Zohydro: The Next Oxycodone is On the Way

A single ingredient sustained release hydrocodone product  to be called Zohydro is currently in phase 3 clinical trials by Zogenix, and if it gets FDA approval is likely to become the next Oxydontin as a drug of abuse and addiction potential.  I watched a segment on the evening news this week about Zohydro, and it is certainly not going to come to market without fanfare.  Experts on the newscast did a pretty fair job of outlining the concerns of Zohydro, the potential for abuse and the issues with high dose single ingredient opioid products.  Opioid overdose is much more likely with drugs where a very high dose of the drug is contained in a single pill.

Oxycontin has a reputation as probably the most abused of the prescription opioids because of its lack of acetaminophen, its high percentage of rapid release oxycodone, and its lack of properties preventing crushing the pills which eliminates the extended release properties and makes it possible to inhale, inject or smoke the drug.  Sometimes known as Hillbilly Heroin, Oxycontin is among the leading causes of prescription drug overdose deaths and opioid addiction in the U.S.

If Zohydro receives FDA approval as a single ingredient, high dose hydrocodone product there is little doubt that it will join Oxycontin as a major drug of abuse.  Proponents of non-acetaminophen opioid pain medications are correct when they state that acetaminophen has its own problems, and especially when too many pain pills are taken to get pain relief the daily acetaminophen dosage can exceed the 4000 mg / day maximum safe dose.  Serious and even fatal acetaminophen liver damage can result.  Still single ingredient opioid products are so prone to diversion, addiction, and abuse that I anticipate that Zohydro, if approved, will quickly become a major drug of abuse.

One thing physicians have on our side now is the Oxycontin experience.  We will be much more skeptical of allowing escalating Zohydro doseage and addiction become commonplace. Still I am not looking forward to one more drug with few advantages and much abuse potential coming to market.

Oxycontin is available in doses of 10, 15, 20,30, 40, 60 and 80 mg tablets.  Using the recommended opioid Morphine Equivalent Dosage calculator available for download at the Agency Medical Directors site, 30 mg of morphine is equivalent to 30 mg of hydrocodone but to only 20 mg of oxycodone (i.e. oxycodone is 1.5 x as potent on a mg for mg basis than hydrocodone).  Using these equivalency ratios it would be expected that Zohydro might become available in doses up to 120 mg per pill.  This would make it highly popular as a drug of abuse, as current hydrocodone products all contain acetaminophen, and maximum hydrocodone dosing even with products with 10 mg hydrocodone and 325 mg acetaminophen are 12 tablets daily, making 120 mg of hydrocodone the maximum daily hydrocodone dosage.


12 Responses to Zohydro: The Next Oxycodone is On the Way

  1. I was recently switched from Oxycontin to Zyhydro and it was the worst experience of my life. A few years ago I was given a saliva test to see how my liver processes drugs and it was low meaning I do not get the full benefit of drugs. I guess my liver works too well. I was taking the Oxy SR , same dose, every six hours instead of twelve for 18 years. After being assured there would be no transition I started it on Sat. morning, taking it twice a day and by Sunday night was in the worst withdrawal I have ever experienced, icy cold skin, sweating, trembling with cold, nauseated, throat and ears closing up with worst headaches and eye pain I have ever experienced and I get severe, complex optical migraines. My eyes hurt so badly I could not see and head pounded so severely I could not communicate. The only thing that saved me was a daily Oxy QR. I called my doctor Monday but the voice mail was full. Called again Tuesday. Called again Thursday afternoon after seeing my in-home nurse who told me my diastolic bp was through the roof and wouldn’t leave until I had taken a QR and it went down to 91. I had also developed pitted edema in my ankles and despite taking three Lasix a day it won’t go down. The RSD pain in my arm is very severe and I developed localized tremendous pain in right hip, knee and shin. I don’t know the answer to this strange reaction but after another week my doctor finally responded by putting me back on same dosage of Oxy. It is not handling my pain anymore effectively unless I take hydrocodone. I suggested I might benefit by taking the Zy four times day like the Oxy and adding Oxy QR but this is what he decided to do. I would warn all considering this “miracle” drug that for some of us it is no miracle so be prepared for the worst and don’t start over the weekend and have your doctor ready to take your call if it goes south. I might also add he was also trying to change me over from Seroquel SR to Cymbalta and I was also unable to tolerate that with severe gastro problems so trying to go to generic Seroquel IR. Too much too fast. I have found in fact sheet online this happens to small number of those transitioning to Zyhydro and am trying to figure out medical terms but appears to be a liver problem.

