500-5 Vicodin Acetaminophen-hydrocodone

[NeoPTLD]

I know that the narcotic analgesic Vicodin is a blend of usually, 100 to 1 ratio acetaminophen with narcotic hydrocodone to prevent recreational use.

When you look at the clinical side of it, is there a synergetic effect that makes the combo of 500mg of acetaminophen + 5mg of HC more effective at killing pain compared to dosing 5mg of hydrocodone byitself?

 

[Gibsons]

acetaminophen can reduce fever.

 

[bobsmith1492]

Acetaminophen also reduces inflammation... I don't know what all hydrocodone does though. It seems like hydrocodone just numbs you up overall; acetaminophen does more useful things like reducing inflammation, swelling, and fever.

 

[sjwaste]

The way I had it explained to me, hydrocodone basically makes you not care about the pain -- dulls the sense. The acetominophen reduces inflammation and fever, which are closer to the cause of the discomfort.

I've also heard they specifically use acetominophen and not an NSAID to curb the recreational uses, esp mixing with alcohol, but I don't really get that. I think someone that's willing to mix painkillers and alcohol, where the acetominophen is going to be most toxic, probably isn't that concerned. That's just my rambling, though, no idea if that's actually true.

 

[destrekor]

Originally posted by: sjwaste
The way I had it explained to me, hydrocodone basically makes you not care about the pain -- dulls the sense. The acetominophen reduces inflammation and fever, which are closer to the cause of the discomfort.

I've also heard they specifically use acetominophen and not an NSAID to curb the recreational uses, esp mixing with alcohol, but I don't really get that. I think someone that's willing to mix painkillers and alcohol, where the acetominophen is going to be most toxic, probably isn't that concerned. That's just my rambling, though, no idea if that's actually true.

Technically speaking, yes, the acetaminophen has its uses as its the true agent that is actually attempting to take out the cause of the pain, with the hydrocodone is simply dumbing down the nerves so you feel less pain and additionally feel uplifted somewhat, based on dosage. But acetaminophen is worse than an NSAID like ibuprofen at reducing swelling, and is why you sometimes see ibuprofen used instead of acetaminophen in hydrocodone preparations. So this generally leads to the belief that its use is more for getting people to shy away from abusing it, which kind of works, because people just move to other narcotics. I think in some ways this is true, but its not there just for that reason, as again, its useful. But then again, a single 500mg dose of tylenol can be rather useless for most people for even something simple like a headache, so not sure how useful for pain it really is in a 5-500 preparation. My dad first was prescribed that strength, but was upgraded to a 7.5-500 preparation, and that would help more. So... the hydrocodone is definitely more important in the mix for pain relief. Plus, tylenol was going to do nothing for his lower back anyhow, as it was a disc-based issue - tylenol can't touch that, and not even sure if ibuprofen could.

 

[CycloWizard]

There are synergistic interactions between certain painkillers, though I don't recall which ones, nor do I recall why. I just remember that I was incapacitated for a week or so without feeling the pain.

 

[Gibsons]

Originally posted by: sjwaste
The way I had it explained to me, hydrocodone basically makes you not care about the pain -- dulls the sense. The acetominophen reduces inflammation and fever, which are closer to the cause of the discomfort.

I've also heard they specifically use acetominophen and not an NSAID to curb the recreational uses, esp mixing with alcohol, but I don't really get that. I think someone that's willing to mix painkillers and alcohol, where the acetominophen is going to be most toxic, probably isn't that concerned. That's just my rambling, though, no idea if that's actually true.

Generally speaking, acetominophen has fewer side effects than NSAIDs. No stomach/kidney issues, and the liver issues only come up at much higher doses. In hospital settings, acetominaphen is usually given out without much concern for headaches and whatnot, the NSAIDs not so much.

 

[BrownTown]

Mo expert here, but doesn't acetominophen work on the COX enzyme and hydrocodone works on the mu-opiod receptor? Seems like you could be working on two front there which might men they enhance each other.

 

[Mark R]

Originally posted by: BrownTown
Mo expert here, but doesn't acetominophen work on the COX enzyme and hydrocodone works on the mu-opiod receptor? Seems like you could be working on two front there which might men they enhance each other.

The mechanisms are different, so there is benefit from having both together. Although with combinations, it's best if the two components have similar efficacies. E.g. having acetaminophen with 6 mg of codeine (as you can often buy over the counter) is completely worthless. The dose of codeine is so tiny, that it offers little additional benefit over acetaminophen alone - it just adds side effects. Hydrocodone is about 6x as potent as codeine - so vicodin is useful combination as the 2 ingredients exert similar effects but by acting on different parts of the pain pathway, so there is a summative effect.

Hydrocodone is an opiate - so it acts on the CNS opiate receptors. Acetaminophen acts on production of prostaglandins (which are substances that promote inflammation), although the mechanism by which it does so isn't known with confidence. However, by reducing production of prostaglandins, it's operation is similar to that of NSAIDs, like Aspirin, ibuprofen and naproxen. The latter 2 do this by blocking the COX enzymes.

 

[bobsmith1492]

Originally posted by: Mark R

Originally posted by: BrownTown
Mo expert here, but doesn't acetominophen work on the COX enzyme and hydrocodone works on the mu-opiod receptor? Seems like you could be working on two front there which might men they enhance each other.

