイノン
Italian Diidrocodeinone, Idrocodone
Polish Dicodid, Hydrokodon, Hycodan
Portuguese Di-Hidrocodeinona, Hidrocodona
Spanish dihidrocodeinona, hidrocodona (producto), hidrocodona (sustancia), hidrocodona, Dihidrocodeinona, Hidrocodona
French Hydrocodone
German Dihydrocodeinon, Hydrocodon

Ontology: Vicodin (C0483514)

Definition (CHV) a pain killer drug
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C083640
English Vicodin, Abbott brand of acetaminophen, hydrocodone tartrate drug combination

Ontology: Hydrocodone Bitartrate (C0546868)

Definition (NCI) The bitartrate salt form of hydrocodone, a semisynthetic hydrogenated codeine derivative and opioid agonist with analgesic and antitussive effects. Hydrocodone primarily binds to and activates the mu-opioid receptor in the central nervous system (CNS). This leads to analgesia, euphoria, respiratory depression, miosis, decreased gastrointestinal motility, cough suppression and physical dependence. Hydrocodone is converted to hydromorphone by the cytochrome P450 enzyme CYP2D6.
Definition (NCI_NCI-GLOSS) A drug used to treat moderate to severe pain and cough. Hydrocodone bitartrate is made from codeine and binds to opioid receptors in the central nervous system. It is a type of analgesic agent, a type of antitussive, and a type of opiate.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D006853
SnomedCT 3874004, 412406001
English Hydrocodeinonebitartrate, hydrocodone bitartrate, HYDROCODONE BITARTRATE, hydrocodone bitartrate (medication), HYDROCODONE BITARTRATe, dihydrocodeinone bitartrate, HYDROcodone Bitartrate, Hydrocodone Tartrate (1:1), Hydrate (2:5), Hydrocodone Bitartrate [Chemical/Ingredient], Dihydrocodeinone bitartrate, Hydrocodone bitartrate, Hydrocodone bitartrate (substance), Hydrocodone bitartrate (product), Hydrocodone Bitartrate
German Hydrocodeinonbitartrat
Spanish bitartrato de dihidrocodeinona, bitartrato de hidrocodona (sustancia), bitartrato de hidrocodona, bitartrato de hidrocodona (producto), Hidrocodeinonebitartrato
Portuguese Hidrocodeinonabitartarato