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App Butalbital

           
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App Butalbital or dihydrocodeinone (marketed as Vicodin, Anexsia, Dicodid, Hycodan,  Hycomine, Lorcet, Lortab, Norco, Novahistex, Hydroco, Tussionex,  Vicoprofen) is a semi-synthetic opioid derived from two of the  naturally occurring opiates, codeine and thebaine. App Butalbital is an orally active narcotic analgesic and antitussive. Sales and  production of this drug have increased significantly in recent years,  as have diversion and illicit use. App Butalbital  is commonly available in tablet, capsule and syrup form.

As a narcotic, App Butalbital  relieves pain by binding to opioid receptors in the brain and spinal  cord. It may be taken with or without food. When taken with alcohol, it  can intensify drowsiness. It may interact with monoamine oxidase  inhibitors, as well as other drugs that cause drowsiness. It is in FDA  pregnancy category C: its effect on an embryo or fetus is not clearly  known and pregnant women should consult their physicians before taking  it. Common side effects of App Butalbital  include dizziness, lightheadedness, nausea, drowsiness, euphoria,  vomiting, and constipation. Some less common side effects are allergic  reaction, blood disorders, changes in mood, mental fogginess, anxiety,  lethargy, difficulty urinating, spasm of the ureter, irregular or  depressed respiration and rash.

App Butalbital can be habit-forming , and can lead to physical and psychological addiction. In the U.S., pure App Butalbital  and forms containing more than 15 mg per dosage unit are considered  Schedule II drugs. Those containing less than or equal to 15 mg per  dosage unit in combination with acetaminophen or another non-controlled  drug are calledApp Butalbital compounds and are considered Schedule III drugs. App Butalbital is typically found in combination with other drugs such as paracetamol  (acetaminophen), aspirin, ibuprofen and homatropine methylbromide. The  purpose of the non-controlled drugs in combination is often twofold. 1)  To provide increased analgesia via drug synergy. 2) To limit the intake  of App Butalbital by causing  unpleasant and often unsafe side effects at higher than prescribed  doses (See Below). In the UK it is listed as a Class A drug under the  Misuse of Drugs Act 1971.

Overdosing risks

The presence of acetaminophen in App Butalbital -containing  products deters many drug users from taking excessive amounts. However,  some users will get around this by extracting a portion of the  acetaminophen using hot/cold water, taking advantage of the  water-soluble element of the drug. It is not uncommon for addicts to  have liver problems from consuming excessive amounts of acetaminophen  over a long period of time; taking 10,000 to 15,000 milligrams (10 to  15 grams) of acetaminophen in a period of 24 hours typically results in  severe hepatotoxicity, and doses in the range of 15,000-20,000  milligrams a day have been reported as fatal. It is this factor that  leads many addicts to use only single entity opiates such as OxyContin.

Daily consumption of App Butalbital should not exceed 40 milligrams in patients not tolerant to opiates.  However, it clearly states in the 2006 PDR (Physicians Desk Reference)  that Norco 10, containing 10 milligrams of   App Butalbital  and 325 milligrams of APAP (viz., acetaminophen or paracetamol), can be  taken at a dosage of up to twelve tablets per day (120 milligrams of App Butalbital ). Such high amounts of App Butalbital are only intended for opiate-tolerant patients, and titration to such  levels must be monitored very carefully. This restriction is only  limited by the fact that twelve tablets, each containing 325 milligrams  of APAP, puts the patient right below the 24-hour FDA maximum of 4,000  mg of APAP. Some specially compounded products are routinely given to  chronic pain patients in doses of up to 180 mg of App Butalbital per day. Tolerance to this drug can increase very rapidly if abused.  Because of this, addicts often overdose from taking handfulls of pills,  in pursuit of the high they experienced very early on in their App Butalbitaluse. Symptoms of App Butalbital overdosage include respiratory depression, extreme somnolence, coma,  stupor, cold and/or clammy skin, sometimes bradycardia, and  hypotension. A severe overdose of App Butalbitalmay involve circulatory collapse cardiac arrest and/or death.

Alcohol

It is not recommended to mix any amount of App Butalbital with any amount of alcohol as doing so could cause health problems.  APAP is metabolized solely by the liver. Therefore the risk of fatal  overdose due to hepatotoxicity can occur with significantly lower  levels of APAP when mixed with ethanol. This fact is often neither  known nor given credence as it does not stop people from mixing them  due to the feeling of euphoria it provides.

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