Vicodin is the brand name for the popular painkiller, hydrocodone
bitartrate and acetaminophen. Hydrocodone bitartrate is an opioid
analgesic and antitussive, occurring as fine, white crystals or, as
a crystalline powder. The chemical name is:
4,5(alpha)epoxy-3-methoxy-17-methylmorphinan-6-one tartrate (1:1) hydrate (2:5).
Vicodin has the following structural formula:
C18H21NO3C4H6O6 – 2 1/2 H2O M.W. 494.50
In the U.S. there are over 200 products containing hydrocodone,
typically combined with acetaminophen (Vicodin, Lortab).
However, it is also combined with aspirin (Lortab ASA), ibuprofen
(Vicoprofen), and antihistamines (Hycomine). Both tablet and liquid
forms of hydrocodone are available (Tussionex). Other brand names
include Anexsia, CoGesic, Hydrocet, Hy-Phen, Lorcet, Maxidone, Norco,
Panacet, and Zydone. Street names for Vicodin include vikes and
Hydrocodone is in Schedule II of the Controlled Substances Act.
Preparations containing hydrocodone in combination with other
non-narcotic medicinal ingredients are in Schedule III.
Hydrocodone dates back to the 1920’s when Knoll, a German
pharmaceutical company, believed hydrogenizing codeine could make it
less toxic, making it easier on the stomach. As its name implies,
hydrocodone is the codeine molecule with a hydrogen atom attached.
During this time in the U.S., a disturbing percentage of middle class
Americans were hooked on opium derivatives. The government, anxious
for a non-addictive painkiller, gave extensive funding to research
new compounds like hydrocodone.
Vicodin is a phenathrene-derivate opiate agonist, effective both as
an antitussive (anti-cough) agent, and as an opiate, an effective
analgesic for mild to moderate pain. Five mg of hydrocodone is
equivalent to 30 mg of codeine when administered orally. 15 mg
(1/4 gr) of hydrocodone is considered equivalent to 10 mg (1/6 gr)
of morphine. Hydrocodone is considered to be like morphine in all
Source: DEA: Drug Enforcement Administration
The combination of acetaminophen and hydrocodone is available in
tablet or capsule form, as well as liquid, to be taken by mouth.
Generally, it is taken every 4-6 hours as needed (PRN). The usual
dose of Vicodin is 1 or 2 tablets, up to a maximum of 8 tablets per
day. The usual dose of Vicodin HP® is 1 tablet, up to a maximum of 6
tablets per day. For Vicodin ES®, the usual dose is 1 tablet, up to a
maximum of 5 tablets per day. Vicodin can be habit forming or
addictive, and it is imperative that patients take the medication
precisely as prescribed by their physician.
Do not increase the amount or frequency without your doctor’s
approval. Do not take this drug for any reason other than the one
FDA: Food and Drug Administration
Vicodin is a semisynthetic narcotic analgesic and antitussive with
multiple actions qualitatively similar to those of codeine. Most of
these involve the central nervous system and smooth muscle. The
precise mechanism of action of hydrocodone and other opiates is not
known, although it is believed to relate to the existence of opiate
receptors in the central nervous system. In addition to analgesia,
narcotics may produce euphoria; drowsiness; lethargy; relaxation;
difficulty in concentrating; decreased physical activity in some users
and increased physical activity in others; mild anxiety or fear, and
Typical side effects of Vicodin therapy include constipation, nausea,
vomiting, drowsiness, dizziness, lightheadedness, stomach pain, and
Less common but potentially hazardous effects include respiratory
depression and mood changes. If you experience either, call your
doctor immediately. Elderly patients are particularly susceptible to
respiratory depression, particularly when Vicodin is used in
conjunction with other CNS depressant medications.
- Vicodin may make you drowsy. Do not drive a car, operate machinery, or perform any other potentially dangerous activities until you know how this drug affects you.
- Narcotics such as Vicodin may interfere with the diagnosis and treatment of abdominal conditions.
