Vicodin (a trade mark of AbbVie) is a common brand name for Hydrocodone/paracetamol (also known as hydrocodone/acetaminophen, hydrocodone/APAP or under other brand names such as Lortab or Norco) is a combination narcotic analgesic drug consisting of hydrocodone and paracetamol. It is indicated for relief of moderate to moderately severe pain of acute, chronic, or post-operative types. It is also used as a cough suppressant.
Vicodin can be prescribed to anyone age 6 and up, but children under the age of 12 should not be prescribed a time released formulation.
Common side effects of Vicodin are common to all narcotic analgesics and include nausea, vomiting, constipation, and dry mouth. Some less common side effects are allergic reaction, blood disorders, changes in mood, mental fogginess, anxiety, lethargy, difficulty urinating, spasm of the ureter, irregular or depressed respiration and rash.
The U.S. DEA previously classified Vicodin as a Schedule III drug, meaning it has a Moderate Risk of physical dependence, and Low risk of psychological dependence. As of October 6, 2014, all hydrocodone products were rescheduled to schedule II, meaning it has a high potential for abuse, physical dependence, and psychological dependence; but that there are still accepted medical uses for the drug in the U.S. Since physical dependence rises with the length and dose prescribed, it is highly recommended that patients with physical dependence be slowly weaned off the medication.
Vicodin poses some danger of overdose. In 2011, 37 deaths and over 30,000 incidents were reported to poison control centers from accidental use of the drug. Non-medicinal use of the drug accounted for over 82,000 emergency room visits. Of those visits, 372 resulted in the death of the patient and 118 were directly tied to the drug.
Medicine interaction is not common, but physicians should be wary when prescribing Vicodin to patients who already take Anti-depressants, antihistamines, anti-psychotics, MAOIs and sedatives. Care should also be taken in patients who suffer from irritable bowel syndrome, Parkinson's disease, seizures and ulcers.
Like most other narcotics, Vicodin is abused for its ability create a sense of euphoria. However, the body builds tolerance to its effects, which results in the abuser having to consistently increase the dose to get the same effect. Cesation of the drug leads to symptoms of withdrawal. About 23 million people over the age of 12 are estimated to have used it for non-medicinal purposes at least once during their lifetime.
Because it does not face the restrictions of stronger more habit forming opiate based products, Vicodin is often a target for addicts who use such methods as fake and altered prescriptions, theft and illicit internet purchases. Addicts often combine it with alcohol as the risk of medicine interaction is lower with Vicodin than with other narcotics. Hydrocodone is abused for Hydrocodone diversion and abuse has escalated in recent years. In 2009 and 2010, hydrocodone was the second most frequently encountered opioid pharmaceutical in drug evidence submitted to U.S. federal, state and local forensic laboratories as reported by DEA’s National Forensic Laboratory Information System (NFLIS) and System to Retrieve Information from Drug Evidence (STRIDE). It is usually seized in pill form. It is also a major problem with high-school aged individuals. About 1.3% of 8th graders and 3.8% of 12th graders had used it for a non-medicinal purpose in a 2012 survey. However, abuse crosses all age groups and ethnic groups.
Abuse of the drug also appears to be related to the perception that as a widely used prescription drug, it is somehow safer or more socially acceptable than other narcotics. Some of the common signs of abuse are:
- Frequent drowsiness
- An obsession with procuring and consuming the drug
- Inability to focus
- Extreme anxiety and paranoia
- Severe mood swings
- Nausea and vomiting
Unlike many other abused drugs, there is very little illicit Vicodin production. Almost all abuse is fed through diversion of legitimately manufactured pills.
In 2007, 99% of hydrocodone was consumed in the United States. Hydrocodone was the most commonly prescribed opiate in the United States as of 2012. 142 million prescriptions were dispensed in the US for hydrocodone combination products and hydrocodone/acetaminophen combination was the most common of those.
Hydrocodone: hydrocodone acts at μ-opioid receptors. Hydrocodone is metabolized to hydromorphone by the activity of cytochrome P450 2D6. Cytochrome 3A4 forms the substrate norhydrocodone. Note that this conversion is only somewhat responsible for the effects of hydrocodone. Hydrocodone passes through the blood–brain barrier because of its modifications. The brain is typically where the analgesic effects are being carried out. Many of side-effects of this drug are caused by the fact that it so readily crosses the blood–brain barrier. The half-life of hydrocodone is approximately 3.8 hrs.
