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These combinations are considered extremely harmful and should always be avoided. Reactions to these drugs taken in combination are highly unpredictable and have a potential to cause death.
There is considerable risk of physical harm when taking these combinations, they should be avoided where possible.
These combinations are not usually physically harmful, but may produce undesirable effects, such as physical discomfort or overstimulation. Extreme use may cause physical health issues. Synergistic effects may be unpredictable. Care should be taken when choosing to use this combination.
Hydrocodone has significant abuse potential with abuse liability similar to morphine. Compulsive redosing is commonly reported, and chronic use is considered moderately to highly addictive with capability of causing psychological dependence.
Physical dependence develops with chronic use, and withdrawal symptoms occur upon sudden cessation. Newborns of mothers taking opioid medications regularly will be physically dependent at birth. Tolerance develops to many effects with prolonged use, requiring increasingly large doses.
Plasma hydrocodone concentrations in acute fatal overdoses typically range from 100-1,600 μg/L, compared to 5-30 μg/L in therapeutic use and 100-200 μg/L in recreational users. Co-administration with food or alcohol can significantly increase plasma concentrations. Fatal overdose risk increases sharply after periods of cessation and relapse due to reduced tolerance.
Dose-related respiratory depression is the primary life-threatening toxicity; at high doses or overdose this can progress to shallow or stopped breathing, anoxia, and death, particularly when combined with other CNS depressants.
Hydrocodone alone does not cause significant hepatotoxicity, but pharmaceutical preparations commonly contain acetaminophen which can cause serious liver damage or acute liver failure at high doses or with repeated use, particularly when combined with alcohol.
Progressive bilateral hearing loss unresponsive to steroid therapy has been described as an infrequent adverse reaction to hydrocodone/acetaminophen misuse.
Serious cardiovascular effects including bradycardia, hypotension, and QT prolongation may occur, primarily in overdose situations or at heavy doses.
Constipation is a consistent effect that occurs even at therapeutic doses; tolerance to this effect develops particularly slowly compared to other opioid effects.
Seizures are listed as a serious side effect and symptom of overdose; they are not commonly reported at typical doses but may occur in overdose situations.
Hydrocodone was first synthesized in Germany in 1920 by chemists Carl Mannich and Helene Löwenheim as a semi-synthetic derivative of codeine. The compound was patented in 1923 and first marketed by the pharmaceutical company Knoll under the trade name Dicodid beginning in February 1924. This naming…
Classified as a controlled drug requiring a prescription. Schedule 8 substances are considered drugs of addiction with recognized therapeutic use.
Hydrocodone is no longer available for medical use in Belgium.
Classified as a prohibited narcotic substance. Hydrocodone is no longer available for medical use in France.
Available by prescription under the trade name Biocodone. Prescriptions are more commonly issued for use as a cough suppressant (antitussive) rather than for pain relief.
Classified as a List I substance under the Opium Law (Opiumwet). Hydrocodone is not available for medical use and possession without a prescription or license is illegal.
Hydrocodone is no longer available for medical use in Sweden. The last remaining formulation was deregistered in 1967.
Listed as a Class A drug under the Misuse of Drugs Act 1971 and Schedule 2 under the Misuse of Drugs Regulations. Hydrocodone is not available for medical use in the UK; dihydrocodeine formulations are commonly used as alternatives.
Regulated under the Austrian Suchtmittelgesetz (SMG) in a similar manner to Germany. Since 2002, hydrocodone products from Germany and elsewhere in the European Union have been available under Article 76 of the Schengen Treaty.
Controlled under the Controlled Drugs and Substances Act. Available only by prescription, both as a single-ingredient formulation and in proprietary combinations with NSAIDs or paracetamol.
Listed under Anlage III of the Betäubungsmittelgesetz (Narcotics Act) as a Suchtgift. Can only be prescribed using a special narcotic prescription form (Betäubungsmittelrezept).
Requires a valid prescription for legal acquisition. Not available over-the-counter despite contrary rumors.
Classified as a Schedule I controlled substance under Russian drug control legislation.
Listed as a controlled substance under Verzeichnis A of Swiss narcotics legislation. Medicinal use is permitted with appropriate authorization.
As of October 6, 2014, all hydrocodone products are designated Schedule II controlled substances under the Controlled Substances Act. Prior to this date, combination products containing 15 mg or less per dosage unit were classified as Schedule III. Prescriptions cannot be refilled and require a new written prescription for each fill.
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