WhiteCoat

Bye Bye Generic Vicodin

Let the wailing and gnashing of teeth begin.

Vicodin pills are about to get a lot more expensive.

You see, according to this Abbott Vicodin Announcement (.pdf file), Abbott Labs is very concerned about the Tylenol content in its combination pain medications. After all, too much acetaminophen per dose in prescription medications may cause “severe liver injury from acetaminophen overdosing.”

In bowing to pressure from the FDA, Abbott decided to stop making the combination pills containing hydrocodone with 325 mg Tylenol or more and decided to start producing all of its combination pills with 300 mg Tylenol, instead.

Phew. I’m glad they took care of that. I’m sure that the extra 25 mg of acetaminophen in the current formulation was just causing an untenable overload of all the liver transplant centers throughout the country.

The other thing that creating a new formulation and discontinuing the current formulation does is create a new patent on the medication. Which will undoubtedly mean that, much like how the cost of colchicine went from 10 cents per pill to $5 per pill, the cost of brand name Vicodin will soon skyrocket as the medication goes “non-generic”.
Since states don’t like spending a lot of money on medical care, it is also likely that the “safer” brand name Vicodin will no longer be covered under state insurance plans. I’m sure there will still be generic versions of hydrocodone/acetaminophen available along with Oxycontin and Tylenol with codeine — until the remaining manufacturers also create their own “safer” versions of the medications.

For now, any time that a physician writes a prescription for the brand “Vicodin”, patients are going to not only have pain in their body, but they will also have pain in their wallets. I’m predicting $2.50/pill price point.

Look for lots more hassles to both pharmacists and to the doctors writing the prescriptions.

52 Responses to “Bye Bye Generic Vicodin”

  1. Don says:

    One of the requirements of being granted a patent is that the patent be “non-obvious”.

    Why wouldn’t an examiner looking at the application say “changing the dosage on an existing medication is an obvious solution”

    In fact, it wasn’t even Abbott Labs solution. It was the FDA’s solution.

    Since the idea originated with the Government, Abbott shouldn’t get a patent

  2. SeaSpray says:

    That med makes me queasy, etc. But, if I did take it I guess the outflow from my wallet would as well.

    Why not just make the pain med with minimal or no tylenol and supplement with regular tylenol capsules? More work and bottles around, but would get drug companies off the hook. And keep cost down.

    • JackOwens says:

      The law states that a pure form of hydrocodone (or > a drug containing > 15mg of HC) is illegal.

      Old topic, just info.

  3. Ryan says:

    I think that the name brand vicodin was a minimum of 500 of tylenol. This always bothered me because people would dose them like percocet (eg 2 q 4hours) and this could end up with someone getting 6g of tylenol in a day.

    I’m not saying this isn’t about continuing to make name brand meds, but I do think changing down from 500 is a good idea.

  4. Brian says:

    I just don’t see a patent issue here – this isn’t one of those circumstances where a drug company does something to try and extend a patent or spin it off. Generally, they can do this if a drug was originally patented as a racemic mixture (Prilosec), and then later gets patented as a single stereoisomer (Nexium). Or, somewhat related, they can first patent one drug, loratadine (Claritin), and then later get a patent on the active metabolite, desloratadine.

    In this case, it’s a trival change in the strength of one of the components, without a change in chemical formula. It’s still hydrocodone and acetaminophen. Same chemicals, same effects on the body. Plus, as @Don pointed out above, the change was motivated by Government safety concerns, not because the drug company thought the new mix was more effective.

    Note that the situation with colchicine (and 17OHP, from the Slate article linked) is yet another legal spin on things, that had nothing to do with patent law, and everything to do with FDA regulatory power. I can at least see the FDA’s point in its Unapproved Drugs initiative, but they should’ve thought more carefully about what would happen when a drug effectively goes from generic status back to protected status (think of what would happen if ibuprofen suddenly became re-patented tomorrow!).

    • B.J. says:

      I have taken all of these variations. And there is a definite difference between the generic and the brand name. I am now on the 10/300 of the generic version and they DO NOT have the same pain relief as the NARCO even when I add and additional two extra strength Tylenol.

