Vicodin – Should it Be Banned?

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A 30-year-old Michigan man was recently arrested for possession of prescription pills not in a prescription bottle. The pills he was carrying were Vicodin.

New York recently conducted a drug amnesty program in a bid to curb teen drug abuse. One of the drugs included in the program was Vicodin.

A 44-year-old doctor, Constance Sweet, was arrested in Bradford County for prescribing Vicodin to patients for treating drug addictions.

So what is it that makes Vicodin desirable as well as a restricted substance at the same time?

Vicodine is an analgesic given orally in a tablet form. It contains hydrocodone and paracetamol (acetaminophen) and is generally the drug of choice for pain relief, because it provides better pain relief than either of the two constituents taken separately; however, inappropriate and uncontrolled use of the drug can be dangerous, and the potential for addiction and abuse is well known.

The human body develops tolerance to the drug, meaning that increasingly larger doses are required to produce the same degree of analgesic effect. For this reason, patients might start increasing the dosage or the frequency without being actually addicted to it. However, over a period of time, patients develop an addiction, physical or psychosocial, to the drug.

Prolonged usage of Vicodin results in physical and emotional dependence. Initially, patients tend to convince themselves that nothing is wrong and that a slight increase in dosage or frequency is not going to harm them. They couldn’t be further from the truth. Therefore, it is important to recognize the symptoms of addiction to Vicodin.

Symptoms of Addiction:

• Using the drug even after the pain for which it was used is no longer there
• Inability to cope with routine things       
• Feeling physically ill
• Trying to buy Vicodin without prescription or looking for doctors who will prescribe Vicodin
• Your family or friends indicate that your behaviour has changed after starting the medication

Please remember that addiction is treatable, and, if one feels that he/she is showing signs of addiction, a doctor should be immediately consulted, since it is much easier to control at the initial stages. The withdrawal symptoms on stopping the medication include insomnia, tremors and agitation.

It is estimated that the drug, along with its other generic equivalents is prescribed more than a 100 million times a year in the US alone. The hydrocodone/paracetamol is also available under other brand names like Anexsia, Dolorex Forte, Hycet, Liquicet, Lorcet, Lortab, Maxidone, Norco, Polygesic, Stagesic, Vicodin, Xodol, Zamicet, and Zydone.

In the US hydrocodone is a schedule II drug, but when combined with paracetamol it becomes a schedule III drug, essentially meaning that it can cause low or moderate physical dependence and high psychological dependence if abused. A federal advisory panel has voted to ban sale of Vicodin because of its harmful effects on the liver.

By itself, hydrocodone has the same structure as morphine, even though it is not as potent as morphine and is metabolized by different enzymes. Paracetamol (Acetaminophen) overdose, on the other hand, causes close to 400 deaths and about 40,000 hospitalizations.

Side Effects:

A visual representation of the side effects of Vicodin can be appreciated in the interactive diagram presented at the following link:

http://upload.wikimedia.org/wikipedia/commons/b/b7/Side_effects_of_Vicodin.svg

The side effects of Vicodin are upset stomach, dizziness, and lightheadedness, and can occasionally cause seizures, allergic reactions, fatigue, bleeding, sweating, hot flashes, nausea, vomiting, itching, constipation, etc., and may also have a depressant effect on the nervous system.

An overdose of Paracetamol (Acetaminophen) is known to cause harmful effects to the liver. The maximum amount of Acetaminophen recommended by specialists is 4 grams per day. As Vicodin contains up to 750 mg of Acetaminophen, one needs to be very careful with the intake.

Contraindications and Drug Interactions:

A doctor’s prescription and advice should be taken when taking Vicodin as a medication for pain relief or any other condition. When consulting a doctor who is contemplating prescribing the drug, you must inform him if you have any of the following conditions:

• History of head injury or tumor,
• Low blood pressure
• Liver or kidney disease
• Stomach or intestinal disorder
• Mental illness
• Spinal disorders
• A history of alcohol abuse
• Hypothyroidism
• Adrenal gland disorders
• Asthma, other breathing disorders like COPD or sleep apnoea

Vicodin interacts with more than 500 drugs. That should be reason enough for anyone to shy away from self-medication with Vicodin. Vicodin is also contraindicated during pregnancy. It is not known for sure whether it hurts an unborn baby, but it could cause breathing problems or withdrawal symptoms on birth. Acetaminophen and hydrocodone can pass into breast milk and may harm a nursing baby.

To conclude all the side effects, contraindications and the addictive properties make Vicodin a dangerous drug to use, and perhaps that is why there is a debate about banning the drug.

Beware of Mosquito-Borne Diseases Malaria, Chikungunya and Dengue Fever

The monsoon rains are definitely welcomed by one and all for several reasons, but they also cause the spread of various water-borne and mosquitogenic diseases that can be fatal to many. Beware of the buzz of the mosquitoes. The most common mosquito-borne diseases are Malaria, Dengue and Chikungunya, which have become a growing concern over the past decade as many people have been severely affected. Last month, there was a rise in dengue, chikungunya and malaria cases reported in India. 

Since all the three of the diseases mentioned above are caused by mosquitoes and characterised by fever, it is very important to be aware of the signs and symptoms of each so you can diagnose the condition as early as possible and begin the treatment. So how do you differentiate between Malaria, Dengue Fever and Chikungunya?

