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Confusion with the Vico-Dans

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Alright boys and girls.  We have seem to have a bit of confusion in the patient/crackhead/doctor worlds as to the proper strengths and naming of various hydrocodone products.

I’m tired of seeing Rx’s for Vicodin 7.5/500 or Lortab 7.5/750.  Quit making yourself look like an idiot in front of your local pharmacist and heed my words of wisdom.  Here is the chart, print it out and keep it with you (or just write Hydrocodone/APAP and make it easy on yourself.

First off, Vicodin 5/500 and Lortab 5/500 are THE SAME FUCKING THING.  Don’t give me this bullshit as to Vicodin upsets your stomach while Lortab doesnt.  To be honest, both come from the SAME generic bottle (yes, the Watsons) so that just tells me how full of shit you are.

Now, the breakdown (hydrocodone/APAP):

  • Vicodin

  • 5/500

  • Vicodin ES

  • 7.5/750

  • Vicodin HP

  • 10/660

  • Lortab

  • 5/500

  • 7.5/500

  • 10/500

  • Lorcet

  • 10/650

  • Norco

  • 5/325

  • 7.5/325

  • 10/325

Now, for those at home who actually aren’t on this stuff, you may notice that LORTAB always has 500mg of Tylenol and NORCO always has 325mg of Tylenol.  Amazing!  Learn the rest or print this out so you can get it right on the Rx. 

You may also notice that Lorcet and Vicodin HP only have 10mg difference in Tylenol in them.  If you call me up, and get pissy with me over 10mg of Tylenol for dispensing Vicodin HP vs Lorcet I will drive to your office and kick you square in the teeth.  There is NO point in stocking both over 10 piddly mg of Tylenol.  Thats almost as stupid as getting pissy at me for dispensing Prinivil over Zestril (back in the day when they were both trade name).

This has been a public service announcement from The Angry Pharmacist(tm).  No Doctors or Addicts were harmed in the making of this public service announcement.

Comments #

Comment by Random Pharm Tech on 2008-11-21 11:46:05 -0800 #

I work in a pediatric hospital pharmacy… one we saw recently was the person who wrote for “Lortab Elixir – give 5mg hydrocodone / 500 mg acetaminophen per dose.” Since Lortab Elixir is 7.5/500 per 15ml, are we’re supposed to give 10ml of hydrocodone part and 15ml of the tylenol part? Or give 12.5ml to average it? And when we call to clarify, we’re told we don’t know what we’re talking about. (Of course, the same person wrote to give the sister 2.0925 tabs of ibuprofen per dose.)

Comment by Mike on 2008-11-21 12:12:44 -0800 #

I agree….this drives me crazy too. I always have patients arguing with me about the names. I made a chart similar to yours above and faxed it to the offending physicians’ offices and gave it to some patients too. None of them have listened at all….I shouldn’t have wasted my time and the paper.

Comment by The Ole’ Apothecary on 2008-11-21 16:41:01 -0800 #

Regarding the 660 mg of APAP, that’s not a good drug abuse bargain.

Comment by nodrugs4u on 2008-11-21 18:07:57 -0800 #

I’ve seen so many of these screwed up Rx’s that I stopped calling to clarify. as long as you give me the strength on both hydrocodone and APAP, I don’t care what you write in front of it. Vicodin, Lortab, whatever, I really could care less. Sometime I’ll call when PT has been on Vicodin ES and now you call me and order Norco 7.5 (with the same sig). Otherwise, just give me the strength of both and we’ll thank each other and hang up. I won’t try to tell you Norco doesn’t come in 7.5/750. I’ll bet you dollar for peso that 99% of the time you don’t care as long as it’s 7.5/750, right?

Comment by tap’s biggest fan on 2008-11-21 18:50:26 -0800 #

Thank you so much for this much-needed post. Don’t forget LorAtab.. I was on rotation with a medical school intern who was spelling it that way in a patient’s chart, and I see the occasional rx spelled that way. Oh and a couple you left off your list.. Lortab 2.5/500 (just dispensed some today- though I think that bottle sits on the shelf for about a year between uses) and Lorcet Plus a.k.a. Lorcet 7.5/650. By the way I absolutely love, love, love your site! You are my inspiration!

Comment by Google Account on 2008-11-21 20:39:26 -0800 #

I love that you posted this, because every time I start my rant about what makes each of these different all I see are eyes full of glaze and snoozing techs. I really don’t know why MDs can’t get it right? I assume they got through med school the same way I got through pharmacy school…rote memorization. Let’s practice using our brains and make the pharmacist’s life easier shall we? Oh, and can we please refrain from prescribing Loratab or just plain hydrocodone? The last time I checked hydrocodone wasn’t really a one-man wonder.