      Has anyone else found this to be the case?

      • Empty Pockets says:

        I was thinking the same thing. The formulation must have changed. I just think they are not telling us. In my earlier comment, I mentioned that the medication seemed different and not in a positive way. I think the old version was more effective.

  5. pete says:

    @SeaSpray

    The tylenol in Vicodin is meant to be a deterrent to taking too much. It’s supposed to keep people from using the pills to get high since it will fry their livers. There is also some evidence hydrocodone + APAP is more effective at relieving pain. Finally, pure hydrocodone is a CII drug which is a pain in the ass to prescribe and dispense. That’s why you always see it with something else be it in pain meds or cough suppressant.

    • SeaSpray says:

      Interesting Pete. I never realized that.

      Obviously ..I am clueless when it comes to pharmacology, but couldn’t they just fill it with something else? Oh wait – got it … the combined medications is what is most effective.

      Thanks! :)

    • Keith says:

      That is one of the most ridiculous things ive ever heard!!!(“The tylenol in Vicodin is meant to be a deterrent to taking too much. It’s supposed to keep people from using the pills to get high since it will fry their livers.”) Doctors know how highly abused opiates are and they know an addict isnt going to think twice about how much acetaminophen each pill contains, heroin addicts will use a needle that 15 other people just used to get their fix, you think the extremely high risk of contracting HIV or hepatitis C in that situation isnt an effective deterent to death and overdose but too much tylenol will keep them straight huh? The fact is these extremely powerful opiate pain relievers were developed and intended for end of life use on cancer patients!!! Not for Joe Blow down the street who sprained his ankle. Our country makes up 10-15% of the world population but we use 80% of the worlds prescription opiates and there are several reasons for that but one of the biggest is people here like to over-indulge and get a quick buzz, even the pharmaceutical companies and Doctors arent stupid enough to think that an extra dose of acetaminophine would be an effective or logical deterent to get people to “TAKE AS PRESCRIBED”

      • adam says:

        I am going to disagree with you here. I abuse just about anything i can get my hands on. When it comes to Vicodin with apap in it….I def. treat it with respect and much more cautiously than i do other substances.
        You bet your ass if i could get my hands on pure 10mg Vicodin pills i would be abusing them all day long constantly. However, the only thing that keeps me from doing so…..is the fact that they are loaded with a bunch of shit that will basically kill me slowly from the inside out if i abuse it too hard without performing a C.W.E
        It is ridiculous if you really believe that the addition of the APAP doesnt curb abuse. Not all addicts/junkies are nasty bums with dirt under their nails. Some of us do pay attention, on some level, to what we are putting in our bodies. And for me? APAP is a pain in the ass and i hate seeing it in anything i want to get high on.
        Thank jebus for C.W.E

      • Brannon says:

        I think you think your hardcore huh? Well if you are thinking about the apap and not taking it because of the side effects your nowhere near an addict! I am a diabetic and kidney and liver problems come along with that..I have took 20-30 10mg a day for over 4 years without even thinking of the Tylenol at all (my mom would call them in to a pharmacy acting as a nurse using different dr.’s D.A numbers. That is the least of a addicts worry. If they are putting Tylenol in there to keep addicts away or from getting people to take to much they made a bad mistake wouldnt you say?..Geeez..Look how many people are addicted to them now!! I wish I never had seen or took the first one!!

      • anonfornow says:

        Brannon:
        Adam’s comment didn’t come off as “thinking he’s hardcore” to me – though I do think it’s telling that such was your immediate response.

        Adam’s comment seemed intelligent and very well-informed. He’s pointing out that not all abusers/addicts are basement-dwellers with single-digit IQs who’ll snort drain cleaner if they think it’ll get them high. (Unfortunately that’s a stigma that causes a lot of problems: It hinders addicts in the recovery process and contributes to relapses, and it prevents abusers from seeking intervention at a stage where the help could prevent full-blown addiction.)

        You close your comment by saying you wish you’d never taken the first pill – this may be hard to believe from your perspective, but there are many people who have NO similar regrets, who wish they’d discovered intoxicants sooner, or knew of more powerful or undetectable ones, and who enjoy the hell out of (what may very well be) their addictions. (Or they may simply be recreational usage. Not everyone gets addicted, contrary to the propaganda.)

