GENERIC NAME: hydrocodone and ibuprofen

BRAND NAME: Vicoprofen

DRUG CLASS AND MECHANISM: Vicoprofen is a combination of an opioid analgesic (pain reliever related to narcotics, hydrocodone) and a nonsteroidal anti-inflammatory drug (ibuprofen). Both medications are effective against pain. It is estimated that one tablet of Vicoprofen is as effective as two tablets of Tylenol #3 (acetaminophen 300 mg plus codeine 30 mg). Vicoprofen was approved by the FDA in 1997.

GENERIC AVAILABLE: yes

PRESCRIPTION: yes

PREPARATIONS: Tablets: hydrocodone 7.5 mg and ibuprofen 200 mg

STORAGE: Tablets should be stored at room temperature, between 15 and 30°C (59-86°F).

PRESCRIBED FOR: Vicoprofen is used for the treatment of mild to moderate pain.

DOSING: Vicoprofen usually is taken every 4 to 6 hours as needed for the relief of pain. The manufacturer recommends a maximum of 5 tablets per day.

DRUG INTERACTIONS: Hydrocodone, like other narcotic pain-relievers, interacts with other medications and drugs that slow the brain's processes, such as alcohol, barbiturates, skeletal muscle relaxants including carisoprodol (Soma), cyclobenzaprine (Flexeril), and benzodiazepines (e.g. lorazepam, Ativan; clonazepam, Klonopin).

Opioids such as hydrocodone can slow bowel motility. When combined with medications that possess anticholinergic activity, this effect on the bowel may be accentuated, leading to marked constipation. Such drugs include dicyclomine (Bentyl), some antihistamines [carbinoxamine (Rondec), clemastine (Tavist), diphenhydramine (Benadryl), promethazine (Phenergan)], some phenothiazines [e.g. thioridazine (Mellaril), triflupromazine (Stelazine)], some tricyclic antidepressants [e.g. amitriptyline (Elavil), amoxapine (Asendin), clomipramine (Anafranil), protriptyline (Vivactil)], clozapine (Clozaril), cyclobenzaprine (Flexeril), and disopyramide (Norpace). The use of antidiarrheals [e.g. diphenoxylate (Lomotil), loperamide (Imodium)] in persons taking opioid analgesics such as hydrocodone can lead to severe constipation and possibly greater sedation.

Cimetidine (Tagamet), when used with opiate analgesics such as hydrocodone, can cause confusion, disorientation, seizures or respiratory depression by increasing blood concentrations of the opiate.

Ibuprofen--which has blood thinning (anticoagulant) properties--is used with caution in patients taking other blood thinning anticoagulants such as warfarin (Coumadin), because of an increased risk of bleeding. Patients taking lithium can develop toxic blood lithium levels if ibuprofen is taken at the same time.

PREGNANCY: There is very little information about the effects of hydrocodone on the fetus. Physicians may elect to use hydrocodone if its benefits are deemed to outweigh potential risks.

NURSING MOTHERS: It is not known if hydrocodone is secreted in breast milk.

SIDE EFFECTS: The most frequent side effects experienced with hydrocodone include lightheadedness, dizziness, sedation, nausea, and vomiting. Other side effects include constipation and spasm of the ureter, which can lead to difficulty in urinating.

The most common side effects of ibuprofen involve the gastrointestinal system. It can cause ulcerations, abdominal pain, cramping, nausea, gastritis, and even serious gastrointestinal bleeding. Sometimes, stomach ulceration and bleeding can occur without abdominal pain, and black tarry stools, weakness, and dizziness upon standing may be the only signs of internal bleeding. Rash, kidney impairment, ringing in the ears, and lightheadedness also can occur.

Hydrocodone can depress breathing, and is used with caution in elderly, debilitated patients and in patients with serious lung disease. Hydrocodone can impair thinking and the physical abilities required for driving or operating machinery. Hydrocodone may be habit forming. Mental and physical dependence can occur but are unlikely when used for short-term pain relief.

Reference: FDA Prescribing Information