Head-to-head clinical analysis & difference comparison: details on mechanism of action, dosing, half-life, interactions, and maternal-fetal safety.
ACETAMINOPHEN AND HYDROCODONE BITARTRATE vs OMTRYG
Clinician-reviewed, head-to-head comparison of mechanism, dosing, pharmacokinetics, and safety profiles.
Last clinically reviewed: July 2026 · OpiCalc Medical Review Team
Acetaminophen: analgesic and antipyretic effects via inhibition of cyclooxygenase (COX) and activation of descending serotonergic pathways; central action. Hydrocodone: mu-opioid receptor agonist; activates G-protein coupled receptors to modulate pain perception and emotional response.
OMTRYG is a combination of ombitasvir, paritaprevir, and ritonavir. Ombitasvir is an NS5A inhibitor that blocks viral RNA replication and assembly. Paritaprevir is an NS3/4A protease inhibitor that prevents viral polyprotein cleavage. Ritonavir is a CYP3A4 inhibitor used to boost paritaprevir levels.
Moderate to moderately severe pain,Cough suppression (hydrocodone; off-label)
Treatment of chronic hepatitis C virus (HCV) genotype 4 infection without cirrhosis or with compensated cirrhosis,Treatment of chronic HCV genotype 1 infection (with ribavirin or as part of combination therapy)
1-2 tablets (containing 5-10 mg hydrocodone and 300-325 mg acetaminophen) orally every 4-6 hours as needed for pain; maximum 8 tablets per day.
2 mg orally twice daily; if taste disturbance occurs, reduce to 1 mg twice daily.
Acetaminophen: 2-3 hours in adults; prolonged in hepatic impairment (up to 5 hours). Hydrocodone: 3.8-4.5 hours (range 3-5 hours) in healthy adults; prolonged in elderly or hepatic/renal impairment. Clinical context: repeated dosing may require extended intervals in renal impairment.
Terminal elimination half-life is 12-14 hours in healthy adults, allowing once-daily dosing. In renal impairment (Cr Cl <30 m L/min), half-life prolongs to 24-36 hours requiring dose adjustment.
Acetaminophen: primarily via glucuronidation (UGT1A1, UGT1A6, UGT1A9) and sulfation; minor CYP2E1 oxidation to NAPQI (toxic metabolite). Hydrocodone: CYP3A4 and CYP2D6; N-demethylation to norhydrocodone; O-demethylation to hydromorphone (CYP2D6).
Ombitasvir: primarily metabolized by CYP3A4; Paritaprevir: primarily metabolized by CYP3A4; Ritonavir: primarily metabolized by CYP3A4 and to a lesser extent by CYP2D6.
Acetaminophen: primarily renal excretion of conjugated metabolites (glucuronide and sulfate) with approximately 5% excreted unchanged. Hydrocodone: renal excretion as unchanged drug and metabolites (O-demethylated and N-demethylated); total renal excretion accounts for about 60-70% of dose (parent and metabolites). Biliary/fecal elimination is minimal.
Primarily renal excretion unchanged (approximately 70%), with 30% metabolized hepatically and excreted in feces via bile. Renal clearance accounts for ~60% of total clearance.
Acetaminophen: 10-25% bound, nonspecific binding to albumin. Hydrocodone: 25-50% bound, primarily to albumin and alpha-1-acid glycoprotein.
Approximately 95% bound to serum albumin.
Acetaminophen: 0.8-1.0 L/kg, indicating distribution into total body water; clinically relevant for loading dose calculations. Hydrocodone: 3.0-4.0 L/kg, suggesting extensive tissue distribution; higher Vd may require higher loading doses but has no clinical target.
0.3-0.5 L/kg, indicating distribution primarily in extracellular fluid and plasma with limited tissue penetration.
Acetaminophen: oral bioavailability 85-95% (first-pass metabolism minimal). Hydrocodone: oral bioavailability about 25-45% due to first-pass hepatic metabolism; significant interindividual variability.
Oral: 60-80% (first-pass effect); Subcutaneous: 90-100%.
GFR 10-50 m L/min: administer every 6 hours; GFR <10 m L/min: administer every 8 hours; avoid in severe impairment due to acetaminophen metabolite accumulation.
No dose adjustment required for GFR ≥30 m L/min; avoid use if GFR <30 m L/min.
Child-Pugh A: no adjustment; Child-Pugh B: reduce dose by 50% or extend interval; Child-Pugh C: use with caution, avoid if possible, consider alternative therapy.
No dose adjustment required for Child-Pugh A or B; not recommended in Child-Pugh C due to lack of data.
Dosing based on hydrocodone component: 0.1-0.2 mg/kg/dose every 4-6 hours; maximum daily acetaminophen limit: 75 mg/kg/day; not recommended for children <2 years.
Not approved for pediatric patients <18 years; safety and efficacy not established.
Initiate at lowest effective dose, typically 1 tablet (2.5-5 mg hydrocodone) every 6 hours; monitor for respiratory depression and acetaminophen toxicity; avoid in frail elderly with hepatic impairment.
No dose adjustment required based on age; monitor for taste disturbance and renal function.
