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Why is Hydrocodone only available mixed with Tylenol (e.g. Vicoden) or something else, such as Advil)?

Annie H asked:

Because of character limitations, I phrased my question as briefly as possible. My question is why the fairly common opioid analgesic, hydrocodone, is only available in forms that mix it with other, usually anti-inflammatory type drugs, such as acetaminophen (Tylenol) or ibuprofen (Advil)? Is there a medical purpose (which seems highly unlikely), a marketing purpose, or some other reason?

The most common form of the drug is Vicoden, which is a combination of hydrocodone and acetaminophen, in varying amounts. Because acetaminophen is proven to be extremely dangerous to ones liver, one must limit the amount of Vicoden (or Norco, which contains the least Tylenol with the most hydrocodone of any of the products on the market, as far as I know) that one takes. Ibuprofen isn’t dangerous for your liver, but can harm your stomach. This means that patients undergoing pain management therapy for chronic pain must often switch to stronger, higher “schedule” or “class” as rated by the FDA (hydrocodone is a schedule III controlled substance, whereas most of the drugs listed below are schedule II, which, though slightly confusing, is “higher” or “more controlled”), opioid drugs simply to avoid the serious health risks of these other, ironically over-the-counter, medications.

With all of the myriad versions of hydrocodone-based medications, why do none of the drug manufacturers sell plain hydrocodone, as they do with Schedule II drugs such as oxycodone, morphine, demerol, fentanyl, methadone, etc.? Why should someone who could find relief from hydrocodone at a higher dosage have to switch to a potentially more addictive medication with a higher potential for side-effects such as drowsiness, dizziness, and generally “feeling high”? I don’t wish this to become a forum about the addictive nature of these medications, as I am mostly concerned with the issues facing patients with legitimate chronic pain. However, while researching this question, I read many reports of how Vicoden abuse is on the rise. Since alcohol use and/or abuse is common among addicts, and alcohol greatly increases the risks of liver damage associated with acetaminophen (aka “Tylenol Toxicity”), it would seem an even greater moral imperative to stop combining hydrocodone with acetaminophen (this is a problem that has also been discussed in regards to over-the-counter cold remedies, etc.).

If there is some medical reason why hydrocodone must be mixed with an anti-inflammatory or fever reducer, why not leave it up to doctors to prescribe them together either in their current premixed form or by taking two pills together?

Thank you in advance to anyone with medical and/or pharmaceutical industry knowledge for your time and answers!

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Written by Admin on July 23rd, 2009 with 4 comments.
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4 comments

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Get your own gravatar by visiting gravatar.com brother_lu
#1. July 24th, 2009, at 12:32 PM.

that would be the worst idea ever.

hydrocodine should only be distributed in small does and the patient should NEVER be given a refill without another doctor’s prescription. HC is one of the most addicting substances in the legal drug market today and it doesn’t need to be sold to anyone in it’s pure form, that’s why they put it in with other things, so people CAN’T take alot of it.

if they really have a chronic problem, they should be seeing their doctor on a regular basis anyways.. yes it would be helpful for a small few, but many more than the ones in pain would take advantage of it and it would be hard to keep the two apart.

Get your own gravatar by visiting gravatar.com LAXTON
#2. July 26th, 2009, at 1:38 PM.

All I have to say is they do use it in it’s pure form, but usually only in hospital’s.. There is the rare case that dr’s prescribe it for their patients.. Good Luck

Get your own gravatar by visiting gravatar.com jls1znv9999
#3. July 28th, 2009, at 11:16 PM.

Well due to the obvious facts you stated, that being that abuse is on the incline, i might add at a very alarming rate. Pain pills, diet pills, anti-depressants, any drug that has a effect that others see as a positive are now the reasons why the FDA has came down so hard.

In this day and age, the prescriptions we receive are so readily available and not so illegally to obtain it’s worse than any other drug/alcohol / tobacco or other things that give you that high.

From what i remember if you were to be able to legitimately obtain Hydrocodone in it’s purest form it would come with inherent ill side effects. I am sure the FDA has shown excessive damage to the internal organs due to the testing that was conducted. Also it would create another issue. That being that it would only be a matter of time before some “Home Chemist” discovers how to create a new, bigger, better, cheaper high. I think it would show an utter lack of responsibility on society as a whole to let another “Methamphetamine” come out of the wood work.

Quite simply put there is too much risk involved and not to mention to many current issues at stake. Opiates are the new cocaine, weed, lsd, and everything else the world over has been addicted to only now you only need a prescription, or you could steal it. Trust me i know several people have stolen it, will steal it, will continue by any means to get their next bottle by any means.

There have been many studies on the purifications of Opiates and the benefits vs the possible side effects. In the balance are people’s lives. To which point the FDA makes their rules on what can or cannot be made and distributed legally is entirely what they are intrusted to do.
I understand your argument and it does show your intelligence and i agree with your many very well stated points. However the potential for something seriously dangerous to come of it would just bring those who can’t just stop taking the pills once their prescription is over is too big of risk.

There is another potential risk of purifying opiets in that it would just as easy to get your hands on it as it is to get your hands on a bag of weed. To the point the scum of society has brought us all down to their level. If we need something for pain we have to take the preverbial horse with a bad leg. Tougher laws will not change anything.

On a side note i would say someone very close to me worked for a pharmacy and they stole a bottle(s) of 1400 tablets of Vicodin (the name brand stuff). That person has an addiction, however their common sense was overidden by their compulsion to get that feeling that most opiets create. I can only imagine the issues at hand that he/she and I would have to endure due to their lack of judgement if Vicodin was a pure form.

I have listed a study that was done by the FAA back a few years ago. It does make a few valid points.

Get your own gravatar by visiting gravatar.com V. S
#4. July 30th, 2009, at 4:18 PM.

tylenol & advil help the hydrocodone bond to the pain receptors in the brain better. Also because just 5mg of hydrocodone is a strong amount for someone not opioid tolerant. Vicodin is made for people in pain who were not taking opiates before and it’s strong enough for them. It is not meant for chronic pain. And it’s impossible to make a 5mg pill large enough without some filler. Rather than using inactive fillers like many drugs do, they use Tylenol because it works on the same receptors & will help relieve the pain even better than just 5mg hydrocodone + inactive ingredients alone. Also because hydrocodone is addictive they want to prescribe the lowest dose possible. Adding tylenol provides more pain relief meaning less addictive medicine is needed.

The pain management part, if you have enough pain to warrant use of opiate painkillers, several times a day, long term, then it is safer to switch to something like MS Contin or Oxycontin.codiene & hydrocodone are meant for moderate-severe acute pain (pain lasting 6 weeks or less), and if you need to take several vicodins a day longer than that, you can get better relief, with less pills from a long-lasting medicine. Once your pain starts it takes more medicine to stop it. A low constant dose or morphine can help people much more efficiently than hydrocodone which only lasts 4-6 hours with or without tylenol. If you are truly suffering from chronic pain there is not more risk of addiction from one opiate to another. And once you’ve become opiate tolerant from vicodins the side effects are minor when moving to a different opiate. It’s not like vicodin is this amazing miracle painkiller but morphine is this awful dangerous medicine.

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