acetaminophen/hydrocodone (Anexsia, Lorcet, Lortab, Vicodin, Norco)
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Introduction
DEA-controlled substance: class 3.
To be rescheduled to DEA class 2.
Indications
- pain
- combinations of acetaminophen & opiate no longer recommended due to risk of acetaminophen toxicity[3]
Contraindications
Caution: in patients with G6PD deficiency
Dosage
500 mg acetaminophen _ 2.5 mg hydrocodone (Lortab)
- 1-2 tabs PO every 4-6 hours
500 mg acetaminophen + 5 mg hydrocodone
- 1-2 tabs PO every 4-6 hours
500 mg acetaminophen + 7.5 mg hydrocodone (Lortab)
- 1-2 tabs PO every 4-6 hours
650 mg acetaminophen + 7.5 mg hydrocodone
- 1 tab PO every 4-6 hours
650 mg acetaminophen + 10 mg hydrocodone (Lorcet)
- 1 tab PO every 4-6 hours.
325 mg acetaminophen + 10 mg hydrocodone
- 1 tab PO every 4-6 hours. (Norco)
Dosage adjustment in renal failure
Table
| creatinine clearance | dosage |
|---|---|
| 10-50 (mL/min) | every 6 hours |
| < 10 (mL/min) | every 8 hours (metabolites may accumulate) |
Pharmacokinetics
elimination: liver > kidney
Adverse effects
- rash
- nausea/vomiting
- blood dyscrasias
- nephrotoxicity with chronic use
- hepatotoxicity
- drowsiness
- respiratory depression is dose & tolerance-related
- tolerance & dependence
- constipation
- acetaminophen toxicity
- drug adverse effects of opiates
- drug adverse effects of psychotropic agents
- drug adverse effects of sedatives
Drug interactions
- agents that increase acetaminophen hepatotoxicity
- carbamazepine, hydantoin, barbiturates, chronic alcohol use, rifampin
- acetaminophen can elevate INR in patients takin warfarin
- naloxone is a direct opiate antagonist
- drug interaction(s) of acetaminophen in combination with GLP1-agonist
- drug interaction(s) of acetaminophen in combination with phenylephrine
- drug interaction(s) of benzodiazepine with opiates
- drug interaction(s) of antidepressant with opiates
- drug interaction(s) of Z-drugs with opiates
- drug interaction(s) of alcoholic beverage with opiates
- drug interaction(s) of pregabalin with opiates
- drug interaction(s) of gabapentin with opiates
- drug interaction(s) of alcoholic beverage with acetaminophen
- drug interaction(s) of ethanol with acetaminophen
Mechanism of action
- see acetaminophen
- see hydrocodone
Notes
- counterfeit Norco containing fentanyl & promethazine, led to several hospitalizations in the San Francisco Bay Area in 2016[5]
More general terms
Components
- acetaminophen (Tylenol, Paracematol, Panadol, Tempra, Datril, APAP, non-Aspirin)
- hydrocodone; dihydrocodeinone (Zohydro ER, Hysingla ER)
References
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998. - not on National VA formulary
- ↑ 3.0 3.1 Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
- ↑ Department of Justice. Durg Enforcement Administration. 21 CFR Part 1308. [Docket No. DEA-389] Schedules of Controlled Substances: Rescheduling of Hydrocodone Combination Products from Schedule III to Schedule II. https://s3.amazonaws.com/public-inspection.federalregister.gov/2014-19922.pdf
- ↑ 5.0 5.1 Vo KT et al Counterfeit Norco Poisoning Outbreak - San Francisco Bay Area, California, March 25-April 5, 2016 MMWR. Early Release / April 26, 2016 / 65 http://www.cdc.gov/mmwr/volumes/65/wr/mm6516e1.htm