Posted by mattw84 on January 14, 2005, at 15:31:27
In reply to Re: CHEMIST-difference between hydrocodone/oxycodone? » jerrympls, posted by ed_uk on January 14, 2005, at 11:30:23
Subjectively most patients could differentiate between the effects of these two very similar drugs. Hydrocodone is generally used for a limited duratation -- as tolerance develops rather quickly. Indicated largely for cough suppression or short-term management of mild to moderate acute pain. (ie, respiratory infections, post-op pain releif..) -- As a side note studies have shown that hydrocodone is elative (euphoric) than most other natural and synthetic opioids.
Oxycodone can be used for similar purposes, most MD's would say that from experience oxycodone in low doses is much less likely to induce psychological dependance by dose relation to hydrocodone. However, oxycodone is available in extended release forms that allow for much more 'flexible' management of a patients pain. Generally you will see oxycodone exclusive formulations (Non aspirin containing) prescribed for long-term treatment and management of MODERATE to SEVERE pain. The anti-inflammatory/analgesic preparations are generally used for the same purpose as those with hydrocodone.
I read your earlier post about being prescribed oxycodone to treat refractory depression, which is very rare! Typically last case scenerio, largely because this class is not considered a psychological treatment -- thusly most MD's would shy away from prescribing opiates in your case. So consider yourself extremely fortunate to have such an open minded doctor.
I have seen a few case reports regarding the topic of opiates as treatment for refractory depression, one using Dialudad (Oxymorphone), and another with Buprenorphine. The results seemed very promising of an effective treatment.
Most recent research has been done involving Subutex (buprenorphine), not to mention with very high success rates. (70%+ overall improvement on the HAM-D scale) It all depends on what journal your doctor reads and his/her own personal experience on what he elects to use as treatment. Wisely he/she did not choose hydrocodone as the only available preparations contain aspirin or ibprofin -- which can be harmful with long term use. You might want to mention oxymorphone or buprenorphine if you aren't having any success with the oxycodone. Best of luck... and keep us posted on your progress!
Sincerely,
MattHere's a little tech info on some pharmokinetic differences between the two:
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Hydrocodone causes suppression of the cough reflex by a direct effect on the cough center in the medulla of the brain. The drug also appears to exert a drying effect on respiratory tract mucosa and to increase viscosity of bronchial secretions. On a weight basis, antitussive activity of hydrocodone is slightly greater than that of codeine. At equivalent therapeutic doses, hydrocodone is more sedating than codeine. The constipating effect of hydrocodone is less than that of morphine and not greater than that of codeineHydrocodone is well absorbed from the GI tract. Following oral administration of a single 10-mg dose of hydrocodone to adult males in one study, a mean peak serum hydrocodone concentration of 23.6 ng/mL occurred after 1.3 hours. Following oral administration, antitussive action is maintained for 4–6 hours.
The elimination half-life of hydrocodone is reportedly about 3.8 hours in healthy adults. Like other phenanthrene derivatives, hydrocodone is probably metabolized in the liver and excreted mainly in urine. Metabolism of hydrocodone includes O-demethylation, N-demethylation, and 6-keto reduction.
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Following oral administration of conventional preparations of oxycodone, the analgesic effect occurs within 10–15 minutes, reaches its maximum in 30–60 minutes, and persists for 3–6 hours. Following oral administration of oxycodone as an extended-release tablet, the onset of analgesia occurred within 1 hour in most patients. Oxycodone is extensively metabolized to noroxycodone and oxymorphone and their glucuronide conjugates, with the formation of oxymorphone mediated by cytochrome P-450 (CYP) isoenzyme 2D6; oxycodone and its metabolites are excreted principally in urine.The relative oral bioavailability of extended-release tablets of oxycodone hydrochloride compared with conventional oral preparations is 100%. The extended-release tablets are formulated to provide controlled delivery of oxycodone over 12 hours. In healthy individuals, the absorption half-life is 0.4 hours for conventional preparations versus 2 apparent absorption half-lives of 0.6 and 6.9 hours (corresponding to initial and prolonged release) for extended-release tablets. Release of the drug from the extended-release tablets is pH independent. In healthy adults who received a single dose of oxycodone as one 160-mg extended-release tablet after a high-fat (500–600 fat calories) breakfast, the peak plasma concentration was increased by 25% compared with administration in the fasting state. Following rectal administration of oxycodone hydrochloride extended-release tablets in healthy adults, the area under the plasma concentration-time curve (AUC) and peak plasma concentration were increased by 39 and 9%, respectively, compared with oral administration. With multiple oral dosing, steady-state plasma concentrations usually are achieved within 24–36 hours in healthy individuals receiving an extended-release preparation of oxycodone. The apparent elimination half-life following oral administration of extended-release or conventional preparations is 4.5 or 3.2 hours, respectively.
Following oral administration of oxycodone hydrochloride extended-release tablets in patients with renal impairment (creatinine clearance less than 60 mL/minute), peak plasma concentrations of the drug and its noroxycodone metabolite were 50 and 20% higher, respectively, and AUCs of oxycodone, noroxycodone, and oxymorphone were 60, 50, and 40% higher, respectively, than values in individuals with normal renal function. The elimination half-life of oxycodone was increased by 1 hour in patients with renal impairment compared with individuals with normal renal function. Administration of oxycodone hydrochloride extended-release tablets to patients with mild to moderate hepatic impairment resulted in increases in peak plasma concentrations and AUCs of oxycodone (50 and 95%, respectively) and noroxycodone (20 and 65%, respectively) but decreases in peak plasma concentrations and AUC of oxymorphone (30 and 40%, respectively). The elimination half-life of oxycodone was increased by 2.3 hours in patients with mild to moderate hepatic impairment compared with individuals with normal hepatic function.
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poster:mattw84
thread:441983
URL: http://www.dr-bob.org/babble/20050113/msgs/442189.html