Comparative Pharmacology
Head-to-head clinical analysis: DURAGESIC 12 versus VICODIN.
Peer-Reviewed Evidence
Head-to-head clinical analysis: DURAGESIC 12 versus VICODIN.
DURAGESIC-12 vs VICODIN
Comparing the clinical profiles, pharmacokinetic behaviors, and safety indices of these two therapeutic agents.
Fentanyl is a potent synthetic opioid agonist that primarily binds to mu-opioid receptors in the central nervous system, leading to analgesic effects by increasing potassium conductance and decreasing calcium influx, thereby inhibiting ascending pain pathways and altering pain perception.
VICODIN (hydrocodone/acetaminophen) is a combination opioid agonist and analgesic. Hydrocodone acts on mu-opioid receptors in the CNS to alter pain perception and response; acetaminophen inhibits cyclooxygenase (COX) activity, likely in the CNS, reducing prostaglandin synthesis and providing antipyretic effects.
Transdermal patch, initially 12 mcg/h applied every 72 hours in opioid-naive patients; titrate based on response and tolerance.
1-2 tablets (hydrocodone 5-10 mg and acetaminophen 300-325 mg) orally every 4-6 hours as needed for pain; maximum daily acetaminophen dose 4 g.
None Documented
None Documented
Terminal elimination half-life is approximately 20–27 hours (range 13–44 hours) after transdermal patch removal; prolonged in elderly, hepatic impairment, and with continuous use due to drug accumulation in skin and adipose tissue.
Hydrocodone: 3.8-6.4 hours (terminal); Acetaminophen: 2-3 hours (terminal). Clinically, steady-state achieved in 1-2 days.
Renal: approximately 75% as metabolites (primarily norfentanyl and other inactive metabolites) and <10% as unchanged fentanyl; fecal: approximately 9%; biliary: minor.
Hydrocodone: primarily renal (~60% as metabolites, 12% unchanged); minor biliary. Acetaminophen: renal (90-100% as metabolites, 2-4% unchanged).
Category C
Category C
Opioid Analgesic
Opioid Analgesic