Comment by daverph on 2008-11-21 21:25:57 -0800 #

i am sending this to every single doctor’s office i know.

Comment by Google Account on 2008-11-21 22:04:03 -0800 #

Awww, TAP, now you’ve made it too easy for my really bad forgers to get it closer to correct! The one that wrote Hydrorodone/APAP 1750/17.5 (no typos there – that’s what she wrote) can just look at your little chart now… Well, not now – after she gets out of jail…

Comment by John Loertscher on 2008-11-22 09:43:13 -0800 #

You really messed up this time TAP.
Everyone know it’s spelled and pronounced
I’m going to one further you on the 660/650 debate. What’s the point even with those? We should just carry Lortab errrrrr Loritabs and Norco.
I do have a patient that absoultely INSISTS that Lorcet works while Lortab oops Loritabs doesn’t. And yup, they’re both Watson.
Fortunately I have enough dentists that don’t know any better, and write out of habit, to justify carrying Lorcet.
I’ve got a huge amount of patients on Suboxone. They are being helped by a doc with the infinite wisdom to actually give a shit about people and help them solve their problems. After these folks get clean, I won’t have anything to complain about!

Comment by Google Account on 2008-11-22 12:07:45 -0800 #

Oh, but the white Lortab makes my stomach hurt. I have to have the pink Lorcet. Please don’t dismiss my pain. I told the doctor that lortab upsets my stomach, so they are calling me in lorcet.
OMG–I must have STUPID tatooted on my forehead! Come on!

Comment by JenOK on 2008-11-22 18:05:20 -0800 #

Just wanted to let you know I had a drug rep from Abbott in yesterday. She said they had put in for a NDA for extended release hydrocodone/APAP. I asked the strengths but she wasnt sure yet. I really hope this isnt approved. We have no more room for another strength on our shelves!

Comment by rxkerber on 2008-11-22 20:42:01 -0800 #

This drives me crazy too. I always call the doc…or excuse me PA/ NP since no docs actually write rxs anymore. More just to drive my point home than to really clarify the drug name/strength. I got a prescription today for Vicodin 500mg. Calling MD office on Monday. Strangely the father didn’t seem to mind at all that his son wouldn’t have med for his ankle injury. And a note to all the DDS/DMDs….Vicodin ES is a max of 5 tabs per day. Stop writing 1-2 every 4-6 hours. It must be stamped in the DDS code somewhere that this is the proper Vicodin ES dose. I call everytime to educate on APAP dose limits.

Comment by neumeindil on 2008-11-22 21:45:17 -0800 #

“No Doctors or Addicts were harmed in the making of this public service announcement.”
Pity. A good whack with that stock bottle of 5/500 might knock some sense into them. Small chance, but possible considering how much it hurts when you drop a full one on your pinky toe.

Comment by Shalom (R.Ph.) on 2008-11-23 08:40:45 -0800 #

Don’t forget Zydone (7.5/400 and 10/400).
Or Maxidone (10/750).
I’ve tried numerous times to educate doctors about the various types of hydrocodone preparations. Especially when I see them writing for Vicodin-ES, and then put “1-2 tabs q4-6h prn”. Um, doc, do you want this patient to still have a liver when you’re done? I’ve begged them to switch to a lower APAP product; after all, it’s only there to keep the hydrocodone out of schedule 2, does it really matter how much there is?. One or two have accepted my suggestion to switch to Lortab or Norco. Most don’t.
Historical note: Zydone was once basically the same as Lortab 5/500, except it was in a capsule form. Back when I was in school, we had one doctor who only ordered that. There was also a Lortab-ASA for those who were allergic to APAP; haven’t seen that one around lately.
(I think I mentioned once in this forum that when I was in school, I never heard the name Vicodin; every doctor in that neighborhood called it Lortab 5/500, and the generic was shelved under “L”. Wasn’t until I moved back to the NYC area that I started seeing Vicodin scripts.)
Then there was Anexsia. This was originally 7.5/650, same as Lorcet-Plus, but I just checked, and it seems that Watson bought the name and began producing it in *all* the strengths listed above, except the Zydones. Nobody I know carries it, though.

Comment by KDUBZ on 2008-11-23 22:31:10 -0800 #

Does the dose really matter if they patient intends on taking half the bottle within 10 minutes of leaving the pharmacy? Furthermore, it amazes me how many freaking patents pharmaceutical companies have been able to squeeze out of the same combination product. I should patent my own combo product so all the crack heads make my rich while insisting on brand!