  2. My son suffered a back injury in a construction accident when 12 roof trusses were dropped on him. His back was severely compromised as was his right leg crushed, had a steel rod replace his femur and severe damage to his right knee. He is now 42 and suffers constantly. We did see a KU Medical Center pain specialist, they prescribed Zohydro ER … it helps. I believe for those who are truly in need it is a good alternative to other opiods. However, many insurance companies do not cover the cost. My son is now unable to work, so has lost his insurance coverage, we are trying to get a disability claim going, in the mean time we are unable to afford going to the specialist. The local GP prescribes oxycotin 20 2x daily… I believe the extended release of the Zohydro is better than the oxycotin 20 er … I feel so frustrated and sad that there is not a better system for chronic pain sufferers, they should not be penalized for unethical doctors and drug addicts actions.

  3. I was in a serious car accident even had two surgeries to the spine. I have been on norcos and muscle relaxers for years. I recently got a prescription for Zohydro and so far it’s not even helping me at all. I’m just experiencing head aches and itchy skin. I’m going to talk to my Dr. Next week about it.

  4. I just want to say , these pharmacist are suposed to be professional no matter what.As a woman with three cervical herniated disc Multiple Schlerosis etc I’m always in pain., about to try zohydro,im looking to downgrade from all my pain meds.So I can save my much needed organs from damage etc.so tired of like yall say judgements!!!! Next time I get my meds
    im going to have a yellow square sign that reads ms pain on board level◆◆◆◆◆◆◆◆◆◆ My prayers go out to all who gets misunderstood . It’s about time . We deserve a better quality of life outside of a cure…

  5. Until people really know how you feel most people will treat you as a drug addict. I had to explain why I was getting my prescription early even when dr wrote on it ok to fill early. After I started to explained I said to myself why do I have to explain it to them. It is none of their business. The druggist said he had to follow the rules. I just told him to do what he had to do. Why should we really care what people think we are the ones in pain. Hope to god they don’t have to go through it.

  6. Dec.. 6 2014 I can concur with dominic. I am 60 years old and have cppd arthritis and back problems .I take 8 10 325 of hydrocodone 60 mg er of morphine per day . when I pick up my prescriptions I get the same looks and whispers .It is very uncomfortable I wish they could feel my pain when I wake up to pain around 3;00 in the morning, take my prescribed dose then wait for a hour to go back to sleep (every day).Well I just got zohydro 20 mg es I know they will look at me in disgust but I don’t care I’m looking forward to a full nights sleep.I wish they would mind their own business and stop judging.They have no idea what its like. It’s horrible. If it wasn’t for these meds I would not be able to get out of bed.I would not have any kind of life at all I pick up my zohydro tomorrow I hope it works Wally

  7. I can’t wait to try this new drug. I jus got in a car accident and broke 6 ribs and I have been getting roxicodone 30mg 6x a day so 120 pills every 2 weeks. But still I used to take up to 20 10/325 norco at once back in the day so I bet this zohydro won’t be as good as people think it will. It will be over priced and oxycodone is way better than hydro codone. The only thing that would make this drug more popular than oxy is if u can snort it cuz it has no Tylenol in it. I never snorted norco (hydro codone) because of the Tylenol. So this actually might blow up like oxycontin did. We’ll see I’ll post once I get one cuz snorting 12 pills at once(the equivalency) sounds like people will abuse it. But what about the people who used to snort the oc80 Oxys when they were around. I could do 5 in a row and be fine. Fucked up but able to work and function. This is just another way to make is addicts excited. Thanks drug companies