- Vicodin suppresses the cough reflex; therefore, be careful using Vicodin after an operation or if you have a lung disease.
- High doses of Vicodin may produce slowed breathing; if you are sensitive to this drug, you are more likely to experience this effect.
- Vicodin slows the nervous system. Alcohol can intensify this effect.
Use Vicodin with caution if:
- You have a head injury. Narcotics tend to increase the pressure of the fluid within the skull.
- If you have a severe liver or kidney disorder, an underactive thyroid gland, Addison’s disease (a disease of the adrenal glands), an enlarged prostate, or urethral stricture.
- You are elderly and/or in a weakened condition.
- Vicodin usage may obscure the diagnosis or clinical course in patients with acute abdominal conditions.
If Vicodin is taken with certain other drugs, the effects of either
may be increased, decreased, or altered. It is especially important
to check with your doctor before combining Vicodin with the following:
- Valium and Librium
- Tricyclic Antidepressants such as such as Elavil and Tofranil
- Antihistamines such as Tavist
- MAO inhibitors such as Nardil and Parnate
- Major tranquilizers such as Thorazine and Haldol
- Other narcotic analgesics such as Demerol
- Other central nervous system depressants such as Halcion and Restoril
Any medication taken in excess can have serious consequences. A
severe overdose of Vicodin can be fatal. If you suspect an overdose,
seek emergency medical treatment immediately.
Symptoms of a Vicodin overdose include:
Blood disorders, bluish tinge to skin, cold and clammy skin, extreme
sleepiness progressing to a state of unresponsiveness or coma,
general feeling of bodily discomfort, heart problems, heavy
perspiration, kidney problems, limp muscles, liver failure, low blood
pressure, nausea, slow heartbeat, troubled or slowed breathing, and
Psychic dependence, physical dependence, and tolerance may develop upon repeated administration of vicodin.
Psychic dependence is unlikely when vicodin is used for a short period of time.
Vicodin addiction can develop when continued use of the drug is needed to
avoid withdrawal symptoms. This problem only becomes relevant after
several (2 weeks to 2 months) of continued narcotic use.
Tolerance is when ever increasing doses are required to produce the
same degree of analgesia. Tolerance is initially manifested by a
decreased duration of analgesic effect, followed by decreases in the
intensity of analgesia. The rate of tolerance varies among patients.
Vicodin has an analgesic potency similar to or greater than that of
oral morphine. Generally, this drug is abused by oral rather than
When taken as directed, Vicodin can produce physical dependence in a
few weeks time.
According to the FDA, addiction is characterized by compulsive use,
use for non-medical purposes, and continued use despite harm or risk
Patients no longer requiring Vicodin, should set a gradual taper
schedule to avoid acute withdrawal.
If a regular Vicodin user abruptly stops taking Vicodin, withdrawal
should begin within six to twelve hours. The intensity of withdrawal
depends on the degree of the addiction, and symptoms are usually not
life-threatening. Typically, Vicodin withdrawal symptoms may intensify
for twenty-four to seventy-two hours and then gradually decline over a
period of seven to fourteen days.
The symptoms of Vicodin withdrawal include but are not limited to:
restlessness, muscle pain, bone pain, insomnia, diarrhea, vomiting,
cold flashes, goose bumps, involuntary leg movements, watery eyes,
runny nose loss of appetite, irritability, panic, nausea, chills, and
Any person using Vicodin for more than several weeks should consult
their medical professional before stopping the drug. Generally
speaking, a gradual weaning off of the drug is optimal and less
traumatic to the user’s physical and emotional health. With a
moderate to severe addiction, an in patient detox in a hospital or
medically supervised setting is highly recommended for its
multi-disciplinary approach. The “information age” has
produced numerous on line support forums, popular with many recovering
addicts, useful to some addicts as their sole means of support and for
others, as adjunct therapy. Drug addiction is treatable, with help out
there for everyone.