Comment by chemoqueenrph on 2008-11-24 17:52:07 -0800 #

Sweet mother of God. Sustained release hydrocodone/APAP? What a bunch of horseshit. Lemme guess. They will make it in the same strengths as what’s already on the market, further increasing our frustration over another call to clarify. And hey, lets just give the crackheads another dosage form to crush and snort for that extra special high.
The orders for ‘hydrocodone 5 mg’ still annoy the crap out of me. Nine times out of ten it is because someone doesn’t have the ability to write down what’s on the pt’s prescription bottle accurately. Then you get ‘What’s APAP?’
It’s great that we now interchange hydrocodone/APAP products to Norco based on the strength of Hydrocodone. APAP strength be dammed. They can garble that as much as they want. They get what’s on the shelf.

Comment by Lynn on 2008-11-25 17:56:54 -0800 #

I actually had a doctor give a woman 3 different prescriptions at the same time, hydrocodone/APAP 2.5/500 for mild pain, hydrocodone/APAP 5/500 for medium pain and vicodin es for severe pain. Good thing we have 25 different strengths of the same drug on the shelf.

Comment by Google Account on 2008-11-29 13:26:25 -0800 #

Thanks for the list TAP! I wished I had this on my first day working at the pharmacy.

Comment by dumb medicine on 2008-12-08 23:02:49 -0800 #

I had a prescription for Percot yesterday done in magic marker. The crazy thing is it was legitimate.

Comment by Daniel on 2008-12-09 21:05:05 -0800 #

For all you pharmacist just fill the prescription that you are given and stop giving crap to the patient
That you really don

Comment by Google Account on 2008-12-10 14:50:39 -0800 #

Yup, just another category of bullshit to contend with. I WISH I had the time to call & educate every douche-rocket with a medical license about APAP (what’s that?) limits who writes for vicodAn es 1-2 q 4-6 hrs. I just cover my own ass by putting a max daily dose of 5 tablets on the label. On an only slightly related topic (harassing incompetent prescribers), I had a pediatrician who persisted in writing for orapred odt tablets in doses that included 1/2 tabs. WE all know they can’t be split & the other half saved for later, but damned if that arrogant bitch was going to listen to a lowly pharmacist. Hey, what the fuck do I know? So, every time she did it, I informed the patient’s parent that the rx was inappropriate and the md knew it cuz I had told her, AND I faxed the doc the part of the package insert stating that the tablets were not to be split. I did it over & over until she cut the shit, and I enjoyed it every time I did it. Arrogant know-it-all fuckers.

Comment by CaliPA on 2008-12-11 22:24:38 -0800 #

Great blog…I love to hear the Pharmacist point of view. I cringe when certain chronic pain patients come for refills. Their chart is on volume 4, they all smoke, have depression. Cannot remember to take their daily lantus but for some crazy reason seem to run 3 days short of their Vicodin “500s” (why do all patients call them by 500s?)
Half of these patients I inherited from a pain doc whom left the practice, some have normal x-rays or 3percent curvature of their spine so they need the vicodin because of the pain..”oh can I get the morning after pill too?” (guess the back didn’t hurt that bad?)
Why does the guy who doesn’t work and has stiff back, squats more than I weigh get Norco 10 #120/30days and the guy with Colon CA manage with Vicodin 5 #30?
I started cracking down on some chronic pain pts, getting some UA drug screens finding meth and neg for opiates. Crazy I went from their hero to just a PA, what do you know..I need to see the MD. Anyhow keep up the work…thanks for saving us providers…

Comment by PA pharmacy intern on 2008-12-22 16:19:50 -0800 #

Just filled a prescription today for “Vicodin 7.5/500″…I saw Vicodin 7.5 and initially thought Vicodin ES..but looking at it again i noticed the 500. Gotta love doctors and their knowledge of the medications that they are prescribing.

Comment by CA Tech on 2008-12-24 13:44:38 -0800 #

I’m cracking up at the title VICO-DANS! This is what I call them at work as a joke, because that’s what the patients call them.
No joke I had a patient a couple of weeks ago come in and say “Can I have my Vico-Dans refilled, because I be painin’.