        This type of person is likely to be exactly as Adam describes: Very careful, even meticulous, about the quality of substances s/he is using. After all, bad product or prep could kill you, and dying would mean you’d miss out on 20-50 years of enjoying more highs.

        As someone who’s been working with addicts in a private inpatient setting since 1986, I can tell you there are just as many like Adam as there are like you. And in case YOU’RE feeling “hardcore,” I’d like to share this: I have a friend, a physician actually, who was addicted to hydrocodone for more than 15 years. When he checked himself in for detox, he was taking 80 – that’s eighty, eight times ten – of the 10/325s a day (no CWE). He’ll tell you he has no idea how he’s alive, and with a healthy liver, but he is. And he’s been clean and sober for more than 12 years. Now THAT is hardcore. The 12 years of sobriety, I mean. B@lls of steel, there.

        Think about it.

        (Admin, if you see this, I’d be obliged if you’d forward the relevant bit of my comment to Brannon’s email. At 4-5 years, any liver damage is probably reparable or at least manageable. He may feel fatalistic, given that he’s predisposed to liver/kidney issues as a diabetic, and therefore feel that he shouldn’t even bother trying. But given his last sentence, I feel like it’s worth a shot, even though his comment is 6 months old.)

  6. TxPharmguy says:

    Vicodin has 500 mg of acetaminophen. Vicodin ES has 750 mg. Just write for Norco. They have 325 mg of acetaminophen and are available generically.

    • Joe says:

      No…I’m looking at a Vicodin 10/325 right now that’s not Norco…it’s Vicodin. Yellow oblong.

      • christy says:

        Joe; That yellow oblong pill(10/325) is Norco. It’s most likely the “Watson” generic. Each pain medication containing acetaminophen & hydrocodone all have different dosages of acetaminophen. They all make them with the same amount of hydrocodone but different amounts of acetaminophen. For example:
        Norco has 325 mg of acetaminophen: *5/325 *7.5/325 *10/325…
        Vicodin also called Lortab: *2.5/500 *5/500 *7.5/500 *10/500
        Vicodin ES: *5/750, 7.5/750, 10/750….

        Note: There are several drug manufactures out there making generic forms of the “name brand”, same dosage & drugs, just priced differently and carry their own look. Watson, Quailitest, Sandoz, Mallinckrodt, Teva, Apotex, Greenstone, Mylan, Hospira,… these are all examples of generic company names. Which also make many kinds of generic medications.
        The reason there are so many name brand formulations of the acetaminophen & hydrocodone combinations is so that they could patent a “New Drug”. But never the less, if u are prescribed the Vicodin just ask your doctor to write for Norco, for financial reason!!!

      • ff850 says:

        These are the facts, plain and simple.

        Norco 5/325. 7.5/325, 10/325, Generic and Name Brand both made by Watson.

        Original Vicodin 5/500, Vicodin ES 7.5/500, Vicodin HP 10/660

        Lortab 5/500, 7.5/500, 10/500

        Lorcet 5/500, 7.5/750, 10/650

        New Formulation Vicodin 5/300,7.5/300, 10/300
        New Generic formulations availabe from Boca Pharma.

        325 mg of APAP will be the max on all combination painkillers starting 1/1/2014. All of these different combos are being phased out. It will take a while for docs to catch up.

      • ff850 says:

        Sorry, one correction original Vicodin ES 7.5/750

  7. MamaOnABudget says:

    I was prescribed vicodin once – when I had my wisdom teeth removed. I hated it! It made me hallucinate – I started seeing things moving around in the popcorn ceiling in my house.

    I’m sure that’s why people love it, but I always request NOT to have it for that reason. I’d rather take ibuprofen and cry, honestly.

    • SeaSpray says:

      It causes me to feel nauseated and intestinal. But, I didn’t know it initially because I had it for knee surgery and was already so sick post-op. And didn’t even need next day. then next time I took it was left over from that surgery, but was already so sick from stone. It wasn’t until I came home with it and used after a uro issue when not vomiting that I realized it.

