J OralMaxillofac 50:916-917.
Surg
1992
THECORREarticularly limited in the failing heart, and the prolonged nfusion of glucagon into dogs caused glucagon particles to accumulate in their lungs4 For these reasons the use of gucagon in cardiac patients has not become popular.’
SIDNEYPESKIN,DDS, MS Chicago, Illinois BIGGER ISN’T ALWAYS BETTER To the Editor:-It is important that the health practitioner remain analytical toward advertising claims made by manufacturers of biomedical devices and pharmaceutical agents, as the Food and Drug Administration cannot always be relied on to police them. A case in point is the marketing of Vicodin ES (Extra Strength). This analgesic combination is claimed to be “tablet for tablet, the most potent analgesic you can phone in” and “provides greater central and peripheral action than other hydrocodone/acetaminophen combinations.” A review of the literature and a request for information from the manufacturer (Knoll Pharmaceuticals, Whippany, NJ) will show that there are no internal or published studies
916
917
LETTERS TO THE EDITOR
comparing 5 mg and 7.5 mg of hydrocodone for analgesic potency or the incidence of side effects. It seems that these claims are based on a study’ by the reknowned pain researcher Dr William Beaver in which 10 mg of hydrocodone wascompared with codeine. He found that, at this strength, hydrocodone was six times more potent than codeine. However, as we all know, the analgesic response curve is not a straight line and whether a clinically significant difference exists between 5 and 7.5 mg is not known. I realize that the “extra strength” version also contains 250 mg more of acetaminophen than their “regular strength,” but again, whether this alone or in combination with hydrocodone makes any clinical significance has not been tested. The purpose of this letter is not to discourage the use of hydrocodone, as I believe it is one of the most useful drugs
in our pain control armamentarium, nor to imply that any currently marketed acetaminophen-hydrocodone combinations are dangerous or ineffective, but to point out that claims sometimes can be misleading. DAVID S. EVASKUS,
DDS, MS Chicago, Illinois
Reference 1. BeaverWT, McMillan D: Methodological considerations in the
evaluation of analgesic combinations: Acetaminophen [paracetamol] and hydrocodone in postpartum pain. Br J Clin Pharm IO:21SS,1980
CHILDREN 2101 Wilson Blvd
l
Suite 550 Arlington, VA 22201 l
f7os)TDD: l-800-826-7653
MONICA NICOLE DASILVA Non-Family Abduction Date Missing: 09123190 Missing From: Rena, Nevada Date of Birth: 0642183 Age at Disappearance: 7 years Sex: Female Race: White Hdght: 3 t-t Weighty40 lb Hair: Blonde Eyes: Brown Identifying Infom&iotr Child has a scar on web of right hand and has freckles on her cheeks. Circum&nce~ Child was last seen in her bedroom at hur home at approximately 9:oOPM. At 7:00 AMthe next morning, her father went in to her bedroom and she was gone. ANYONE HAVING INFORMATION SHOULD CONTACT ‘Ihe Natkmal Center for Missing and ExpMed Children 1400-8434678
OR Rena Police DepmtmaM (Nevada) MkingPemnsunit l-702-334-2115
Surg
1992
THECORREarticularly limited in the failing heart, and the prolonged nfusion of glucagon into dogs caused glucagon particles to accumulate in their lungs4 For these reasons the use of gucagon in cardiac patients has not become popular.’
SIDNEYPESKIN,DDS, MS Chicago, Illinois BIGGER ISN’T ALWAYS BETTER To the Editor:-It is important that the health practitioner remain analytical toward advertising claims made by manufacturers of biomedical devices and pharmaceutical agents, as the Food and Drug Administration cannot always be relied on to police them. A case in point is the marketing of Vicodin ES (Extra Strength). This analgesic combination is claimed to be “tablet for tablet, the most potent analgesic you can phone in” and “provides greater central and peripheral action than other hydrocodone/acetaminophen combinations.” A review of the literature and a request for information from the manufacturer (Knoll Pharmaceuticals, Whippany, NJ) will show that there are no internal or published studies
916
917
LETTERS TO THE EDITOR
comparing 5 mg and 7.5 mg of hydrocodone for analgesic potency or the incidence of side effects. It seems that these claims are based on a study’ by the reknowned pain researcher Dr William Beaver in which 10 mg of hydrocodone wascompared with codeine. He found that, at this strength, hydrocodone was six times more potent than codeine. However, as we all know, the analgesic response curve is not a straight line and whether a clinically significant difference exists between 5 and 7.5 mg is not known. I realize that the “extra strength” version also contains 250 mg more of acetaminophen than their “regular strength,” but again, whether this alone or in combination with hydrocodone makes any clinical significance has not been tested. The purpose of this letter is not to discourage the use of hydrocodone, as I believe it is one of the most useful drugs
in our pain control armamentarium, nor to imply that any currently marketed acetaminophen-hydrocodone combinations are dangerous or ineffective, but to point out that claims sometimes can be misleading. DAVID S. EVASKUS,
DDS, MS Chicago, Illinois
Reference 1. BeaverWT, McMillan D: Methodological considerations in the
evaluation of analgesic combinations: Acetaminophen [paracetamol] and hydrocodone in postpartum pain. Br J Clin Pharm IO:21SS,1980
CHILDREN 2101 Wilson Blvd
l
Suite 550 Arlington, VA 22201 l
f7os)TDD: l-800-826-7653
MONICA NICOLE DASILVA Non-Family Abduction Date Missing: 09123190 Missing From: Rena, Nevada Date of Birth: 0642183 Age at Disappearance: 7 years Sex: Female Race: White Hdght: 3 t-t Weighty40 lb Hair: Blonde Eyes: Brown Identifying Infom&iotr Child has a scar on web of right hand and has freckles on her cheeks. Circum&nce~ Child was last seen in her bedroom at hur home at approximately 9:oOPM. At 7:00 AMthe next morning, her father went in to her bedroom and she was gone. ANYONE HAVING INFORMATION SHOULD CONTACT ‘Ihe Natkmal Center for Missing and ExpMed Children 1400-8434678
OR Rena Police DepmtmaM (Nevada) MkingPemnsunit l-702-334-2115
