Saturday, December 13, 2008

Cough and hydrocodone products

Today, I'd like to write about a very delicate topic. I can't ever remember reading about all of this in any journal and yet I've seen this being used in practice in every state in which I have lived: use of narcotic medications to treat cough.

Part of the cough reflex travels up to the brain and back down the vagus nerve to the chest wall muscles. When these muscles contract, the lungs are suddenly and harshly squeezed, which we hear, see, and feel as a cough. The brain and muscles can be literally relaxed with dextromethorphan, a non-narcotic, or hydrocodone or codeine, both narcotics. This means the latter have substance-abuse potential and are "controlled substances" - that is a special license for physicians is necessary for these to be prescribed. The distribution of these medications is closely monitored in each state. Unfortunately, a number of generic manufacturers of hydrocodone used to exist plus the use of hydrocodone was assessed to be excessive. The result was that the
FDA took enforcement action on 9/28/07. It stated there should no further manufacture of unapproved products containing hydrocodone by 12/31/07 and no further sale of unapproved products by 3/31/08. This had the intended effect of reducing hydrocodone prescriptions, by reducing the number of manufacturers, now 7 by count, but also by raising the price.

I try very hard not to prescribe hydrocodone, but there are times when it can quiet a severe cough long enough for the patient to get some rest from not coughing so hard or so long. When used for short periods of time without recurrent use and in small doses, the potential for addiction and abuse is very low. If you have questions about cough and hydrocodone products, ask your doctor...

Addendum: ballpark prices I have been quoted is $9.00 per ounce or more. So they are expensive cough medications.

Addendum 2 (1/18/09): I've learned that seven available products combine hydrocodone with different medications. None are superior to any other to my knowledge.


Anonymous said...
This morally despicable forced change of medication is making thousands upon thousands of asthma

sufferers sick.

See their explanations of what is going at these two links:

Fight back and hold those responsible for this travesty accountable.
The National Campaign to Save CFC Asthma Inhalers

Neil Kao said...

The comment above may be on the wrong post. CFC inhalers are nearly total and permanent extinction.

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