      My d-i-l is that way with percocet and can handle vicodin. Go figure. Wonder why tho?

      Thankfully, nothing ever caused me to hallucinate tho. Not even anesthesia.

      • Had the same effect after gum surgery but sometime later I reluctantly tried vicodin and it worked well. Must be a special formulary or larger dosage prescribed for some dental procedures to causes nausea. About half the people love
        vicodin, the other half hate it!!

      • Keith says:

        Probably because the active narcotic in Percocet is actually Oxycodone and not Hydrocodone like in Vicodin, while they are both opiates Oxycodone is a much stronger opiate and basically prescription heroin

      • ff850 says:

        Keith,

        Oxycodone is 1.5 x stronger than hydrocodone. Nothing close to Heroin. Closest to heroin strength is hydromorphone(dilaudid)

  8. Amy says:

    That’s just evil. Is it any wonder why people hate and resent Big Pharma so much?

    • Chuck says:

      It’s evil that the FDA forces such nonsense. It’s not Big Pharma’s fault they take advantage of it. (In fact it’s their duty to their stock holders to take this gift horse and run with it)

      If the FDA hadn’t pressured Abbot to reduce the Tylenol content you would still have access to $.25 vicodin and Abbot was good with that.

      After the FDA’s involvement in a obviously useless and stupid way, it will be back to $2.50 a pill.

      How is this big pharma’s fault?

      As the Cliche goes. Don’t blame the player, blame the game.

      My first thought was

      THIS is why we don’t want the government anywhere near controlling the health care industry. They act in stupid and capricious ways with unintended side effects and no accountability.

      Unless someone wants to argue that the 25 mg difference was a REAL safety issue then how do you get an appointed official fired for being stupid? Answer is, you can’t.

      • WhiteCoat says:

        This is one of the things I was trying to point out in the original post, but which I didn’t do a very good job at expressing. Thanks.
        Unintended and misguided governmental regulations coupled with pharmaceutical companies that are only too willing to comply with governmental requests in order to improve profits.

  9. ee md says:

    The author of this article is not familiar with Vicodin as exemplified by his statement about dropping the acetaminophen content from 325mg to 300mg. In fact, Vicodin brand offers the highest, and inappropriately high, level of acetaminophen in their Vicodin-ES: 7.5mg hydrocodone and 750mg acetaminophen. While perhaps not prescribed to, patients often take two at a time which quickly leads to immediate overdose of acetaminophen (limit should be 1000mg/dose). To make matters worse, Vicodin-ES are most often prescribed to be taken one every 4 hours which, if done, leads to 6 tabs/day, overdosing the pt on acetaminophen since they should not exceed 4000mg/day. The pt is seldom instructed to limit this Q4h drug to 5 tabs/day.

    While Vicodin-ES is the worst offender in contributing to mixed opiate acetaminophen overdose. Vicodin-HP is not far behind with a 10/660 dosing. The author is ignorant, as are many MDs prescribing mixed opiates – which is the main problem that forced the FDA to step in.

    • WhiteCoat says:

      First, you are correct that brand name Vicodin does not come in a 325 formulation. Only 500 and 750. My mistake.

      Next, you’re asserting that because patients may take medications incorrectly that those medications should be restricted and/or reformulated. I disagree. That’s a slippery slope that we shouldn’t venture down. If we choose to venture down that route, then we really should focus on banning the hydrocodone and not the Tylenol since 500 people per year die from Tylenol overdose in the US while 37,000 plus people die from prescription narcotic overdoses each year. Oh, and at what point do we just get rid of Tylenol altogether? That would make us so much safer.

      Do you know any patient who purposefully wakes up in the middle of the night to take a medication prescribed “every four hours”? I imagine that there are some such patients, but I don’t think that there are many and I haven’t met any in my career. When applied practically, your premise doesn’t hold as much water as it does when applied logically.

      Out of 109 million prescriptions for combination opioids each year, there are roughly 250 deaths from unintentional overdoses. If you’re that much into saving lives through government regulation of Tylenol, one study in England showed that a law requiring packaging combination opioids in blister packs decreased the number of overdose deaths or transplants by 74%.

