Vicodin

Vicodin Side Effects:  Vicodin is a commonly used opioid analgesic approved for treatment of moderate to severe pain.  It is a combination of two pain medications and Vicodin is the combination of hydrocodone 5 mg with acetaminophen 500 mg.  Vicodin ES is hydrocodone 7.5 mg and acetaminophen 750 mg, and Vicodin HP is hydrocodone 10 mg with acetaminophen  660 mg.  All Vicodin products are a combination of  acetaminophen and hydrocodone, so Vicodin side effects can be related to either the hydrocodone or the acetaminophen.  Vicodin is available as a generic hydrocodone-acetaminophen product, and as several other brands including Norco and others.   Vicodin is somewhat unusually high in the fixed doses of acetaminophen when compared to Norco and other fixed dose brands of this drug combination, and special care needs to be taken to avoid acetaminophen over dosage.

Black Box Warnings:  Acetaminophen toxicity can occur with acute liver failure and death or need for liver transplant when over dosage of acetaminophen is ingested.  Use of greater than 4000 mg of acetaminophen daily, and use of more than one acetaminophen product can put patients at risk for these serious Vicodin side effects.

Common Vicodin Side Effects:  The common Vicodin side effects are those related to the class side effects of opioids.  These include several gastrointestinal side effects, because the mu opioid receptors in the GI tract are especially sensitive to opioids.  These gastrointestinal Vicodin side effects are especially common and include opioid induced constipation, nausea and vomiting.  Other common Vicodin side effects also common to most opioids include pruritus, lightheadedness, dizziness, confusion, sedation, drowsiness, rash, psychomotor impairment, and dependence or tolerance.

Serious Vicodin Side Effects:  This is where the acetaminophen usage issues come into place.  Hepatotoxicity is a potentially very serious Vicodin side effect as mentioned in the Black Box warning section above.  Opioid related serious Vicodin side effects include respiratory depression, dependency and abuse, diversion of the drug for street sale.   Agranulocytosis, thrombocytopenia, and anaphylaxis are serious but rare Vicodin side effects.

Cautions and Drug Interactions:  The most important issue is to avoid mixing acetaminophen containing products to avoid inadvertent acetaminophen over dose and hepatic toxicity.  This should be avoided.  Special care should be taken when using products in which the acetaminophen may not be recognized as an ingredient.  Examples are some cold and cough medications, sleep aids and headache medications.  Additionally, avoiding mixing medications with potential for sedation or respiratory and CNS depression is necessary.  Examples of this type of medication include benzodiazapines, barbiturates, tricyclic antidepressants, medications with anticholinergic side effects, ethanol, and other opioid containing products.  The list of drug interactions is extensive, and readers should refer to the product labeling information or their pharmacist for more complete information.

Pregnancy and Lactation:  Vicodin is pregnancy category C, and safety is considered unknown for use during lactation.

Opioid Induced Constipation:  This Vicodin side effect is so common as to warrant specific coverage.  The gastrointestinal mu receptors are sensitive to opioids and the constipation that is nearly universal with opioid use is different from most other types of constipation.  Treatment with fiber supplements is not usually helpful.  Sennakot-S is often a specific antidote for opioid induced constipation, and patients should discuss this with their physician to decide on appropriate dosing and constipation management.

Opioid Withdrawal Syndrome:  As with all opioid drugs, physical dependence is nearly universal at higher doses used regularly.  Withdrawal is to be expected if a regular moderate to high dose of Vicodin is discontinued abruptly. Typical symptoms include diarrhea, abdominal pain and cramps, sweating, anxiety and generally feeling “sick.”  Gradual tapering of the medication is usually recommended. In cases of abuse and physical tolerance admission to a detox facility and rehab program may be beneficial.

Unusual Vicodin Side Effects:  Most Vicodin side effects are common to other opioids.  The agranulocytosis and thrombocytopenia issues are somewhat unusual.

In addition to the hydrocodone component Vicodin contains acetaminophen.  This is advantageous because acetaminophen itself is a potent analgesic, and the combination with hydrocodone has been shown to enhance the analgesic efficacy of opioids. This is also a major issue with high dose Vicodin therapy, especially with accidental or intentional vicodin overdose.  Acetaminophen overdose is very serious, and can lead to hepatic necrosis and liver failure.  The damage to the liver can be asymptomatic while it is happening, and the symptoms only occur long after the damage to the liver cells has occurred.  There are no hydrocodone products on the market at this time without another component, either aspirin or acetaminophen.  The dilemma is that hydrocodone alone has a much higher abuse potential than when in combination with acetaminophen, but the safety of hydrocodone used alone, by avoiding the acetaminophen side effects that can occur as Vicodin side effects, would be a positive.  A long acting hydrocodone only analgesic is under consideration for U.S. FDA approval.  Other potential acetaminophen issues include rare patients with acetaminophen allergy, the potential for rebound headaches with acetaminophen regular use, and the potential nephrotoxicity (kidney damage) from high dose long term acetaminophen use.

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