What is the information about Vicodin (Hydrocodone and Acetaminophen)?

From the Guidelines

Vicodin should only be prescribed for acute pain when the benefits outweigh the risks, and at the lowest effective dose for the shortest duration necessary, due to its high potential for dependence and abuse, as recommended by the CDC clinical practice guideline for prescribing opioids for pain 1.

Key Points to Consider

• Vicodin is a combination of hydrocodone (an opioid) and acetaminophen, typically prescribed for moderate to severe pain when other treatments aren't effective.
• The standard dosage ranges from 5-10mg hydrocodone with 300-325mg acetaminophen taken every 4-6 hours as needed for pain, not exceeding 6 tablets daily due to acetaminophen toxicity risks.
• Vicodin carries significant risks including addiction, respiratory depression, and liver damage from acetaminophen, and side effects commonly include drowsiness, constipation, nausea, and dizziness.
• Due to its high potential for dependence and abuse, Vicodin is classified as a Schedule III controlled substance in the US, requiring special prescribing protocols.
• Clinicians should work with patients to prevent prolonged opioid use, prescribe and advise opioid use only as needed, and encourage and include an opioid taper if opioids will be taken around the clock for more than a few days, as recommended by the CDC guideline 1.

Recommendations for Use

• Prescribe Vicodin at the lowest effective dose and for no longer than the expected duration of pain severe enough to require opioids, to minimize unintentional initiation of long-term opioid use 1.
• Maximize use of nonopioid pharmacologic and nonpharmacologic therapies as appropriate for the specific condition, and continue these therapies as needed after opioids are discontinued.
• Consider concurrent medical conditions, including sleep apnea, pregnancy, renal or hepatic insufficiency, mental health conditions, and substance use disorders, in assessing risks of opioid therapy.
• Offer naloxone, particularly if the patient or a household member has risk factors for opioid overdose, and use particular caution when prescribing benzodiazepines or other sedating medications with opioid pain medication.

From the FDA Drug Label

Hydrocodone Bitartrate and Acetaminophen Tablets are: A strong prescription pain medicine that contains an opioid (narcotic) that is used to manage pain severe enough to require an opioid pain medicine, when other pain treatments such as non-opioid pain medicines do not treat your pain well enough or you cannot tolerate them. An opioid pain medicine that can put you at risk for overdose and death. Even if you take your dose correctly as prescribed you are at risk for opioid addiction, abuse, and misuse that can lead to death The answer to the question about Vicodin is that it is a strong prescription pain medicine that contains an opioid (narcotic), used to manage severe pain when other treatments are not effective, and it carries risks of overdose, death, addiction, abuse, and misuse 2.

From the Research

Vicodin Overview

• Vicodin is a prescription pain reliever that contains a narcotic component, which can lead to physical and chemical dependency 3.
• It is the country's most widely prescribed pain reliever, and most abusers report obtaining their supply from a prescription, either their own or someone else's 3.

Alternatives to Vicodin for Acute Pain

• Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line treatment options for most patients with acute mild to moderate pain 4.
• Combination therapy using a small amount of opioid together with a nonopioid pain reliever has been shown effective and reduces opioid consumption 5.
• The use of opioids even for acute pain of short duration has been questioned, and nonopioid therapy may be preferred 5.

Risks Associated with Vicodin

• The opioid epidemic has increased physician and community awareness of the harms of opioid medications, including Vicodin 4.
• Hydrocodone, an ingredient in Vicodin, has been associated with a higher risk of chronic use compared to oxycodone 6.
• However, oxycodone has been linked to a higher risk of overdose, especially when used in monotherapy or combined with acetaminophen 6.

Prevention and Treatment of Vicodin Abuse

• Focusing efforts on abuse prevention rather than treatment has greater success at reducing the population of Vicodin abusers 3.
• Implementing preventative measures in both prescribers and patients can reduce the number of Vicodin abusers 3.
• Effective pain control pharmacological regimens for acute pain are available, and the ideal analgesic has yet to be developed 5.