      If you think this dose change is all about saving lives, you are by far more ignorant than I.

      • robyn says:

        Of course it ain’t about saving lives! Its due to the fact that government sees how much money the people are making and they want a cut….like always. Poor people sell drugs to feed their families….there aren’t any jobs left. You reallly wanna knoow who’s behind this? The Illuminati. Yep. They don’t want anyone to have any money but them. They are bigger drug dealers then anyone since they get taxes and profits from every opiate out there. They have no more right then the drug dealers do. Same difference. 25 mg less doesn’t do a damn thing. All about increasing their profits and making everyone else suffer. God will get His revenge.

      • ff850 says:

        Original Vicodin comes in 500, 750, and HP 660 APAP. New formulations will all be 300mg, just different enough from the generic Norco at 325 apap, just to make some additional $$$ for Abbott.

        Those narcotic overdose stats include street drugs that don’t contain APAP. People die far more often from liver failure from Pain medicine with APAP in formulation, than respiratory failure, depression from the opioid contained in it.

    • ff850 says:

      EE MD,

      Well said.

  10. Nick says:

    Yeah, WhiteCoat – the way you phrase this is a bit disingenuous. While it’s true there are formulations of Vicodin with 325mg of acetaminophen, the most common formulations have 500mg or 750mg. All of these levels are dropping to 300mg.

    And while I’m no IP lawyer, I don’t think Abbot has separate patents out on the 500mg and 750mg formulations, nor do I think they’re earning a new patent on the 300mg formulation.

    The reason colchicine price shot up is interesting and kind of evil but at least new research was done to justify the IP protection – I don’t think that’s the case with vicodin. Blogged about it here – http://blogborygmi.blogspot.com/2012/01/inflammatory-condition.html

    • WhiteCoat says:

      We’ll have to wait and see about the patents and prices. Changing formulations of patented formulations is one of many ways in which drug manufacturers attempt to extend patents on medications.
      If there’s no price bump, I’ll freely admit that I was wrong.
      As for the colchicine issue, my intent was to show how the government/Pharma complicity increases costs with little incremental benefit in both cases, not to compare the two processes step by step.

  11. SeaSpray says:

    I’m looking forward to your next open forum. I definitely have a question regarding conflicting information.

  12. Carolina_D says:

    Today is Oct. 24, 2012. I was just prescribed Vicodin yesterday. I don’t know if it’s generic, it is yellow with a ‘V’ on the front, but it’s got 325 mgs. of acetaminophen according to the label. (It’s 10-325) As I remember (it’s been a LONG time since I last took this) this was the ‘normal’ formulation. Does this mean that no change was made after all, or just that this is a generic formulation and that hasn’t changed? My scrip is only for 20 tabs, so I’m not overly worried, just curious.

  13. Same old tricks says:

    Surely, they lobbied the FDA to do this to increase profits the same way pharmaceutical companies lobbied them to ban an inactive ingredient in albuterol and all other inhalers (for asthma) so that they could all get new patents and eliminate all generic inhalers. They went from less than $10 to over $50 overnight! Don’t be fooled into thinking the FDA isn’t controlled by the big pharmaceutical companies and their billions and billions of dollars!

    • ..and the pharmaceuticals control the medical schools and the course of medical treatment. God forbid if one is in pain that they take a pill that makes them feel good. Seems they would like us to believe coupling these medications with NSAID drugs is the ONLY way to make this pill. Could it have to do with the owners of the NSAID companies? Please you gifted scientists and retired attorneys, doctors, teachers other professionals stand up and challenge ignorance without fear and free us and out WORLD from zombie corporate control!!!!

  14. Keith says:

    Ive been saying that this needed to happen for years, why doctors are so quick to write a script for Vicodin 7.5/750 and Lortab 10/660 is beyond me especially when the Norco 10/325 are just as readily available, most idiots on the street know that 3000mg of acetaminophen a day is way too much on the liver and that is if the pills are being taken as doctors usually write a typical script, so why doctors would subject the liver of any patient to that kind of thrashing when other safer options exist is beyond me. As for the guy predicting 2.50 per pill vicodin, people have been paying 3/4.00 per pill for them for years already

  15. Jonesy says:

    Hey, didn’t they start combining acetaminophen with Vicodin to lower the chance of overdosage? Are they planning to find a new “mixer” that doesn’t have the liver risks, or are they just getting rid of a “mixer” all together?

