http://www.nlm.nih.gov/medlineplus/ency/article/007285.htm Hydrocodone/oxycodone overdoseEmail this page to a friendShare on facebookShare on twitterBookmark & SharePrinter-friendly version Hydrocodone and oxycodone are drugs that are mostly used to treat extreme pain.
Hydrocodone/oxycodone overdose occurs when someone intentionally or accidentally take too much medicine containing these ingredients. A person may accidentally take too much of the medicine because they are not getting pain relief from their normal doses. There are several reasons why a person may intentionally take too much of this medication. It may be done to try to hurt oneself or to “get high” or intoxicated.
See also: Overdose
This is for information only and not for use in the treatment or management of an actual poison exposure. If you have an exposure, you should call your local emergency number (such as 911) or the National Poison Control Center at 1-800-222-1222.
Hydrocodone and oxycodone belong to a class of narcotic medications called opiates. These medications are man-made versions of the natural compounds found in opium.
Hydrocodone and oxycodone are usually found in prescription painkillers. The most common painkillers that include these two ingredients are:
OxyContin Percocet Percodan Vicodin Vicodin ES These medicines may also be combined with a non-narcotic medicine, acetaminophen (Tylenol). See also: Acetaminophen overdose
When you take the correct or prescribed dose of these medicines, side effects may occur. In addition to relieving pain, you may feel drowsy, confused and in a daze, constipated, and possibly nauseous.
When you take too much of these medications however, symptoms become much more serious. Symptoms include:
Extreme sleepiness Breathing problems Small pupils -- the black circle in the colored part of your eye The first thing that will likely occur is that you will become extremely sleepy. Depending on how much you take, this can range from struggling to stay awake to being completely unconscious -- family members may shake you very hard without waking you up.
The most dangerous complication of this type of overdose is the effect on your breathing. A hydrocodone/oxycodone overdose can cause your breathing to slow down, become more shallow, and possibly stop, depending on how much medication you have taken. (See: Breathing - slow or stopped)
If someone looked at your eyes, they would likely see that your pupils were extremely small. Doctors call this “pinpoint pupils” -- this sign is often used to help identify a hydrocodone/oxycodone overdose.
Before Calling Emergency
Determine the following information:
The patient's age, weight, and condition Name of product (as well as the ingredients and strength if known) The time it was swallowed The amount swallowed If the medication was prescribed for the patient Poison Control
The National Poison Control Center (1-800-222-1222) can be called from anywhere in the United States. This national hotline number will let you talk to experts in poisoning. They will give you further instructions.
This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.
Take the container with you to the hospital, if possible.
See: Poison control center - emergency number
What to Expect at the Emergency Room
If you arrive in the emergency room it is likely that someone found you unconscious or extremely drowsy. The health care team will give you oxygen to help you breathe better.
If your breathing is so poor that doctors believe serious danger to your health exists, they will likely give you medicine to rapidly reverse all of your symptoms. Such medicine is known as an antidote. The antidote used for this type of overdose is naloxone (Narcan). However, doctors may not rush to use it. The medicine can have very severe and unpleasant side effects. As long as your breathing is acceptable, no long term damage will occur. The health care team may just closely monitor you.
Other treatments include activated charcoal with a laxative to try to soak up drug that is still left in your stomach or intestines.
Additional therapies may be needed if you took the hydrocodone/oxycodone with other drugs such as Tylenol or aspirin.
If you receive medical attention before serious problems with your breathing occur, you should have few long-term consequences, and will probably be back to normal in a day.
However, this overdose can be deadly or can result in permanent brain damage if treatment is delayed and a large amount of oxycodone or hydrocodone is taken.
Overdose - hydrocodone; Overdose - oxycodone; Vicodin overdose; Percocet overdose; Percodan overdose; MSContin overdose; OxyContin overdose
Goldfrank LR, Flomenbaum NE, Lewin NA, et al. Goldfrank's Toxicologic Emergencies. 8th ed. New York, NY: McGraw-Hill; 2006.