Addiction, abuse, and misuse; life-threatening respiratory depression; accidental ingestion of acetaminophen; neonatal opioid withdrawal syndrome; interaction with alcohol; risk of medication errors.
WARNING: HEPATITIS B VIRUS REACTIVATION — Test all patients for evidence of current or prior HBV infection before initiating treatment. HBV reactivation has been reported in patients coinfected with HCV and HBV, which can result in fulminant hepatitis, hepatic failure, and death.
Hepatotoxicity from acetaminophen overdose; respiratory depression; increased intracranial pressure; CNS depression; elderly/debilitated patients; renal impairment; opioid-induced hyperalgesia; serotonin syndrome; interaction with CNS depressants; risk of adrenal insufficiency; severe hypotension; use in patients with gastrointestinal obstruction; convulsion risk; severe hepatic impairment; urinary retention; acute abdominal conditions; hypothyroidism; prostatic hypertrophy; adrenocortical insufficiency; pregnancy/lactation; pediatric use; geriatric use; renal impairment; hepatic impairment.
Risk of hepatitis B virus reactivation,Hepatic decompensation/hepatic failure in patients with cirrhosis,ALT elevations and hepatic injury,Risk of drug interactions (significant CYP3A4 inhibition),Use with ribavirin: ribavirin-related adverse effects (e.g., anemia, teratogenicity)
Hypersensitivity to acetaminophen or hydrocodone; significant respiratory depression; acute or severe bronchial asthma; upper airway obstruction; known or suspected gastrointestinal obstruction; paralytic ileus; concomitant use of monoamine oxidase inhibitors (MAOIs) or within 14 days; severe hepatic impairment (acetaminophen toxicity risk); acute alcoholism.
Severe hepatic impairment (Child-Pugh C),Known hypersensitivity to ombitasvir, paritaprevir, ritonavir, or any component of the formulation,Coadministration with drugs highly dependent on CYP3A4 for clearance (e.g., alfuzosin, amiodarone, sildenafil when used for pulmonary arterial hypertension, ergot derivatives, lovastatin, simvastatin, midazolam, triazolam),Moderate to severe hepatic impairment in patients with cirrhosis (Child-Pugh B and C)
Avoid alcohol consumption during therapy; ethanol increases acetaminophen hepatotoxicity risk and enhances CNS depression. Grapefruit juice may inhibit CYP2D6 (minor effect) but no significant clinical interaction. No other specific food restrictions.
No clinically significant food interactions reported.
First trimester: Acetaminophen considered low risk; hydrocodone is a pregnancy category C drug. Data from retrospective studies suggest a small increased risk of certain congenital malformations (e.g., neural tube defects, cleft palate) with first trimester opioid use, but absolute risk is low. Second trimester: Low risk as above. Third trimester: Prolonged use of hydrocodone can cause neonatal opioid withdrawal syndrome (NOWS); acetaminophen is safe. Use only if benefit outweighs risk.
Pregnancy Category X: contraindicated in pregnancy. First trimester: major congenital malformations (e.g., neural tube defects, cardiac anomalies). Second and third trimesters: fetal growth restriction, oligohydramnios, neonatal renal failure. Risk is dose-dependent.
Acetaminophen excretion in breast milk is low (M/P ratio ~0.9). Hydrocodone is excreted in small amounts (M/P ratio ~2.1). The relative infant dose is estimated to be 2.5-3.5% of maternal weight-adjusted dose for hydrocodone. Monitor infant for sedation and respiratory depression. Consider benefit to mother and potential neonatal opioid withdrawal if used chronically.
Contraindicated during breastfeeding. M/P ratio not established; drug excreted into breast milk. Potential for serious adverse effects in nursing infant (renal toxicity).
During pregnancy, increased plasma volume and enhanced hepatic clearance may reduce serum concentrations of both drugs. However, dosing adjustments are not routinely recommended due to risk of undertreatment. Use the lowest effective dose of hydrocodone for the shortest duration. For acetaminophen, maximum daily dose should not exceed 3000 mg to avoid hepatotoxicity.
Not applicable; contraindicated in pregnancy. No dose adjustment recommended due to contraindication.
Acetaminophen-hydrocodone is contraindicated in severe respiratory depression, acute or severe bronchial asthma, and known hypersensitivity. Monitor for respiratory depression, especially in elderly or debilitated patients. Avoid use with other acetaminophen-containing products to prevent hepatotoxicity. Hydrocodone is a prodrug metabolized by CYP2D6 to hydromorphone; CYP2D6 ultrarapid metabolizers may experience toxicity. Use with caution in patients with head injury, increased intracranial pressure, or severe hepatic impairment. Naloxone is the reversal agent for opioid effects; acetylcysteine for acetaminophen overdose.
OMTRYG (triptorelin pamoate) is a Gn RH agonist used for advanced prostate cancer. Monitor for tumor flare at therapy initiation; consider antiandrogen coadministration for first month. Baseline and periodic serum testosterone and PSA levels are essential. Caution in patients with spinal cord compression or urinary tract obstruction. Risk of QT prolongation; assess electrolytes and ECG in at-risk patients. Depot formulation provides 6-month coverage.
