Anexsia, a discontinued medication with hydrocodone and high-dose acetaminophen, was an opioid analgesic that posed a significant risk of abuse and misuse, potentially resulting in overdose and death. This blog talks about the uses and potential side effects of Anexsia medication, along with the withdrawal process that results from discontinuing or reducing drug usage, especially after prolonged use.

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What is Anexsia?

Anexsia was a prescription medicine that combined hydrocodone and acetaminophen. It had 5 mg of hydrocodone and 500 mg of acetaminophen. Hydrocodone is classified as a narcotic medication, whereas acetaminophen is considered a non-narcotic medication.

Some references to “Anexsia 120 mg” likely refer to the acetaminophen content rather than the hydrocodone, as 120 mg of hydrocodone would far exceed safe dosing limits. Anexsia was historically recommended by physicians to address moderate to severe pain. However, the medication was discontinued following a 2011 FDA guideline that limited the acetaminophen content in combination drugs to 325 mg—an amount that Anexsia exceeded.

Anexsia was habit-forming since hydrocodone activates the brain’s reward system, leading to physical dependence and the desire to consume it regularly. Stopping opioids such as Anexsia abruptly can lead to unbearable withdrawal effects, highlighting the necessity of medical detoxification and rehabilitation [1].

Anexisa Uses

Hydrocodone is part of the class of drugs known as narcotic analgesics (pain relievers). It influences the central nervous system (CNS) to alleviate pain and halt or prevent coughing.

The combination of hydrocodone and acetaminophen is utilized to alleviate pain that is severe enough to necessitate opioid therapy, especially when other pain medications have proven ineffective or are not tolerated.

Acetaminophen is utilized to alleviate discomfort and lower fever in individuals. It does not lead to dependence when used for an extended period. However, high doses of acetaminophen can lead to additional adverse effects, such as liver injury.

Anexsia Side Effects

Anexsia is recognized for causing side effects, with some being common and others potentially very harmful [2].

Typical side effects of opioids such as Anexsia 5/325 include:

Drowsiness and Lightheadedness: A common side effect is drowsiness, often accompanied by lightheadedness. This occurs because hydrocodone modifies pain perception and influences the central nervous system. Individuals should refrain from operating vehicles and engaging in potentially hazardous activities while taking this medication.

Constipation: Opioids like hydrocodone may lead to constipation as they reduce intestinal movement. Monitoring the digestive system is essential, and measures should be taken to promote regular bowel movements, like boosting fluid and fiber consumption.

Nausea and Vomiting: Certain patients might develop nausea or vomiting, particularly during the initial phase of treatment or if the dosage is raised. If these symptoms remain ongoing or severe, a physician should be consulted.

Elevated Liver Stress: Acetaminophen can negatively impact the liver, especially when taken in large doses. Therefore, it is essential to follow the advised dosages and the physician’s guidelines. Excessive amounts of acetaminophen may result in acute liver failure, particularly if doses surpass 4000 mg/day or if various products containing acetaminophen are taken at the same time. Tracking dosage is essential to avoid serious consequences like liver transplants and death.

Withdrawal Syndrome: As mentioned, extended use of Anexsia may lead to the potential for physical dependency. If the drug is abruptly stopped, symptoms like irritability, anxiety, insomnia, sweating, and muscle pain may arise.

In rare cases, Anexisia may cause severe adverse reactions, including:

Mood Disorders: Changes in mood or depression may arise. If thoughts of suicide or suicidal feelings emerge, urgent assistance should be obtained.

Allergic Reactions: A rash, itching, or swelling of the face, lips, or tongue may signify an allergic response. In these instances, immediately stop using the drug and consult a healthcare professional.

Respiratory Issues: CNS depression and respiratory issues might be seen in individuals with a history of substance misuse or specific health conditions like breathing difficulties and brain tumors. This is particularly crucial for individuals with lung diseases or those on respiratory medications. Elderly patients and individuals with specific medical conditions face a higher risk of side effects, especially when these are mixed with substances such as alcohol and tobacco. In severe cases, improper use or overdose can lead to dangerously shallow breathing.