Update Date: 2/2/2011
Updated by: Eric Perez, MD, Department of Emergency Medicine, St. Luke's-Roosevelt Hospital Center, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
January 30, 2013
FDA Advisory Committee Votes 19 to 10 In Favor of Rescheduling Combination Hydrocodone By Delia A. Stubbs –
Last Friday, January 25, 2012, after two days of discussion and deliberation, an FDA Advisory Committee voted 19 to 10 in favor of rescheduling combination hydrocodone from its current placement in Schedule III to Schedule II.
The decision was informed by presentations from various perspectives, including high ranking government officials from FDA and DEA, professional societies, practitioners, industry representatives, and family members who lost loved ones to prescription drug abuse. What began as a conversation about abuse-ratios (FDA and DEA had competing views), soon developed into a conference about prescription drug abuse generally; the practical impact of rescheduling on prescribing practices, patient access, drug distribution, opioid abuse and misuse; and alternatives to rescheduling that would equally or more effectively reduce hydrocodone misuse and abuse.
Industry representatives argued that up-scheduling hydrocodone would impose huge costs on pharmacies, distributors, and patients with no discernible reduction on abuse and diversion. While some committee members gave little weight to these increased costs, they also shared a concern about the change’s overall effectiveness, noting the widespread abuse of opioids currently placed in Schedule II. Patient representatives remarked that rescheduling would increase patient (and payer) costs and impede patient access because Schedule II controlled substances, versus Schedule III controlled substances, may not be refilled. Thus, patients who currently see their physicians twice-a-year would be required to do so as often as once a month. To avoid the need for monthly visits, they explained, prescribers may react by increasing prescription volume, which, in turn, raises the risks of abuse and diversion, by increasing the number of pills available inside the home.
Advocating for the change from Schedule III to II, DEA Deputy Assistant Administrator, Joseph Rannazzisi, argued that tightening security and control of combination hydrocodone products by pharmacies and distributors, and increasing DEA’s enforcement tools, would reduce abuse and diversion of combination hydrocodone. See DEA Slides, here. He argued that many individuals start abusing combination hydrocodone due to its ease of availability, build a tolerance, and consequently move on to stronger opioids such as oxycodone and heroin. However, he recognized that, “I am not going to be able to provide you with clear evidence [that rescheduling will work to reduce prescription opioid abuse] because there is no clear evidence until the drug actually gets rescheduled.” In response to patient access concerns, he asked, “Is it really that bad to have to see a patient every 3 months?,” and identified a rule DEA promulgated in 2008 that allows prescribers to issue up to three post-dated 30-day prescriptions for the same Schedule II substance at one time. He recognized, however, that many prescribers do not avail themselves of the rule.
The Committee discussed other activities that might address misuse and diversion of hydrocodone, including interoperable Prescription Drug Monitoring Programs, drug disposal initiatives, provider and patient education, and Risk Evaluation and Mitigation Strategies (“REMS”). One Committee member who voted in favor of rescheduling stated that placing hydrocodone combination products in Schedule II is the best way to educate providers on the drug’s abuse potential.
Overall, in recommending rescheduling, many Committee members were persuaded by evidence showing combination hydrocodone acts similar to other Schedule II controlled substances, such as morphine and oxycodone. Sharon Walsh, Ph.D., from the Center on Drug and Alcohol Research, University of Kentucky, presented evidence from human studies showing no significant difference between combination hydrocodone and combination oxycodone drugs on pupil diameter and drug “likeability.” See S. Walsh Slides, here. When asked by committee members for her opinion as to whether there was a meaningful difference in those drugs’ abuse potential, she opined that the drugs’ abuse potential was indeed the same. Many Committee members later referenced Ms. Walsh’s presentation when casting their vote in favor of rescheduling.
The Advisory Committee’s recommendation is not binding on FDA and there is no statutory time-limit on when FDA must respond to DEA’s request for a scheduling recommendation. Because there is a pending petition before DEA to reschedule these drugs, when FDA provides its recommendation to DEA, DEA will then likely proceed with a notice and comment rulemaking proposing to reschedule the drug.
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