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Despite wide scale use for many decades, hydrocodone by itself has not been convincingly linked to instances of clinically apparent acute liver injury. However, when combined with acetaminophen, hydrocodone combinations have become a common cause of acetaminophen acute liver injury. The typical history is of a patient who began taking more than the prescribed number of pills over several days, attempting to achieve more of an opiate effect and leading secondarily and unintentionally to an overdose of acetaminophen. Because of the potential for hepatotoxicity, the FDA has warned against the use of opioid combinations in which the dose of acetaminophen is greater than 325 mg per tablet.
Hydrocodone, like other opiates, is metabolized in the liver by the P450 microsomal oxidizing enzyme system, and levels can be significantly affected by either inhibitors of CYP 3A4 (which increase levels and can lead to toxicity) or inducers of the enzyme (which decrease levels and can affect efficacy).
References on the safety and potential hepatotoxicity of hydrocodone are given in the Overview section of the Opioids.
Drug Class: Opioids
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REPRESENTATIVE TRADE NAMES
Hydrocodone (with Acetaminophen) Generic, Co-Gesic, Vicodin
Product labeling at DailyMed, National Library of Medicine, NIH
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CHEMICAL FORMULA AND STRUCTURE
DRUG CAS REGISTRY NO. MOLECULAR FORMULA STRUCTURE