Hydrocodone
Hydrocodone is a semi-synthetic opioid of the morphinan class, derived from codeine.12 First synthesized in Germany in 1920 by Carl Mannich and Helene Löwenheim,3 it is used primarily as an analgesic and cough suppressant.1 Hydrocodone is almost exclusively prescribed within the United States, where it is most commonly formulated in combination with acetaminophen or ibuprofen.14 The presence of acetaminophen in most preparations poses a significant risk of liver toxicity at high doses.2
Contents
Dosage & Duration
Dosage
Duration
Subjective Effects
The hydrocodone experience is dominated by classic opioid effects: pain relief, mood elevation, and a warm, relaxed euphoria accompanied by sedation. Sensory alteration is minimal; instead, the experience centers on physical comfort and an emotionally contented, mentally clouded state. At higher doses, sedation deepens into drowsiness and respiratory depression becomes a serious risk.
Physical
Pronounced analgesia and muscle relaxation form the core of the body experience, accompanied by sedation and itchiness. Uncomfortable effects such as nausea, vomiting, constipation, dizziness, light-headedness, and dry mouth are common.
Cardiovascular
Sedation
Uncomfortable
Cognitive
The headspace is characterized by an improved and abnormally happy mood alongside mental clouding, with noticeable changes in focus and attention. Some users instead experience anxiety or a shift toward a low mood.
Emotional
Mood elevation is a defining feature, though anxiety and abnormal sadness are also reported.
Suppressions
Reagent Testing
Loading reagent data
Pharmacology
Pharmacodynamics
Hydrocodone is a highly selective full agonist of the μ-opioid receptor (MOR), which constitutes its primary pharmacological target.5 It also acts as an agonist at the δ-opioid receptor (DOR) and the κ-opioid receptor (KOR), though with substantially lower affinity; its affinity at DOR is approximately six-fold less than at MOR. Through these receptor interactions, hydrocodone inhibits pain signaling in both the spinal cord and brain.5 It is reported to be approximately one-tenth as potent as morphine at binding to opioid receptors.
Pharmacokinetics
Hydrocodone is available only as an oral medication, with an estimated oral bioavailability of approximately 25%.6 It is metabolized in the liver through multiple pathways: CYP2D6 catalyzes O-demethylation to hydromorphone (a more potent active metabolite with approximately 5-fold higher MOR binding affinity), while CYP3A4 catalyzes N-demethylation to norhydrocodone, the major metabolite.75 Despite its higher receptor affinity, hydromorphone is not generally present in sufficient quantities to contribute significantly to the effects of hydrocodone. Norhydrocodone is a MOR agonist with similar receptor potency to hydrocodone but appears to produce minimal analgesia due to poor penetration of the blood-brain barrier.8 Approximately 40% of hydrocodone metabolism is attributed to non-cytochrome P450-catalyzed reactions.7 Hydrocodone and its metabolites also undergo 6-ketoreduction and glucuronide conjugation, with urinary excretion (primarily as conjugates) representing the main elimination route.5 The average plasma elimination half-life is reported as 3.8 hours (range 3.3–4.4 hours), though values of 7–9 hours have also been reported.59 Plasma protein binding ranges from 20 to 50%.6
Dangerous
Highest riskThese 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.
Unsafe
AvoidThere is considerable risk of physical harm when taking these combinations, they should be avoided where possible.
Caution
Use cautionThese 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.
Tolerance
Opioids (all opioid receptor agonists)
Harm Potential
Addiction & Dependence
Psychological
HighHydrocodone has significant abuse potential with abuse liability similar to morphine.10 Compulsive redosing is commonly reported, and chronic use is considered moderately to highly addictive with capability of causing psychological dependence.2
Physical
HighPhysical dependence develops with chronic use,2 and withdrawal symptoms occur upon sudden cessation.2 Newborns of mothers taking opioid medications regularly will be physically dependent at birth.2 Tolerance develops to many effects with prolonged use, requiring increasingly large doses.2
Toxicity
Dose-related respiratory depression is the primary life-threatening toxicity;2 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.2
Progressive bilateral hearing loss unresponsive to steroid therapy has been described as an infrequent adverse reaction to hydrocodone/acetaminophen misuse.11
Serious cardiovascular effects including bradycardia, hypotension, and QT prolongation may occur, primarily in overdose situations or at heavy doses.2
Constipation is a consistent effect that occurs even at therapeutic doses; tolerance to this effect develops particularly slowly compared to other opioid effects.
Seizure Risk
Seizures are listed as a serious side effect and symptom of overdose;2 they are not commonly reported at typical doses but may occur in overdose situations.
History & Culture
Synthesis and Early Development
Hydrocodone was first synthesized in Germany in 1920 by chemists Carl Mannich and Helene Löwenheim as a semi-synthetic derivative of codeine.13 The compound was patented in 1923 and first marketed by the pharmaceutical company Knoll under the trade name Dicodid…
Legality
International
Hydrocodone is listed in Schedule I of the 1961 Single Convention on Narcotic Drugs. It is not listed under the 1971 Convention on Psychotropic Substances. It is not listed under the 1988 Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances.
By Country
References
Source Pages
Citations
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