Comment by whoops on 2008-12-29 15:42:02 -0800 #

I love this site! A dear friend of mine is a PharmD, so I get to listen to her saying the same stuff that you guys are saying. I have been screwed up physically by stupid docs prescribing meds for BS Dx’s that only wrecked my body. Now I clear all my meds with my buddy first, since she is very familiar with my health conditions and pays a helluva lot more attention to details that any MD I have ever known. Also, the pain med seekers piss ME off, too, because I AM a chronic pain patient that does not abuse meds or take more than Rx’d. But I still get “that look” from new Pharms, which I understand, and that pisses me off as well! However, I’m more than willing to allow them the time it takes to see that I am not one of the typical pain-pill seekers. I take my meds like I am supposed to and I don’t give the Pharms any shit about their initial attitudes, because I GET IT. Folks like to get fucked up and their behavior fucks MY needs up. Yeah, boy howdy, sometimes life’s a bitch, but oh well, whatchgonnado?

Comment by Nathaniel on 2012-04-14 00:18:16 -0700 #

I would like to know how many days would a script of ten lortab 7.5 tablets last me???

Comment by Silky 1 on 2012-09-12 15:11:20 -0700 #

It depends on how they are prescribed to be taken. A good educated guess would be 5 days.

Comment by Gaby on 2012-09-25 16:54:13 -0700 #

So I had a question for those more versed in this script business. My script reads Lortab 7.5/500 MG, 15 ML, 3 times a day/900 ml, 3 refills. How many ML in total is that? How many days is each refill? How many days in total was the script for?….I’m starting to doubt the pharmacy techs at my pharmacy. When I first dropped off my script the lady was like “Whoa why is your doc prescribing you Lortab for 90 days?”. I was idk I just take what he gives me, drop it off and pick it up. So as she is trying to figure out how to put it in the computer she asks another to come help her, who then corrects her and says “No the script reads 900ML in total for a duration of 60 days”. As they sit there with a calculator trying to figure out how to dispense it the pharmacist comes over and laughs shakes his head and says “Thats a 20 day script” then walks away. They enter it into the computer and then realize they only have 135 ml left and say to come back in 3 days for the rest. I come back and they gave me a bottle of Lortab (Qualitest brand) which is 435 ml that says I had 2 refills left. Took my medicine as prescribed then called in for a refill, sent my husband the next day to pick it up and he comes back with another Quakitest brand that then read that I have 1 refill left…I’ve been mulling over it for awhile so I call to ask if they’re dispensing it right. The lady then says that I have a total of 900 ml I can pick up in total, that I have 200 and something ml left to pick up. Something doesn’t sound right so I keep questioning her and ask her to check the original script, so she “checks it” and says that according to the script I never had any refills, that I can pick up the 200 something mls left but she can’t do anything else….dafuq? So the label printed out said I had 2 refills, then 1 refill, but yet according to her I never had any? According to their logic I was supposed to get 900ml in 20 days that equaled 3 refills? But just by what I’ve been prescribed so far I’ve already gone over their “900ml” and I still have 1 refill left? I have no idea what they’re trying to pull, if they’re just stupid, or shit if their trying to jip me and steal the rest themselves!

Comment by Charles on 2012-11-18 23:28:14 -0800 #

It Depends on why they were prescribed, if a bad toothache and you’re going to see the dentist in 3 days , you got 3 days worth ,take one every 8 hours as needed for pain. if you broke a bone probably 2 days worth one every 4 hours ,and your appt is for within 2 days. AND REMEMBER NO ALCOHOL WITH HYDROCODONE OR ANY OTHER NARCOTIC, THIS COMBINATION CAN KILL YOU! this includes wine and yes even beer.
And for the MD’s who laugh when a patient takes the wrong dosage, you need to get a different job. heard 2 MD’s talking about an older man who mistook 3 a day – as 3 at once ,who had to be rushed to the er by ambulance ,thats not funny. you are in the wrong business. GET AWAY FROM PRESCRIBING FOR PEOPLE and ANIMALS EVEN. We deserve better. if you want an person to take 1 pill 3 times a day ,you might ask if they understand what that means, 1 every 8 hours ,not 3 at once every 24 hours. what you didn’t speak to the patient you had a golf game and had an NP write it without a consultation. no wonder you have high MP insurance.

Comment by Don on 2012-12-24 20:52:00 -0800 #

Whether you are right or wrong … You sound like a real dickhead .. I wouldn’t mind smacking u in the face

Comment by Tiarra on 2013-01-11 06:55:36 -0800 #

I hate that the DEA is breathing down the docs backs but from what people on this site have been saying looks like the DEA NEED to be. Some docs are real idiots. Back when I was a kid things weren’t like this but NOW??? I just don’t know.