II. Indications

  1. Moderate pain not relieved with NSAIDs or Acetaminophen

III. Classification

  1. Will be reclassified as FDA Schedule II Opioid in United States as of Spring 2013

IV. 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)

V. Dosing: Acetaminophen with Hydrocodone (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)

VI. 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

VII. Preparations

  1. Reformulated as of January 2014 in United States to lower Acetaminophen doses per pill (maximum 300 mg)

VIII. References

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

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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