  16. sheryl says:

    What has happened is the price jumped up tremendously for a drug that has less drug in it and is only two-thirds the size of the old pill. The acetaminophen that’s bad for you is what made the pill work. Now what will happen is people will probably double the dosage or take something in addition to the Vicodin brand which totally defeats the purpose of the change. I hate the results of the acetaminophen on the liver, but unfortunately drugs like Norco or Demerol or the low dose oxy don’t help my pain at all but simply work as sleeping pills, and I don’t need help sleeping.

    • kate says:

      My meds were recently reduced to.generic 7.5 325 these do not work, and yes I end up taking two at a time more frequently, this defeats the purpose I shattered my hip and pelvis, in New England somedays I can’t walk without pain, when my dr. Prescribed 7.5,750 I was fine.1 ever 5/6 hours.what is going on.with this, I’m scared of the new blend, I throw up, my.stomach hurts I feel clouded, tired and walked yesterday for an hour in a store then my back and left hip went into pain, normally on my other dosage I could go in a store or mall for 3 hours, so.much for xmas shopping, pharmacist trying to.tell me their is no difference,, please I’m not stupid I’m not addicted, obviously I’m.getting sick from the blend,manuf.Watson.generic for Norco Anyone else feeling gross and it doesn’t work like the other from this stuff, waiting on.my dr. To call today,,Ugh why now???

  17. gizmo Brennan says:

    I just paid out of pocket for 100-7.5mg/325mg without insurance and just using my AAA card and without AAA it would be $70.00
    with AAA IT cost me $37.00 and that was the watson brand

    • c4 says:

      I just posted mine went from $11 to $125 no insurance, just out of pocket for 60 pills! I thought someone made a huge mistake…

  18. Deborah says:

    FWIW I just paid $96 for 240 generic Norco. They went up to $130 at my old pharmacy so I had to change to a small local one to get the $96 script. I called all the pharmacies (except Wal-Mart) from CVS to Walgreens to K-Mart. The highest quote I got was $199.

  19. Empty pockets says:

    I just got a prescription for the “new” dosage 5-300. It cost me $49.40 at CVS. I was shocked. This was covered under my insurance before, but they said not anymore. Also, I’m wondering if they changed something about the formulation. I feel jittery, but with the “old” version of vicodin 5-500, I didn’t have that problem. Is that my imagination or has anyone else experienced that?

  20. cody says:

    You know people apap, aspirin, ibuprofen, and paracetamol ARE NOT DETERRENTS TO DISCOURAGE DRUG ABUSE. I will point out the obvious now. Why oh why would the big drug companies and fda put everyone at risk when the new reformulation or any formulation could include narcan to stop the drug abuse if this was a real concern. If i was a pill junky i wouldnt care about the apap cuz i could just get a new liver but if i was a pill junky and had narcan to worry about i would just go to herion. Just do some research and you will see that narcan is a deterrent more so than apap but thats just a little education for you.

    • Peebles says:

      So the answer is to give people who are in pain, a tablet containing both an opioid agonist and an opioid antagonist?

      Yes, I can see why pain sufferers would not want to use, let alone abuse, such a formulation.

  21. cody says:

    Btw i have cancer and metal rods in my spine. I have had the metal rods since i was a child and i hate to say it but this whole my back hurts me doc can i have pills for it is just a drug addicts way of getting high. I never once took pills for my back pain only for the surgery. As for the cancer treatments and the pain that goes with it all i take a low dose of norco only when needed and within reason. My point is if everyone hit the drug makers where it hurts being the pocket book or started a petition to limit the drug makers to only being able to rais the drug prices when voters vote on it then we could keep cost down. But how many people here will stand up and do something. We complain about th e cost but we still pay sounds to me like its not that big of a deal. Otherwise prove me wrong and get out there and do something cuz nothing ever got done by sitting there doing nothing

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