Malaria

Malaria is a worldwide disease that has been around for more than 50,000 years. The disease is widespread in the tropical and sub-tropical regions, including the Americas, Asia and Africa. Each year about 350–500 million cases are reported. About 1 million of those succumb to the disease. According to WHO, there are 109 countries in Africa, Asia and Latin America, which are affected by Malaria. WHO observed April 15, 2010, as World Malaria Day 2010, and has declared Dec. 31, 2010, as the universal coverage deadline for delivering effective and affordable protection and treatment to all people at risk of malaria.

Malaria is an infectious and life-threatening disease that is caused by Plasmodium parasites, which are transmitted to people through the bites of infected Anopheles mosquitoes. These mosquitoes are called “vectors.” There are four species of malaria, of which Plasmodium falciparum is the most serious. The other three, P. vivax, P. malariae, and P. ovale, are generally less serious and not considered to be life threatening.

The characteristic signs and symptoms of malaria appear seven days (usually 10-15 days) after the infective mosquito bite. The person has fever with chills, headache and vomiting, which may be mild and difficult to diagnose initially. A typical sign of malaria is a cycle of chills, fever, and sweating that repeats every one, two or three days. There can also be vomiting, diarrhea, coughing, and yellowing of the skin and whites of the eyes due to the destruction of red blood cells and liver cells. A simple blood test can detect the malarial parasites within the red blood cells of an infected person and confirm the diagnosis.

Chikungunya

Chikungunya and Dengue are both viral diseases caused by the bite of Aedes Egyptii Mosquitoes, which breed only in fresh water that has stagnated in flowerpots, cans, air conditioners, etc. In Asia, the mosquitoes Aedes aegypti and Aedes albopictus are the two main species involved in transmitting the virus from infected individuals to healthy contacts. They usually bite during the daylight hours. Chikungunya was first detected in the year 1952 at a place called Makonde Plateau, in Africa. Since then, Chikungunya virus (CHIK) outbreaks, which are known to occur cyclically, have occurred occasionally in Africa, South Asia and Southeast Asia, and most recently in limited areas of Europe. The name ‘Chikungunya’ is derived from a root verb in the Kimakonde language that means "to become contorted" and describes the stooped appearance of sufferers with joint pain. The good news is that this virus is not contagious and therefore the disease does not spread from person to person, but only from the bite of the infected female mosquitoes. More than 1.25 million suspected cases were reported in India in 2006.

CHIK viral infection begins with a short incubation period of 2-4 days. Typically, after 48 hours of being bitten by an infected mosquito, the person will experience sudden high fever with shaking chills. Sometimes they may also develop a maculopapular rash (red flat patches that may contain small raised spots) over the trunk, limbs and face, which may last for 3 or 4 days. However, the most common symptom is severe muscle pain and joint pain. Pain initially starts in the small joints of the hands and feet, wrists and ankles, and later the larger joints. Most patients recover fully, but in some cases joint pain may persist for several months, or even years. Other non-specific symptoms may include headache, slight photophobia and insomnia.

Dengue Fever

Dengue, also known as Dengue Fever, is a viral disease that imitates influenza and is found in tropical and sub-tropical climates worldwide, mostly in urban and semi-urban areas. The WHO site says, “Some 2.5 billion people--two fifths of the world's population – are now at risk from dengue. WHO currently estimates there may be 50 million dengue infections worldwide every year. In 2007 alone, there were more than 890,000 reported cases of dengue in the Americas, of which 26,000 cases were DHF.” It was during the dengue epidemics in the Philippines and Thailand in the 1950s that Dengue haemorrhagic fever (DHF) was first recognized to have potentially lethal complications. Today, DHF affects most Asian countries and has become a leading cause of hospitalisation and death among children in the region.

Dengue is caused by four distinct serotypes of viruses and affects people with low levels of immunity. Therefore, it is possible for a person to get dengue fever multiple times. However, an attack of dengue produces immunity for a lifetime to that particular serotype to which the patient was exposed. Dengue is also known as “breakbone fever” or “dandy fever” due to the intense joint pains and muscle pains suffered by the patient.

The characteristic sign of dengue fever is a severe, flu-like illness that affects infants, young children and adults, but seldom causes death. The infants and young children may develop rashes along with the fever, whereas older children and adults may have either a mild fever or the classical incapacitating disease with abrupt onset and high fever, severe headache, pain behind the eyes, muscle and joint pains, and rash. Classically, the symptoms of dengue fever may range from a mild fever to incapacitating high fever, with severe headache, pain behind the eyes, muscle and joint pain, and rash.

It goes without saying that the best method to prevent these diseases is to control the breeding of mosquitoes in stagnating water and to use mosquito repellents. Travellers need to take precautions when going to tropical countries, since some locations, as well as some seasons, can be of a higher risk. It is best to keep in mind that the mosquitoes that bite during “daytime” transmit dengue fever and yellow fever, whereas the mosquitoes that bite during the “night time” transmit malaria and Japanese encephalitis.

The following precautions can be taken:

1. Taking prescription anti-malarial drugs.
2. Practise the 5 “D”s – Don’t go out during Dusk and Dawn. Dress so your skin is protected from mosquito bites (long shirt sleeves and pants). Apply mosquito repellent containing Deet to bare skin and clothing. Drain out water to avoid stagnation and dry out the containers.
3. Use mosquito netting to sleep. It is proved to be the most effective way of preventing mosquito bites.
4. Sleep in an air-conditioned room or well-screened room.

Note: Chloroquine is NOT an effective anti-malarial drug in India and should not be taken to prevent malaria in this region.