Paracetamol: the major active metabolites are sulphates and glucuronide conjugates. Its main mode of action is to inhibit the activity of the enzyme cyclooxygenase (COX). COX enzymes are necessary for the production of prostaglandins. Prostaglandins are a form of hormone (although rarely classified as such) that are indicated to be mediators of pain, fever, and inflammation. The half-life of paracetamol may be measured either by salivary or by plasma counts. Both measurements give a varying half-life between 1 and 4 hours. Peak levels are reached 40–60 minutes after ingestion. It has been proposed that paracetamol aids in the reduction of pain by increasing serotonergic neurotransmissions.
It can be taken with or without food as desired. When taken with alcohol, it can intensify drowsiness. It may interact with monoamine oxidase inhibitors, as well as other drugs that cause drowsiness. It is in FDA pregnancy category C: its effect on an embryo or fetus is not clearly known and pregnant women should consult their physicians before taking it.
The brand name Vicodin is sold in three doses.
- Standard - 5 mg hydrocodone & 300 mg acetaminophen
- ES - 7.5 mg hydrocodone & 300 mg acetaminophen
- HP - 10 mg hydrocodone & 300 mg acetaminophen
Other brands and generics for oral use the same hydrocodone doses, but typically use 325 mg of acetaminophen instead. Zohydro and Hysingla ER (Hydrocodone Extended Release) are the only form of Hydrocodone without a combination currently on US market.
Hydrocodone is habit-forming, and can lead to physical and psychological addiction; however, the potential for addiction varies from individual to individual depending on unique biological differences. In the U.S., many combination products containing hydrocodone were formerly Schedule III if under 15 mg per individual dose. As of October 6, 2014 all hydrocodone combination products were rescheduled to Schedule II.
The rescheduling of hydrocodone combination products came shortly after the controversial approval of an extended release pure hydrocodone (brand name Zohydro). The dosing range of Zohydro exceeds the previous 15 mg cap with dosage options of 10 mg, 15 mg, 20 mg, 30 mg, 40 mg and 50 mg delivered over 12 hours.
In Germany and elsewhere, hydrocodone is available as single-active-ingredient tablets as Dicodid (by analogy to the original manufacturer's other products Dilaudid and Dinarkon and others) available in 5 and 10 mg strengths.
In the UK, it is listed as a Class A drug under the Misuse of Drugs Act 1971. Vicodin is not licensed for use in the United Kingdom although the drug Co-Dydramol, which is a close equivalent is widely prescribed in its place.
Proposed U.S. ban
On June 30, 2009, a FDA advisory panel voted by a narrow margin to advise the FDA to remove Vicodin and another painkiller, Percocet, from the market because of "a high likelihood of overdose from prescription narcotics and acetaminophen products". The panel cited concerns of liver damage from their acetaminophen component, which is also the main ingredient in commonly used nonprescription drugs such as Tylenol. Each year, acetaminophen overdose is linked to about 400 deaths and 42,000 hospitalizations.
In January 2011, the FDA asked manufacturers of prescription combination products that contain acetaminophen to limit the amount of acetaminophen to no more than 325mg in each tablet or capsule. Manufacturers will have three years to limit the amount of acetaminophen in their prescription drug products to 325mg per dosage unit. The FDA also is requiring manufacturers to update labels of all prescription combination acetaminophen products to warn of the potential risk for severe liver injury.
The opioid constituent hydrocodone has the same basic structure as morphine but is metabolized by different enzymes. Hydrocodone, like oxycodone, is an intermediate-strength analgesic that has similar effects as morphine; hydrocodone is approximately twice as potent as morphine by mouth for acute use. The theory of using the mix comes from the idea that these drugs alleviate pain using different mechanisms and also that the adverse side-effects of each separate drug are reduced by using reduced dosages of both drugs in order to get the same analgesic effect. Both hydrocodone and paracetamol are white crystalline powders, which are then manufactured into tablet form. Manufacturers of hydrocodone include Abbott Laboratories (makers of trademark Vicodin), Amerisource Health Service Corp, Cardinal Health, Drx Pharmaceutical Consultants Inc, Eckerd Corp, Hospira Inc, Mallinckrodt Pharm. Quality Care, Pdrx Pharmaceuticals Inc, Physicians Total Care Inc, Rx Papoos Packaging Inc, and Watson Pharmaceuticals. Hydrocodone/paracetamol, in all strengths by all manufacturers, has been the #1 prescription filled in the US since 2002 with an estimated 136.7 million prescriptions filled in 2011.
