Comparative Pharmacology
Head-to-head clinical analysis: ABSTRAL versus NORCO.
Peer-Reviewed Evidence
Head-to-head clinical analysis: ABSTRAL versus NORCO.
ABSTRAL vs NORCO
Comparing the clinical profiles, pharmacokinetic behaviors, and safety indices of these two therapeutic agents.
Fentanyl is a potent mu-opioid receptor agonist, producing analgesia and sedation by activating G-protein coupled opioid receptors in the central nervous system.
NORCO is a combination of hydrocodone, a mu-opioid receptor agonist that inhibits ascending pain pathways and alters pain perception, and acetaminophen, which inhibits cyclooxygenase (COX) enzymes, particularly in the CNS, leading to decreased prostaglandin synthesis and antipyresis.
For breakthrough pain in opioid-tolerant patients: initial dose 100 mcg sublingual tablet, titrate across strengths (100, 200, 300, 400, 600, 800 mcg) as needed; maximum 2 doses per episode, minimum 2 hours between episodes.
One tablet (5 mg hydrocodone/325 mg acetaminophen, 7.5 mg/325 mg, 10 mg/325 mg) orally every 4-6 hours as needed for pain. Maximum acetaminophen dose 4000 mg/day; maximum hydrocodone dose 60 mg/day.
None Documented
None Documented
Terminal elimination half-life: 6-10 hours (mean 8 hours); prolonged in elderly and hepatic impairment
Hydrocodone: terminal elimination half-life is 3.8 to 6.0 hours (mean 4.5 hours) in adults; prolonged in hepatic or renal impairment. Acetaminophen: half-life 1.5–3 hours.
Renal: ~70% as metabolites (primarily fentanyl conjugates and norfentanyl), ~10% unchanged; Fecal: ~9%; Biliary: minimal
Hydrocodone: primarily renal (approximately 60% as unchanged drug and metabolites, including norhydrocodone, hydromorphone, and conjugated metabolites). Biliary/fecal excretion accounts for <10%.
Category C
Category C
Opioid Analgesic
Opioid Analgesic