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Medical
Hydrocodone/paracetamol medication is used to relieve moderate to severe pain. It contains an opioid (narcotic) pain reliever (hydrocodone) and a non-opioid pain reliever (acetaminophen also known as paracetamol). Hydrocodone works in the brain to change how your body feels and responds to pain. Acetaminophen (Paracetamol) can also reduce a fever. Hydrocodone is an opioid pain medication, sometimes called a narcotic. Acetaminophen (paracetamol) is a less potent pain reliever that increases the effects of hydrocodone. Together paracetamol and hydrocodone is a combination medicine used to relieve moderate to severe pain.

Recreational
It’s believed that hydrocodone works like other opioids, in that when it’s taken it binds to opioid receptors, which are located throughout the central nervous system. It doesn’t stop pain from occurring, but it does raise a person’s tolerance for pain, and it changes how they sense pain. At a normal dose, when hydrocodone is used for legitimate pain, a person won’t feel much of a high, but a high is possible when people take larger doses, or they abuse the drug. When used recreationally, hydrocodone produces effects very similar to morphine, heroin, and oxycodone. Intensity is slightly lower than morphine or heroin because these two drugs are generally administered intravenously. Contrary to popular belief, hydrocodone is actually a very addictive drug when misused. When used under medical settings exactly as prescibed, most users of hydrocodone do not become addicted to the drug. But many other people can go doctor shopping to obtain this drug and use it for their own recreational use.

Pregnancy
There are no adequate and well-controlled studies of hydrocodone in pregnant women. Hydrocodone readily crosses the placenta. Use paracetamol; hydrocodone during pregnancy only if the potential benefit clearly justifies the potential risk to the fetus. Hydrocodone is not recommended for use in women during and immediately prior to labor and obstetric delivery because oral opioid agonists may cause respiratory depression in the newborn. Opioid analgesics can prolong labor by reducing the strength and frequency of uterine contractions; however, this effect may be offset by an increased rate of cervical dilation.

Hydrocodone
For relief of moderate to moderately severe pain. Also used for the symptomatic relief of nonproductive cough, alone or in combination with other antitussives or expectorants. Hydrocodone is an opioid agonist with relative selectivity for the mu-opioid receptor, although it can interact with other opioid receptors at higher doses. The precise mechanism of action of hydrocodone and other opiates is not known; however, hydrocodone is believed to act centrally on the cough center.

Paracetamol
Paracetamol (called acetaminophen in the USA) is a derivative of p-aminophenol, which corresponds to the active principal metabolite phenacetin. Its mechanism of action is not clearly established. It appears that paracetamol inhibits prostaglandin biosynthesis in the central nervous system but not (or hardly) in the peripheral tissues. In any case, paracetamol only has minimal anti-inflammatory action compared to non-steroidal anti-inflammatory agents.

DEA Class
Rx, schedule II

Classes: Opioid Agonists and Other Drug Combinations

Boxed Warning
Asthma, chronic obstructive pulmonary disease (COPD), coadministration with other CNS depressants, coma, cor pulmonale, hypoxemia, obesity, pulmonary disease, respiratory depression, respiratory insufficiency, scoliosis, sleep apnea, status asthmaticus

Use with central nervous system (CNS) depressants
Taking opioids with CNS depressants, such as benzodiazepines or alcohol, may result in excessive sedation, slow breathing, coma, and death. Avoid the use of hydrocodone in patients with impaired consciousness.

May cause liver failure
Taking too much paracetamol can cause liver failure. Sometimes, this results in the need for liver transplant, or death. Most reported cases of liver injury have occurred when a person took more than 4,000 mg of paracetamol per day, usually together with more than one product containing acetaminophen.

May cause addiction, abuse, and misuse
Hydrocodone is an opioid agonist and therefore has abuse potential and risk of fatal overdose from depressed respiration. Addiction may occur in patients who obtain hydrocodone illicitly or in those appropriately prescribed the drug. The risk of addiction in any individual is unknown. However, patients with mental illness (e.g., major depression) or a family history of substance abuse, have an increased risk of opioid abuse. Assess patients for risks of addiction, abuse, or misuse before drug initiation, and monitor patients who receive opioids routinely for development of these behaviors or conditions. Someone abusing hydrocodone may experience negative side effects immediately after use. Taking this drug increases your risk of opioid (narcotic) addiction, abuse, and misuse. This could lead to overdose and death.