On the show
Gregory House's Vicodin addiction can rightfully be seen as its own story arc through the series, essentially starting with the events in Three Stories and finally ending with the final episode Everybody Dies. Episodes where House tries to kick the habit (either intentionally or when circumstances force it upon him) punctuate other key story arcs in the series from Tritter to Huddy.
The addiction is just another parallel with Sherlock Holmes, who later in life became addicted to cocaine to deal with the boredom of a lack of criminal masterminds. Like Holmes, House usually can cut back on his Vicodin use when he has an interesting case.
To prepare himself for the role, Hugh Laurie actually tried Vicodin to see what it was like.
- "If you are in pain, it does the job, and if you're not in pain, it also does the job."
- ―Hugh Laurie on Vicodin
Pilot shows the first cause for concern. When faced with a malingering hypocondriac clinic patient, House writes a prescription for Vicodin for the man, but fills the bottle with mints from a candy machine nearby, pocketing the real drug himself. This is despite the fact we are already aware he has a "free floating" prescription for the drug.
In Paternity, House meets a patient who has stabbed himself with a nail file and obviously has a history of suing physicians. House offers him a Vicodin to try to build a relationship, but the patient sues him anyway. House gets back at him by faking a positive gonorrhea test, meaning he has to tell the man's wife about the result by law.
First withdrawal attempt
Detox marks the first time House tries to kick the habit. House is, at this point, in denial about his addiction. He insists that he needs the Vicodin to treat his leg pain, which allows him to do his job. Wilson suggests to Cuddy that she bet House that he can't give up Vicodin. Cuddy has a file for House and finds him engaged in another behavior typical of addicts - he's at the pharmacy venting his anger at Marco because the hospital's new Vicodin shipment will be an hour late. When he returns an hour later and gulps down the pills, Cuddy suggests the bet. House can't see any reason why he should co-operate, but Cuddy makes him an offer he can't refuse - a full month without clinic duty if he can go without Vicodin for a week. House takes the bait and stops taking the pills.
Wilson goes to visit House's team to let them know about the bet and keep an eye on House to make sure he's all right. House first insists he's not feeling any of the effects of withdrawal. He even arranges for House to get a massage from a beautiful woman to help with his pain.
However, aftaser a while, House realizes he's suffering badly from his decision. In a desperate bid to relieve the withdrawal symptoms and the pain from his legs, he deliberately breaks bones in his hand with a large paperweight. Wilson treats the injury and when House says it was because he caught his hand in a door, Wilson knows he's lying because the trauma didn't break the skin. He correctly surmises that House did it to release endorphines to deal with the pain.
Soon, the withdrawal is causing House to vomit, but when Foreman asks about it, House insists that it's pain causing him to vomit. Because Foreman is more interested in the welfare of House's current patient, he offers House Vicodin and promisses not to tell. However, House actually stands on principal and refuses to take the pills.
After House sucessfully diagnoses the patient and gets through the rest of the week, he goes back to Vicodin. He admits he's an addict, but denies that it's a problem as he still functions as a doctor. Wilson doesn't believe him, but is at a loss as how to argue otherwise.
Season One continues....
In Three Stories, House describes the case of Mid 30s man, who is described as a drug seeker. As he tells the students at the lecture that drug addicts are stupid, he pops a Vicodin. Mid 30s man is, of course, a description of House himself at the time he suffered his infarction. We learn for the first time that House had drug problems well before his disability.
At the very end of the last episode of the season, Honeymoon, after he agrees to let his ex-girlfriend Stacy Warner continue to work at the hospital, House tries to walk across the floor of his apartment without his cane. When his right leg gives up on him as he tries to put his weight on it, he reaches for a Vicodin to deal with the pain.
Chase suffers for spilling House's Vicodin all over the conference room while trying to open a safety cap in The Mistake. As a result, Chase is ordered to do the physical exam of the patient. When Stacy hears about the story, she tells Chase not to let the peer review panel know what actually happened.
House celebrates with Vicodin after solving the case in Skin Deep.
After being shot in No Reason, House instructs the emergency team to give him ketamine during surgery. It works and House has weeks free of leg pain. However, as his leg pain starts to return, he begs Wilson to prescribe him Vicodin. Wilson refuses as he thinks House is just suffering normal leg pain. House grows more desperate and steals Wilson's prescription pad, setting up the events for the rest of the season.
