Scientifically known as dihydrocodeinone, hydrocodone is a semi-synthetic opioid which is synthesized from codeine. Hydrocodone falls into a group of medications known as narcotic pain relievers. Depending on formulations, it is categorized as either a Schedule II or Schedule III drug and is prescribed only in combination with other ingredients.
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Hydrocodone comes in different forms like, capsule, syrup, tablet, solutions, extended-release capsule and suspension (liquid) and is administered orally.
The United States ranks numero uno when it comes to hydrocodone prescription. In fact, in 2014, about 119.2 million hydrocodone prescriptions were handed out to Americans, albeit down from around 129.5 million prescriptions. The International Narcotics Control Board reports 99% of the worldwide supply in 2007 was consumed in the United States. Some of the common imprints of Hydrocodone include V4212, M366, M365, M367 and V4212.
An opioid pain medication, hydrocodone is not to be used as an as-needed basis pain medication, and is typically administered for treating moderate-to-severe pain. In fact, people who use hydrocodone for long periods, frequently, and/or in larger dose may start depicting Hydrocodone addiction symptoms.
Hydrocodone is available in various formulations:
- Immediate-release in combination with paracetamol (acetaminophen) (Vicodin, Lorcet, Lortab, Norco, Maxidone, Zydone)
- Immediate-release in combination with ibuprofen (Ibudone, Vicoprofen, Reprexain) Immediate-release in combination with aspirin (Azdone, Alor 5/500, Damason-P, Panasal 5/500, Lortab ASA)
- Controlled-release hydrocodone (Hysingla ER, Zohydro ER)
Times Gone By
German scientists Carl Mannich and Helene Lowenheim were the first ones to synthesize hydrocodone in 1920. Hydrocodone was approved for sale in the US by Food and Drug Administration on March 23, 1943. Hydrocodone made its debut in Canada under the Hycodan brand name after attaining regulatory approvals from Health Canada.
In 1924, Knoll Pharmaceuticals became the first company to market Hydrocodone in Germany under the brand name Dicodid. Dicodid started appearing in the US without any monograph in 1978 in Physicians’ Desk reference, even though it had been marketed under one form or the other in North America in the 1920’s and 1930’s. These were pure hydrocodone tablets and were available in 5 and 10 mg dosing.
Apart from North America, hydrocodone has not been very popular in Europe and even though Germany was ranked second in terms of consumption of hydrocodone, the manufacturing of the drug has been completely stopped in Germany. Of the total hydrocodone produced globally, less than 1% hydrocodone is consumed globally, with United States consuming the balance 99%.
How Does Hydrocodone Work
Hydrocodone interacts as opiate agonist at specific receptors sites in the central nervous system and weakens signals for pain in brain and produces a feeling of elation, generally termed as euphoric effect.
Hydrocodone is prescribed for treating moderate-to-severe pain as well as a cough suppressant. Hydrocodone’s analgesic action starts 20-30 minutes after its ingestion and the effect typically lasts for 4-8 hours. For effective pain relief, the prescribed dosing interval is 4-6 hours approximately.
As a narcotic, hydrocodone relieves the pain by binding opioid receptors (u-Opioid receptor (MOR)) in central nervous system (CNS). While hydrocodone is more powerful than codeine, the potency is less when compared to morphine (about 1/10 potency) at binding the opioid receptors. Some studies have indicated that potency for analgesic properties reduces to as low as 60% in comparison to morphine.
Hydrocodone is typically sold in combination with acetaminophen, aspirin and ibuprofen. However, in 2013, The US FDA approved a single-ingredient type of hydrocodone. Sold under Zohydro ER brand name (Hysingla ER has been approved very recently), the pill is aimed for patients who require round-the-clock, daily, and long-term dose of hydrocodone.
People who abuse hydrocodone, generally crush and snort the contents. Sometimes, patients even inject the drug in its liquid form.
Realizing the dangers of sustained long-term abuse of hydrocodone, the US lawmakers in 2014 changed hydrocodone from Schedule III to more stringent Schedule II. Rescheduling hydrocodone restricted the patients to an initial 90-day supply, and every subsequent refill requires new prescription each time they need a refill. Also, prescriptions for the Schedule II drugs cannot be either faxed or phoned in by the physicians.
Effects and Side Effects of Hydrocodone
Legitimate users and abusers of hydrocodone are difficult to spot since a person having a legitimate prescription may use it outside the doctor’s recommendation. Taking more than the prescribed limit and beyond the prescribed timeframe, or other administration mode (i.e. injecting or snorting them) are all tell-tale signs of hydrocodone abuse.
Some of the immediate effects of using hydrocodone include feeling a sense of relaxation; decreased anxiety; feeling of euphoria; sense of calmness, happiness, and a carefree attitude. Though the person enjoys positive effects, the feeling is temporary and long term effects and side effects that follows makes the user confused, unhappy and uncomfortable even before they realize it.
Few common side effects of hydrocodone include back pain; drowsiness; dizziness; nausea; constipation; vomiting; constriction or dilation of pupils; stomach pain; feeling lightheaded; anxious; having mood swings; dry mouth and throat; urinary issues; itching; rashes; stuffy nose and sneezing frequently, and swelling in hands and feet.
Some lesser known side effects of abusing hydrocodone include bloating of arms, face, hands and feet; body aches; muscle spasms; cough; chills, depression; ear congestion; fear; nervousness; fever; loss of voice; headaches; rapid or unusual weight gain or loss; sneezing; runny nose; tingling in hands and feet, as well as tiredness.