  8. I am on a high dose of oxycodone I’ve been on medication for pain for over 12 years now I am only 50 years old and I can barely walk I’ve had several operations on my back and on my leg circulation they can do no more from me by operating so the only thing that can be done for me to even work or any type of quality-of-life is to take pain medication and I also am so sick of these pharmacists giving me a hard time treat me like I am a drug dealer or a drug addict that I would love to expose them and tape them on my iPhone and put them on the news it is not right that the people who abuse it ruin it for those who need it such as myself and you something has to be done about this I don’t know what but I don’t know who these pharmacist think that they are when they won’t fill them for me because I don’t go to that store all the time with the high-dose that I get it is very hard for me to find where are my rights do you think that since I was 35 years old I want to be in this position I’ve been in the catering and restaurant business my whole life I am now on disability and I have been on disability for over five years I have two children both in college and I cannot afford and then comes the issue of insurance I have worked my ass off my whole life in a family business since I was eight years old bus being one of the reasons I have steel rods in my back and three fake disks this is the gratitude and payback I get for working hard my whole life somebody has to do something about these pharmacists and doctors I am a very large Italian with a very bad temper one of these days one of these pharmacists are going to hit me the wrong way and I’m going to do something I would rather not do I think they should just do their job and that’s that they do not have to go over and beyond what they are trained to do to bust my balls I don’t know how anyone else feels about this but I feel that something definitely has to be done about it thanks for lending me your air Dominic

  9. They need to come out with something new, they have made all these other ones so tapper proof. That it hurts the people that are in real chronic pain, for me being paralyzed from the waist down, my liver wont break down those tapper resistance pain pills I don’t get half of what I take. I know people abuse them but for myself, I don’t cause I need them to bad. I was in a car accident, broke my back, my neck, all my ribs & 1 of my ribs punctured my lung. So I really need something that is not so tapper resistance, cause I stay in pain all the time. I’ve tried so many different pain meds, i’m about to run out of options.

  10. Oxycontin can no longer beabused, not for the last couple years after the formula changes. They have already stated the maximum dosage would be 50mg. I would assume it would be an abuse proof formula too, but that’s still unknown. Maybe people still abuse hydro/apap combos. I think the liver harm reduction outweighs the risks. Even drug abusers have livers too, and most don’t consider that when abusing the lower 10mg/500 acetaminophen combinations, and legitimate patients can suffer liver problems even at the the 4000mg a day mark. Tylenol is at the top of the list for drug overdose lists, and liver cirrhosis lists also. Tylenol has been proven less effective than other NSAIDs. I think it’s garbage. I support time released because of the required monthly check unlike the combinations. Hydrocodone is one of the weaker opiods, so I just don’t seeing being the epidemic they are making it out to be. There’s already boat loads of stronger drugs to abuse via insufflation,injection,etc. Just my 2cents.

  11. Christa: You are a perfect example of the ideal candidate for a moderate dose, single ingredient opioid. I expect Zohydro will be as abused and carry the same stigmata as Oxycontin after it is approved. You need a non-acetaminophen containing medication because of your renal disease, and Oxycontin is a good option for you. Unfortunately because of the very high incidence of abuse everyone on Oxycontin is looked on with suspicion and bias. Good luck with your transplant. DrP.

  12. First, let me say that I love your blog..alot of interesting information!
    I am a 45 year old woman in stage 4 renal failure, also diagnosed with Mixed Connective Tissue Disease that mirrors lupus in many ways without the affirmative diagnosis. I consider myself a pretty well educated patient that remains very active in all of my treatments. Thusfar I have staved off dialysis and am on the transplant list.
    Because I am in considerable muscular and joint pain on a daily basis, sometimes so bad I cannot hardly get out of bed..and because I choose to have some quality of life, I go monthly to a pain clinic to receive oxycontin. I have been taking it for almost 2 years and remain on 20mg 2-3 times a day. While I may be dependant on it, I am not addicted to it. It’s not my choice to take this medicine, yet I am treated like an addict at my local Walgreens…if there were anything else that I could take, that would allow me to remain somewhat active, I would…just to avoid the prejudice that I receive. My doctors commend me because in spite of my pain, I have not had to increase my medicine, nor have I abused it. It can be done.

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