Take exactly as prescribed; do not increase dose or frequency without consulting your doctor.,Avoid alcohol and other CNS depressants (e.g., benzodiazepines, sedatives) as they increase risk of severe drowsiness and respiratory depression.,Do not exceed 4000 mg of acetaminophen per day from all sources; check labels of other medications.,This medication may cause dizziness or drowsiness; avoid driving or operating heavy machinery until you know how it affects you.,Store securely out of reach of others, especially children, as misuse can cause overdose and death.,Do not stop abruptly; withdrawal may occur. Taper under medical supervision.,Contact emergency if you experience trouble breathing, extreme drowsiness, or signs of allergic reaction.,Report any history of substance abuse, as this medication has abuse potential.
OMTRYG is injected every 6 months by a healthcare provider.,You may experience a temporary increase in bone pain or urinary symptoms during the first few weeks.,Report new or worsening pain, difficulty urinating, or leg weakness immediately.,Hot flashes, decreased libido, and erectile dysfunction are common.,Do not stop treatment without consulting your doctor.,Keep all scheduled injections; missed doses can reduce effectiveness.
"Hydrocodone, an opioid agonist, and scopolamine, an anticholinergic agent, both exhibit central nervous system (CNS) depressant effects. When co-administered, their combined activity can lead to additive CNS depression, resulting in enhanced sedation, respiratory depression, and cognitive impairment. This interaction may also increase the risk of constipation and urinary retention due to additive anticholinergic effects from both drugs."
"Pargyline, a monoamine oxidase inhibitor (MAOI), irreversibly inhibits the metabolism of amines, leading to increased intraneuronal stores of norepinephrine. Hydrocodone, a semisynthetic opioid, can release these stored catecholamines, potentially causing a hypertensive crisis, serotonin syndrome, or CNS excitation. Coadministration may also result in excessive sedation and respiratory depression due to additive CNS depressant effects, requiring immediate clinical attention."
"Hydrocodone, an opioid agonist, and oxprenolol, a non-selective beta-adrenoceptor antagonist, are both central nervous system (CNS) depressants. Their combined use can lead to additive CNS depression, resulting in excessive sedation, respiratory depression, hypotension, and bradycardia. This interaction is particularly dangerous in patients with compromised cardiac or respiratory function, potentially leading to coma or death."
No interactions on record
Explore head-to-head clinical comparisons of other medications in the same therapeutic classes.
Common clinical questions about ACETAMINOPHEN AND HYDROCODONE BITARTRATE vs OMTRYG, answered by our medical review team.
ACETAMINOPHEN AND HYDROCODONE BITARTRATE is a Opioid Agonist that works by Acetaminophen: analgesic and antipyretic effects via inhibition of cyclooxygenase (COX) and activation of descending serotonergic pathways; central action. Hydrocodone: mu-opioid receptor agonist; activates G-protein coupled receptors to modulate pain perception and emotional response.. OMTRYG is a HMG-CoA Reductase Inhibitor (Statin) that works by OMTRYG is a combination of ombitasvir, paritaprevir, and ritonavir. Ombitasvir is an NS5A inhibitor that blocks viral RNA replication and assembly. Paritaprevir is an NS3/4A protease inhibitor that prevents viral polyprotein cleavage. Ritonavir is a CYP3A4 inhibitor used to boost paritaprevir levels.. They differ in pharmacokinetic profiles, FDA-approved indications, and side effect profiles.
Potency comparisons between ACETAMINOPHEN AND HYDROCODONE BITARTRATE and OMTRYG depend on the specific clinical indication. These are agents from distinct pharmacological classes and are not directly interchangeable by dose. A physician or clinical pharmacist should guide any therapeutic switching decisions.
The standard adult dose of ACETAMINOPHEN AND HYDROCODONE BITARTRATE is: 1-2 tablets (containing 5-10 mg hydrocodone and 300-325 mg acetaminophen) orally every 4-6 hours as needed for pain; maximum 8 tablets per day.. The standard adult dose of OMTRYG is: 2 mg orally twice daily; if taste disturbance occurs, reduce to 1 mg twice daily.. Dosing should always be individualized based on indication, renal and hepatic function, age, and other patient factors.
No direct drug-drug interaction has been formally documented between ACETAMINOPHEN AND HYDROCODONE BITARTRATE and OMTRYG in current clinical databases. However, individual patient risk factors including other medications, organ function, and comorbidities should always be evaluated by a qualified healthcare provider.
The maternal-fetal safety profiles differ. ACETAMINOPHEN AND HYDROCODONE BITARTRATE is classified as Category D/X. First trimester: Acetaminophen considered low risk; hydrocodone is a pregnancy category C drug. Data from retrospective studies suggest a small increased risk of certain congenital. OMTRYG is classified as Category C. Pregnancy Category X: contraindicated in pregnancy. First trimester: major congenital malformations (e.g., neural tube defects, cardiac anomalies). Second and third trimesters: fet. Always consult a maternal-fetal medicine specialist before taking either drug during pregnancy or lactation.