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Hydrocodone / Acetaminophen Not Superior to Codeine  /Acetaminophen for Acute Pain

Hydrocodone/acetaminophen (Vicodin, AbbVie) was not superior to codeine/acetaminophen (Tylenol #3, McNeil) in acute pain relief reported by patients 24 hours after being discharged from the emergency department, according to a new study.

While Vicodin is the most popularly prescribed opioid in emergency departments, the drug and other hydrocodone combination formulations are under consideration by the US Food and Drug Administration (FDA) for rescheduling from a Schedule III drug to a more tightly regulated Schedule II drug. New York State has already made the change.

With Tylenol #3 representing a potentially ideal alternative, researchers sought to compare the 2 drugs — and found existing evidence was scant.

“The reason we conducted this study was because there was very little evidence supporting the superiority of Vicodin over Tylenol with codeine, despite its heavy preference in the emergency department setting,” said lead author Andrew K. Chang, MD, MS, an associate professor of clinical emergency medicine at the Albert Einstein College of Medicine and attending physician at Montefiore Medical Center, Bronx, New York.

“There was no significant difference in side effects, [and] our results showed that Vicodin failed to provide superior pain relief compared to Tylenol with codeine.”