Pharmacokinetic evaluation of hydrocodone/acetaminophen for pain management.
ABSTRACT Hydrocodone/acetaminophen is not only the most commonly prescribed opioid in the United States but also the most common prescription medication written in America. Although original and early trials confirmed its ability to manage acute pain from surgery and musculoskeletal injury, it is perhaps more widely used today in the management of chronic pain. However, the opioid product was introduced for the management of moderate to moderately severe pain. Because it has been greatly abused as a prescription opioid medication, physicians need to be aware of the current knowledge regarding this analgesic drug. This review summarizes the current knowledge of the pharmacokinetics, pharmacodynamics, and metabolism of hydrocodone. Recent information regarding the possibility of hydrocodone as a prodrug for hydromorphone is discussed. The available clinical trials for the use of hydrocodone in the management of acute, chronic, and cancer pain are presented.
[Show abstract] [Hide abstract]
ABSTRACT: Purpose. The current epidemic of prescription opioid abuse and misuse in the United States is discussed, with an emphasis on the pharmacist's role in ensuring safe and effective opioid use. Summary. U.S. sales of prescription opioids increased fourfold from 1999 to 2010, with an alarming rise in deaths and emergency department visits associated with the use of fentanyl, hydrocodone, oxycodone, and other opioid medications. Signs and symptoms of opioid toxicity may include altered mental status, hypoventilation, decreased bowel motility, central nervous system and respiratory depression, peripheral vasodilation, pulmonary edema, hypotension, bradycardia, and seizures. In patients receiving long-term opioid therapy for chronic pain, urine drug testing is an important tool for monitoring and assessment of therapy; knowledge of opioid metabolic pathways and assay limitations, is essential for appropriate use and interpretation of screening and confirmatory tests. In recent years, there has been an increase in federal enforcement actions against pharmacies and prescription drug wholesalers involved in improper opioid distribution, as well as increased reliance on state-level prescription drug monitoring programs to track patterns of opioid use and improper sales. Pharmacies are urged to implement or promote appropriate guidelines on opioid therapy, including the use of pain management agreement plans; policies to ensure adequate oversight of opioid prescribing, dispensing, and waste disposal; and educational initiatives targeting patients as well as hospital and pharmacy staff. Conclusion. Pharmacists in hospitals and health systems can play a key role in recognizing the various forms of opioid toxicity and in preventing inappropriate prescribing and diversion of opioids.American Journal of Health-System Pharmacy 09/2014; 71(18):1539-1554. DOI:10.2146/ajhp140157 · 2.21 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Many patients with chronic pain receive substandard analgesic therapy. Incomplete or inadequate care often stems from physician fears of patient addiction and/or drug toxicity. As a result, many chronic pain patients are undertreated and have unrelieved pain that tempts them to overuse or to abuse prescribed pharmacologic treatments. In the last few years, educational efforts have targeted physicians who treat chronic, nonmalignant pain with information to improve prescribing strategies and to appreciate side effects. Additionally, opioid prescribing guidelines and educational programs, including World Health Organization-published guidelines for the management of cancer pain in 1986 and the American Pain Society's promotion of pain as the 5(th) vital sign, have increased the propensity of pharmacists, physicians, and pain specialists to dispense pain treatments. Controversial and evolving consequences from this explosion of prescription opioid use have emerged and are discussed in this review, including prescribing principles, opioid analgesic side effects, and driving concerns. With additional appreciation for the untoward effects of chronic analgesia and a better understanding of opioid pharmacology, physicians can utilize pain management treatments in a safer and more effective manner.Ochsner Journal 01/2013; 13(4):525-532.
Journal of opioid management 11/2014; 10(6):3-10. DOI:10.5055/jom.2014.0228