Drug interactions
Hydrocodone and paracetamol are broken down by your liver. If you take these drugs with another drug that can affect your liver, hydrocodone and acetaminophen could build up in your body and cause more breathing problems and other side effects. Paracetamol has been associated with cases of acute liver failure, at times resulting in liver transplant and death. Most of the cases of liver injury are associated with the use of paracetamol at doses that exceed 4000 milligrams per day, and often involve more than one acetaminophen (paracetamol) containing product. The excessive intake of acetaminophen may be intentional to cause self-harm or unintentional as patients attempt to obtain more pain relief or unknowingly take other acetaminophen(paracetamol)-containing products.

Severe allergic reaction
Which may include:


 * trouble breathing
 * swelling of your face, throat, and mouth
 * rash
 * itching
 * vomiting

Long-Term Damage of Opioid

 * Brain damage


 * Hyperalgesia


 * Endocrine system damage


 * Respiratory damage


 * Gastrointestinal damage

Breast-feeding
Consider the developmental and health benefits of breast-feeding along with the mother's clinical need for paracetamol; hydrocodone and any potential adverse effects on the breast-fed infant from the drugs or the underlying maternal condition. Hydrocodone is distributed into breast milk at varying degrees depending upon the dose.

Most common

 * noisy breathing, sighing, shallow breathing;
 * a slow heart rate or weak pulse;
 * pain or burning when you urinate;
 * confusion, tremors, severe drowsiness;
 * a light-headed feeling, like you might pass out; or
 * low cortisol levels--nausea, vomiting, loss of appetite, dizziness, worsening tiredness or weakness.

History
Paracetamol was introduced into the pharmacological market in 1955 by McNeil Laboratories as a prescribed analgesic and antipyretic drug for children under its trade name Tylenol Childrenís Elixir (the name tylenol derives from its chemical name ñ N-acetyl-p-aminophenol). Paracetamol is considered to be one of the most frequently used drugs around the world. Initially synthesized in 1878, this drug was introduced for limited medical use in 1883, and for wide unrestricted use after 1950s. Today, paracetamol is used by patients of practically all ages and for indications, and it is available over the counter.

Hydrocodone

Hydrocodone was initially engineered in Germany during the early 1920s by a pharmaceutical company. By adding oxygen to codeine, the company hoped to create a product that was as effective as codeine without the unwanted side effects: high risk of toxicity and stomach discomfort. In the late 1920s, officials in the United States were investigating methods to find substitutes for opiate-containing cough medicines that were leading to high levels of addiction.

Acute
Despite wide scale use for many decades, hydrocodone by itself has not been convincingly linked to instances of clinically apparent acute liver injury. However, when combined with paracetamol, hydrocodone combinations have become a common cause of paracetamol acute liver injury. The typical history is of a patient who began taking more than the prescribed number of pills over several days, attempting to achieve more of an opiate effect and leading secondarily and unintentionally to an overdose of paracetamol. Because of the potential for hepatotoxicity, the FDA has warned against the use of opioid combinations in which the dose of paracetamol is greater than 325 mg per tablet.

Chronic
This opioid has a high potential risk factor for poisoning.

Withdraw
Stopping the drug abruptly after developing a dependency for it, will likely bring on withdrawal symptoms. These symptoms generally include, insomnia, shakes, chills, anxiety, fatigue, nausea, vomiting, restless leg syndrome, and goosebumps.

Withdrawal symptoms begin shortly before the next dosing time, and continue for 72 hours, increasing in intensity, then after the 72 hour peak, the symptoms drastically recede.

Other forms of withdraw can potentially lead to death.

Brand names
Generic Name: Oxycodone, Hydrocodone, Meperidine, Propoxyphene, and Hydromorphone.

Brand Name: OxyContin, Percodan, Percocet, Roxiprin, Roxicet, Endodan, Endocet, Anexsia, Dicodid, Hycodan, Hycomine, Lorcet, Lortab, Norco, Tussionex, Vicodin, Darvon, Dilaudid, Demerol.

Street Name: Oxy 80s, oxycotton, oxycet, hillbilly, heroin, percs, perks, pain killer, vikes, hydros, pinks, footballs, pink footballs, yellow footballs, 65’s, Ns, juice, dillies, drug street heroin, demmies.

Regulations
Effective in 2014, the U.S. FDA has applied restrictions to hydrocodone-containing products. The action was to take action against the abuse of prescription pain medications and make the medications safer.The Drug Enforcement Administration recently announced that all hydrocodone products will have a CII status effective October 6, 2014. This includes all combination products, which represent the vast majority of hydrocodone that is consumed annually.