Hydrocodone-Acetaminophen (Vicoden, Norco, Lortab, Maxidone, Xodol, Hycet®) – Opioid Agonist + COX-Inhibitor Combination

Overview

Combination hydrocodone/acetaminophen is an analgesic medication prescribed for the treatment of acute and chronic pain.  Hydrocodone activates pre- and post-synaptic μ-opioid receptors in the central nervous system (CNS) and mediates suppression of nociceptive signaling through both ascending and descending neuronal pain tracts.  Hydrocodone is metabolized to hydromorphone, a metabolite with strong agonist properties at the μ-opioid receptor.

Acetaminophen is a non-selective cyclooxygenase (COX) inhibitor that acts primarily in the central nervous system and in endothelial cells, mitigating pain sensation through incompletely understood mechanisms.  Unlike non-steroidal anti-inflammatory drugs (NSAIDS), which also inhibit arachidonate metabolism via inhibition of COX, acetaminophen does not appear to be active in platelets and lymphocytes and thus demonstrates minimal anti-inflammatory or anti-platelet activity.

Opioid combination medications are one of the most frequently prescribed medications in the United States, often given as post-procedural analgesic agents.  They carry a high risk of abuse, dependency, and lethal overdose.

In Plain English

Hydrocodone-acetaminophen medications combine two different painkillers in one pill to decrease pain sensations.  Hydrocodone is an opioid drug, affecting your nerves and brain through the same mechanism as morphine and heroin.  Acetaminophen works by blocking a key enzyme responsible for producing pain sensation and fever.

Clinical Considerations

hydrocodone_acetaminophen

Figure 1. Hydrocodone-Acetaminophen combination clinical considerations at a glance

 

Evidence Basis

 

Hydrocodone-Acetaminophen Combination In the News

 

Citations

  1. Wishart DS, Feunang YD, Guo AC, Lo EJ, Marcu A, Grant JR, Sajed T, Johnson D, Li C, Sayeeda Z, Assempour N, Iynkkaran I, Liu Y, Maciejewski A, Gale N, Wilson A, Chin L, Cummings R, Le D, Pon A, Knox C, Wilson M. DrugBank 5.0: a major update to the DrugBank database for 2018. Nucleic Acids Res. 2017 Nov 8. doi: 10.1093/nar/gkx1037
  2. Epocrates Rx Online [Internet database]. San Mateo (CA): Epocrates, Inc. 2003. Retrieved at mobile.epocrates.com. Web-based; continuous content updates. Accessed 2018 May 14.
  3. “Prescription Prices, Coupons & Pharmacy Information – GoodRx.” Prescription Prices, Coupons & Pharmacy Information – GoodRxhttp://www.goodrx.com
  4. “DailyMed.” U.S. National Library of Medicine, National Institutes of Health, dailymed.nlm.nih.gov/dailymed/.

 

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