The mechanisms are different, so there is benefit from having both together. Although with combinations, it's best if the two components have similar efficacies. E.g. having acetaminophen with 6 mg of codeine (as you can often buy over the counter) is completely worthless. The dose of codeine is so tiny, that it offers little additional benefit over acetaminophen alone - it just adds side effects. Hydrocodone is about 6x as potent as codeine - so vicodin is useful combination as the 2 ingredients exert similar effects but by acting on different parts of the pain pathway, so there is a summative effect.

Hydrocodone is an opiate - so it acts on the CNS opiate receptors. Acetaminophen acts on production of prostaglandins (which are substances that promote inflammation), although the mechanism by which it does so isn't known with confidence. However, by reducing production of prostaglandins, it's operation is similar to that of NSAIDs, like Aspirin, ibuprofen and naproxen. The latter 2 do this by blocking the COX enzymes.

What does Aspirin do?

My understanding was that acetaminophen doesn't affect inflammation or swelling while ibuprofen and aspirin do. Since I'm allergic to ibuprofen, I'm stuck with aspirin when my knee gets sore.

 

[Gibsons]

Originally posted by: bobsmith1492

Originally posted by: Mark R

Originally posted by: BrownTown
Mo expert here, but doesn't acetominophen work on the COX enzyme and hydrocodone works on the mu-opiod receptor? Seems like you could be working on two front there which might men they enhance each other.

The mechanisms are different, so there is benefit from having both together. Although with combinations, it's best if the two components have similar efficacies. E.g. having acetaminophen with 6 mg of codeine (as you can often buy over the counter) is completely worthless. The dose of codeine is so tiny, that it offers little additional benefit over acetaminophen alone - it just adds side effects. Hydrocodone is about 6x as potent as codeine - so vicodin is useful combination as the 2 ingredients exert similar effects but by acting on different parts of the pain pathway, so there is a summative effect.

Hydrocodone is an opiate - so it acts on the CNS opiate receptors. Acetaminophen acts on production of prostaglandins (which are substances that promote inflammation), although the mechanism by which it does so isn't known with confidence. However, by reducing production of prostaglandins, it's operation is similar to that of NSAIDs, like Aspirin, ibuprofen and naproxen. The latter 2 do this by blocking the COX enzymes.

What does Aspirin do?

My understanding was that acetaminophen doesn't affect inflammation or swelling while ibuprofen and aspirin do. Since I'm allergic to ibuprofen, I'm stuck with aspirin when my knee gets sore.

Aspirin also inhibits COX enzymes, but it also interacts with a very complex regulatory pathway (NF kappa B) in the immune system. That's a complicated story, but you can probably think of it as an inhibitor of inflammation and be pretty close to correct.

 

[Comdrpopnfresh]

the acetaminophen is present, as mentioned to reduce inflammation and fever (pain to a small extent), the oxycodone/hydrocodone is there for pain. The acetaminophen serves a dual purpose of making it unsafe to abuse large quantities of the mixture without damaging one's liver, or first removing the acetaminophen.

 

[pnho]

Acetaminophen doesn't provide much of a clinical benefit in terms of the hydrocodone potency, however it does reduce the addictiveness. Mainlly, its a way for drug companies to get around DEA drug control laws. If a pharma company sells the drug at pure 5 mg of hydrocodone, then they fall under the schedule II classification, while adding 500 mg allows the tablet to be classified under schedule III. In essence this contributes to accessibility and $$$$.

 

[sjwaste]

Originally posted by: pnho
Acetaminophen doesn't provide much of a clinical benefit in terms of the hydrocodone potency, however it does reduce the addictiveness. Mainlly, its a way for drug companies to get around DEA drug control laws. If a pharma company sells the drug at pure 5 mg of hydrocodone, then they fall under the schedule II classification, while adding 500 mg allows the tablet to be classified under schedule III. In essence this contributes to accessibility and $$$$.

Ahh, that might be the answer right there. Didn't know the added acetaminophen changed the classification.

Is prescribing a Sch 2 drug that much harder, or does it cause a doctor to have to do additional paperwork?

 

[Gibsons]

Originally posted by: sjwaste

Originally posted by: pnho
Acetaminophen doesn't provide much of a clinical benefit in terms of the hydrocodone potency, however it does reduce the addictiveness. Mainlly, its a way for drug companies to get around DEA drug control laws. If a pharma company sells the drug at pure 5 mg of hydrocodone, then they fall under the schedule II classification, while adding 500 mg allows the tablet to be classified under schedule III. In essence this contributes to accessibility and $$$$.

Ahh, that might be the answer right there. Didn't know the added acetaminophen changed the classification.

Is prescribing a Sch 2 drug that much harder, or does it cause a doctor to have to do additional paperwork?

There's some talk now about changing the scheduling for hydrocodone, making all formulations schedule II. Mostly due to widespread abuse.

I don't know the details about prescribing, but if you go in to the ER for say, getting some stitches, they'll write a scrip for most any schedule III you want. Schedule II's are a different story. Most all of the really strong stuff is schedule II (well, or schedule I, but those don't get prescribed).

 

[hellokeith]

I got vicodin for my knee ligament tear, and it didn't do a darn thing for me. I asked for some codeine ["uh, I don't think so"] and/or liquid morphine [no answer].

 

[PlasmaBomb]

Wikipedia is your friend

http://en.wikipedia.org/wiki/Acetaminophen

Go down to MOA.