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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