In Cane & Able, House is back using Vicodin and is lying to Cuddy and Wilson about his leg pain. Ironically, when Wilson notes House has stopped exercising, he gives House Vicodin willingly to convince him to work on his leg again. House refuses, even though he already has an illicit source.
House takes a Vicodin in full view of a difficult clinic patient in Fools for Love, then sticks a thermometer up the man's rectum. However, the man turns out to be a police officer, Michael Tritter. He follows House on his motorcycle and during a traffic stop, searches for and finds House's Vicodin. He arrests House and holds him overnight.
In Que Será Será, Tritter gets a search warrant and finds several hundred tablets in House's apartment. He gets the district attorney to add a charge of trafficking. Tritter then confronts Wilson about the forged prescriptions in his name. Wilson lies and says he signed all the prescriptions
In Son of Coma Guy, Wilson confronts House about the deception. House is nonchalant and reminds Wilson that Tritter has nothing to go on. However, Tritter is questioning House's team. Cameron protects House by telling Tritter he only takes about six pills a day. Foreman is completely uncooperative due to his dislike of police officers. Chase is similarly protective. However, Tritter turns up the pressure by freezing Wilson's bank accounts.
By Whac-A-Mole, House is desperate for a prescription, but Tritter has also suspended Wilson's ability to prescribe narcotics. Tritter also seizes Wilson's car. House turns to his team, but they turn him down flat. House finally turns to Cuddy, who realizes that if she cuts House off, Tritter will only be more suspicious and she agrees to provide him a prescription.
The pressure is really turned up in Finding Judas. Cuddy puts House on a fixed timetable for his Vicodin rather than a free floating prescription. Tritter freezes the bank accounts of Foreman and Cameron and then makes it look like Chase is co-operating. However, House doesn't fall for the bait. House is, however, getting more and more desperate. During a difficult part of the case, he hauls off and punches Chase, who nevertheless gives House the answer to the case. After Wilson finds out about the assault, he turns to Tritter to co-operate.
In Merry Little Christmas, Tritter and Wilson work out a plea deal, but House refuses it. To put pressure on House to accept the deal, Wilson convinces Cuddy to cut off House's Vicodin altogether. However, they all have second thoughts when their new patient keeps getting worse. House gets more and more desperate for drugs and finally steals a bottle destined for one of Wilson's patients. Cuddy realizes House has managed to get drugs, but when he quickly solves the case, she's willing to live with it. Wilson tells Tritter he's not going to co-operate any more, even if it means both he and House might head to prison. However, when House nearly overdoses, he had a change of heart and goes to Tritter to accept the deal. However, Tritter has found out about the stolen drugs and has withdrawn it.
In order to try to get Tritter off his back, House heads to rehab. Tritter is unimpressed and the court case continues, despite House's angry reaction. However, the case comes to an end when Cuddy perjures herself to say that House got a placebo. The judge dismisses the case and Tritter backs off. House is sent to jail for contempt, and when Wilson visits him, he learns that a hospital orderly has secretly been getting Vicodin to House during rehab. He realizes nothing has changed.
Season Three continues
In Top Secret, one of Vicodin's side effects comes to the fore - House's urethral sphincter goes into spasm, leaving him unable to urinate normally. He deals with the problem by catheterizing himself.
In You Don't Want to Know, the patient, a magician, pranks House by picking the Vicodin from his pocket.
In House's Head, House keeps taking Vicodin to put himself into altered states to try to revive his memory of the evening's events after he is injured in a bus crash.
In Birthmarks, Wilson uses Vicodin to keep House on a tight leash as he drives him to his father's funeral.
In The Softer Side, House's team and friends start to realize they haven't seen him taking Vicodin, he's not limping as much, and he stops breathing at one point. Wilson and Foreman jump to the conclusion that House is on heroin, but it turns out he's on methadone. When Cuddy tells him he has to stop, House quits, but she agrees to take him back when she has a change of heart. However, House starts to feel the methadone is clouding his judgment, and he turns back to Vicodin.
In Saviors, House's Vicodin use combined with severe insomnia and grief over the death of his father and Kutner lead him to hallucinations about Amber Volakis. The Amber hallucination starts to haunt him and provide a direct line to his subconscious mind.
