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Hydrocodone, also known as dihydrocodeinone, is an opioid used to treat pain and as a cough suppressant.[9] It is taken by mouth.[9] Typically it is dispensed as the combination acetaminophen/hydrocodone or ibuprofen/hydrocodone for pain severe enough to require an opioid[10][11] and in combination with homatropine methylbromide to relieve cough.[9] It is also available by itself in a long-acting form under the brand name Zohydro ER, among others, to treat severe pain of a prolonged duration.[9][12] Hydrocodone is a controlled drug, in the United States a Schedule II Controlled Substance.

Common side effects include dizziness, sleepiness, nausea, and constipation.[9] Serious side effects may include low blood pressure, seizures, QT prolongation, respiratory depression, and serotonin syndrome.[9] Rapidly decreasing the dose may result in opioid withdrawal.[9] Use during pregnancy or breastfeeding is generally not recommended.[13] Hydrocodone is believed to work by activating opioid receptors, mainly in the brain and spinal cord.[9] Hydrocodone 10 mg is equivalent to about 10 mg of morphine by mouth.[14]

Hydrocodone was patented in 1923, while the long-acting formulation was approved for medical use in the United States in 2013.[9][15] It is most commonly prescribed in the United States, which consumed 99% of the worldwide supply as of 2010.[16] In 2018, it was the 402nd most commonly prescribed medication in the United States, with more than 400 thousand prescriptions.[17] Hydrocodone is a semisynthetic opioid, converted from codeine[18][19] or less often from thebaine.[20] Production using genetically engineered yeasts has been developed but is not used commercially.[21][22][23]

Medical uses

Hydrocodone is used to treat moderate to severe pain. In liquid formulations, it is used to treat cough.[9] In one study comparing the potency of hydrocodone to that of oxycodone, it was found that it took 50% more hydrocodone to achieve the same degree of miosis (pupillary contraction).[24] The investigators interpreted this to mean that oxycodone is about 50% more potent than hydrocodone.

However, in a study of emergency department patients with fractures, it was found that an equal amount of either drug provided about the same degree of pain relief, indicating that there is little practical difference between them when used for that purpose.[25] Some references state that the analgesic action of hydrocodone begins in 20–30 minutes and lasts about 4–8 hours.[26] The manufacturer's information says onset of action is about 10–30 minutes and duration is about 4–6 hours.[27] Recommended dosing interval is 4–6 hours.

Available forms

See also: Hydrocodone/paracetamol, Hydrocodone/ibuprofen, and Hydrocodone/aspirin

Hydrocodone is available in a variety of formulations for oral administration:[28][29][30]

The original oral form of hydrocodone alone, Dicodid, as immediate-release 5- and 10-mg tablets is available for prescription in Continental Europe per national drug control and prescription laws and Title 76 of the Schengen Treaty, but dihydrocodeine has been more widely used for the same indications since the beginning in the early 1920s, with hydrocodone being regulated the same way as morphine in the German Betäubungsmittelgesetz, the similarly named law in Switzerland and the Austrian Suchtmittelgesetz, whereas dihydrocodeine is regulated like codeine. For a number of decades, the liquid hydrocodone products available have been cough medicines.

Hydrocodone plus homatropine (Hycodan) in the form of small tablets for coughing and especially neuropathic moderate pain (the homatropine, an anticholinergic, is useful in both of those cases and is a deterrent to intentional overdose) was more widely used than Dicodid and was labelled as a cough medicine in the United States whilst Vicodin and similar drugs were the choices for analgesia.

Extended-release hydrocodone in a time-release syrup also containing chlorphenamine/chlorpheniramine is a cough medicine called Tussionex in North America. In Europe, similar time-release syrups containing codeine (numerous), dihydrocodeine (Paracodin Retard Hustensaft), nicocodeine (Tusscodin), thebacon, acetyldihydrocodeine, dionine, and nicodicodeine are used instead.

Immediate-release hydrocodone with paracetamol (acetaminophen) (Vicodin, Lortab, Lorcet, Maxidone, Norco, Zydone)

Immediate-release hydrocodone with ibuprofen (Vicoprofen, Ibudone, Click for more info Reprexain)

Immediate-release hydrocodone with aspirin (Alor 5/500, Azdone, Damason-P, Lortab ASA, Panasal 5/500)

Controlled-release hydrocodone (Hysingla ER by Purdue Pharma, Zohydro ER)[31]

Hydrocodone is not available in parenteral or any other non-oral forms.[4][2]