Serious side effects that hydrocodone abusers suffers include allergic reactions (hives, swelling, itching etc.), chest tightness, irregular or slowed breathing, bowel obstruction, irregular heartbeats, urinary trouble as well as severe vomiting.
Some abusers also end up with having progressive bilateral hearing loss that is unresponsive to steroid treatment or therapy. The reaction is to ototoxicity of hydrocodone. While the jury is still out on this, many researchers believe overuse of paracetamol is the primary cause of this.
Besides these, one major side effect that hydrocodone abusers face, especially female abusers, is the birth of a new born with serious birth defects. Studies by the US Food and Drug Administration states that a baby born to a female who abused opioids frequently before the baby’s birth, would develop physical dependence to the drug. Moreover, infants born to mother who used high doses of opiates even prior to the baby’s birth, can exhibit respiratory depression.
Hydrocodone is not suitable for every individuals and many people suffer allergic reactions to hydrocodone. Some of the allergic reactions include breathing problems; swelling of lips, tongue, throat or face and hives.
Person having allergic reaction to hydrocodone would have confusion; shallow and weak breathing; pain while urinating, tremors; severe drowsiness; impotency; infertility; loss of interest in sex; nausea; vomiting; loss of appetite; dizziness and general weakness. In case you or your loved ones have evidence of any one of these symptoms then seeking medical attention is the best option.
Apart from the above-mentioned side effects, users of hydrocodone can also suffer from serotonin syndrome symptoms (typically occurring within several hours of ingesting a drug or increasing dosage of existing drug). These include behavioral; psychological or physiological issues; fever; hallucinations; profuse sweating; shivering; fast-paced heartbeats; muscle twitching and stiffness; coordination imbalance, nausea; diarrhea and vomiting.
One of the serious long-term side effect of hydrocodone use is addiction. Even when taken under prescribed dosages, one can get addicted to hydrocodone. Repeated use often leads to tolerance, causing the user to taking more to get the desired effect, which leads to addiction. Compulsive usage of drug tends to impact multiple aspects of life and creates numerous problems for those who are caught in its vicious cycle.
Physical problems like liver damage, acetaminophen toxicity, sensorineural hearing loss among others are some other long-term effects of using Hydrocodone over a long period.
Symptoms, Contraindication and Interactions
Hydrocodone users tend to develop physical and psychological dependence which ends up becoming a habit.
Typical overdose symptoms include blurred vision; blue lips and fingernails; chest discomfort and pain; cold clammy skin; confusion; change in consciousness; constriction or dilation of pupil; pink sputum in cough; decreased awareness; dizziness; light-headedness; fainting spells; profuse sweating; irregular heartbeats and breathing; pale skin; excessive sleepiness; drowsiness, and weak muscle tone.
Hydrocodone if taken with other substances such as opioids, anti-histamines, anti-psychotics, anti-anxiety agents or any other CNS depressants may exhibit an additive CNS depression. Hydrocodone may also interact with serotonergic medication.
Side Effects with Hydrocodone and Acetaminophen Combination
Common side effects of the hydrocodone and acetaminophen combination include are low blood pressure, constipation, fainting spells, feeling of throwing up, and malaise in general.
Some infrequent side effects of this combination include spasm of the larynx, abnormal liver function; abnormal nervous system function; change in pulse rate; decreased pulmonary function; giant hives; vocal cord swelling; acute nasal and sinus infection; blurred or double vision; false sense of well being or feeling of unhappiness; gastroesophageal reflux disease; kidney issues with decreased urinary output; quivering involuntarily; urethral spasms and urinary tract infections.
Users of hydrocodone and acetaminophen combination can also develop some very rare side effects like acute liver failure; acute pustule eruptions; adrenal gland problems, and decrease in blood platelets. Besides, a person using this drug combination can also have granulocytes (a type of white cells) deficiency; decreased neutrophils and white blood cells count; increased spinal fluid; inflamed skin due to allergy; skin rashes and discoloration; spasm of bile duct tract; sexual disinterest & erectile problems, and stomach and intestinal irritation.
Various emotional, physical, and mental symptoms occur when a person is weaned off of hydrocodone. These generally range from mild-to-severe symptoms, but most of them are unpleasant and painful at times. Detoxification process in a treatment center setting is highly recommended as they offer both inpatient and outpatient services, but inpatient setting is most suitable for dealing with opiate or opioid withdrawal symptoms.
The effects of withdrawal tends to vary in different individuals largely due to different dosages along with duration of the drug use and the mixing factor (i.e. if hydrocodone is taken along with any other substance). All these factors need to be considered before detox process for rehabilitating the abuser is actually begun.
Some of the common withdrawal symptoms include shivering, diarrhea, sleep difficulties, fever, anxiety, hallucinations, body aches, sweating, nausea, vomiting, irregular and fast heartbeats and depression.
Flushing out hydrocodone from the system of a long-term user can result in very unpleasant and flu-like symptoms, which can prompt the user to relapse. This is the main reason why inpatient treatment centers are safest and effective place to deal with these withdrawal symptoms.
The Bottom Line:
Hydrocodone can slow down or even stop breathing. Caution is to be taken while using this medicine, and the prescribed dosage limit and timeframe for using this drug should never be breached. One should handle extended-release pills very carefully and take care not to crush, break or even open the pill. Swallowing the whole tablet is the best way to avoid exposure to a potentially fatal dose.
Hydrocodone is addictive even in a regular dose. Ensure never to share this medicine with anyone and most importantly never to share it with a person who has drug abuse or addiction history. This medicine has to be kept out of reach of vulnerable population such as children and pregnant women.