The situation gets worse in Under My Skin when House hallucinates an entire episode where Cuddy not only helps him detox from Vicodin, but has sex with him too. In reality, House has insulted Cuddy's daughter and sees a bottle of Oxycodone as Cuddy's lipstick.
In Both Sides Now, House is once again confronted by the Amber hallucination and realizes his belief in both his rehabilitation and Cuddy were delusions. Cuddy is reconciliatory after House embarasses her when she realizes House can't tell the difference, and House finally allows Wilson to take him to a psychiatric hospital.
In Broken, House soon manages to detox, but his treating physician Darryl Nolan won't let him return to practice until he seeks proper treatment, fearing House will soon relapse. Although House initially tries to game the situation, he soon concedes he needs help and, after several weeks, is well enough to leave the hospital.
As he tries to find altenative distractions in Epic Fail, he finally realizes that diagnostic medicine is the only distraction that helps his pain. Dr. Nolan agrees to let him go back.
In Lockdown, Foreman and Taub experiment with Vicodin when they get locked in the hospital's record storage room. They start hitting each other to see if it hurts, then start blabbing personal things about themselves.
After House loses a patient in Help Me, he goes after his last remaining stash of Vicodin, hidden behind the mirror in his bathroom. However, as he's making up his mind, Cuddy appears and tells him she's left her fiance because she's realized she's always wanted House.
In Now What?, Cuddy, just to be on the safe side, picks up the Vicodin that was spilled when House tore his medicine cabinet out of the wall. When Wilson shows up and House says that Cuddy's there, then she hides, Wilson wants to know how many Vicodin House has taken.
In Recession Proof, the team finds Vicodin during an environmental scan of the patient's office. House believes it might not be Vicodin and offers to test it out. After smelling and tasting one of the pills, he puts it back and returns the bottle intact, declaring it is Vicodin. The patient admits he was taking it to deal with the pain of his job as a janitor.
In Bombshells, House is unable to cope with Cuddy's medical scare and takes Vicodin so he has enough nerve to be at her side. When Cuddy realizes he's using again, she breaks up with him and House returns to his use of the drug.
By Out of the Chute, House is self-prescribing. Masters is astounded to find out that House has been working under the influence of the drug for years. House goes on a full on Vicodin binge, ending in an episode where he jumps off a balcony into a hotel pool.
In Fall From Grace, House is openly taking Vicodin in front of Masters.
House tries an experimental muscle building drug in The Fix, telling Thirteen that his leg pain was getting worse and he's afraid increasing his Vicodin will result in him going back to Mayfield. However, when he feels it isn't working, he turns back to Vicodin.
House takes Vicodin to prepare himself for his self-surgery in After Hours. He takes more while he's waiting for a real surgeon to repair the damage.
In Moving On, Wilson finds out that House is forging prescriptions again, and that he's taking a month's supply of the drug in just a week.
Vicodin drives the plot of Twenty Vicodin. The New Confederates have been taking a third of House's daily allotment, usually using it to deal with the pain of their prison tattoos. When they find House is about to be released, they tell him he has to come up with twenty capsules as an "exit tax" even though House won't even get that many before he's released. House turns to Porter for help, but the New Confederates have bought out his entire supply. House starts hoarding his pills, but flushes them down the toilet to avoid a contraband charge that will delay his parole. He first starts a distraction to steal pills, then at the last minute, Adams takes pity on him and supplies him with the drug. However, House uses it to start another distraction, throwing them in the air so he will get injured and sent back to the infirmary.
When Foreman gets House out of prison on parole in Transplant, he makes it clear that if House tries to scam Vicodin, he's going back to jail.
In Runaways, House uses his Vicodin to tempt the patient's mother, a former addict. She gives him back the pills.
In Nobody's Fault, Dr. Cofield is astounded House is on Vicodin. However, later when he tries to take a pill in front of Cofield, it explodes with confetti, a prank developed by Chase to get back at House for his pranks.
- Vicoprofen, a mixture of Hydrocodone and ibuprofen
- Percocet, a mixture of oxycodone and acetaminophen
- Vicodin at the House MD Guide
- Fanpop examines the difference when House is on or off Vicodin
- Hydrocodone/paracetamol at Wikipedia - This article uses content from Wikipedia
- Hydrocodone fact sheet at DEA
- Vicodin at NIH
- Vicodin at Drugs.com
- Vicodin at RxList.com
- Vicodin Abuse at DrugAbuse.com
This article was the featured article for December, 2013.
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