Other side effects that should be immediately reported to the doctor are:

• Interrupted breathing during sleep (sleep apnea)
• Fainting
• Seizures
• Stomach/abdominal pain
• Difficulty urinating
• Adrenal glands not working well (loss of appetite, unusual tiredness, weight loss)

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Anexsia Warnings

Anexsia must be stored in a safe place to avoid theft, misuse, or abuse. If a person mistakenly ingests this medication, seek medical assistance immediately [3].

Here are some warnings for individuals using or being prescribed Anexsia 120mg or any other dosage:

Do Not Mix with Alcohol and Other Narcotic Drugs

The mixture of Anexsia with alcohol and other drugs creates a significant health hazard, potentially resulting in a heightened effect of central nervous system (CNS) depression. Moreover, alcohol and narcotic drugs can change the pharmacokinetics of Anexsia, raising the chances of overdose and serious side effects.

Furthermore, this mixture might lead to psychological and emotional instability, raising the chances of dependency. Hence, individuals must exercise great care and understand that combining these substances may result in unforeseen health risks, including potentially fatal situations.

Dosage and Frequency

As highlighted, large doses of hydrocodone/acetaminophen consumed for prolonged periods carry a risk of abuse and addiction, potentially resulting in overdose and death. This combination can also lead to serious, potentially lethal respiratory issues. Moreover, the likelihood of experiencing serious breathing issues increases when you begin this medication, following a dosage increase, or if you consume an incorrect dose/strength.

Hence, to reduce these risks, doctors should prescribe the smallest dose of hydrocodone/acetaminophen for the minimum time necessary.

Liver Complications

Consuming excessive acetaminophen might lead to severe (potentially lethal) liver damage. Adults must not exceed a daily intake of 4000 milligrams (4 grams) of acetaminophen, while individuals with liver issues and children should consume lower amounts of acetaminophen. Consult your physician or pharmacist regarding the safe dosage of acetaminophen.

Overdose

Get medical help right away if you take too much acetaminophen (overdose), even if you feel well. Overdose symptoms may include nausea, vomiting, loss of appetite, sweating, stomach/abdominal pain, extreme tiredness, yellowing eyes/skin, and dark urine.

Pregnant Women and Females of Child-Bearing Age

Prior to using this medication, women who can become pregnant or are trying to conceive should consult with their doctor regarding the associated risks and benefits. Inform your doctor if you are expecting or intend to get pregnant. With few exceptions, this medication should not be used during pregnancy.

Anexsia could marginally heighten the risk of birth defects if taken in the first two months of pregnancy. Additionally, utilizing it for an extended period or in large quantities close to the anticipated delivery date could jeopardize the unborn child. Infants born to mothers who have used this medication for an extended period may experience severe (potentially life-threatening) withdrawal symptoms since it transfers into breast milk.

To reduce these risks, use the lowest effective dose for the briefest duration.

Anexisa Precautions

Certain precautions that come with taking Anexsia are as follows [3]:

• MAO Inhibitors: Do not use Anexsia if you are using or have used an MAO inhibitor (a type of antidepressants that block the enzyme monoamine oxidase) within the past 14 days.
• CSN Depressants: This medication will enhance the effects of alcohol and other CNS depressants (drugs that may cause drowsiness or reduced alertness) such as antihistamines, sedatives, tranquilizers or sleep aids, prescription pain medications or narcotics, seizure medications or barbiturates, muscle relaxants, and anesthetics (numbing agents).
• Physical Dependence: Anexsia could lead to dependence. If you believe the medication is not effective, do not exceed your prescribed dosage.
• Respiratory Issues: This medication could cause breathing issues during sleep. If you experience sleep apnea while taking it, your doctor might reduce your dosage.
• Adrenal Gland Complication: It could cause issues with the adrenal glands, which could cause skin darkening, diarrhea, dizziness, fainting, decreased appetite, mental depression, nausea, skin rash, unusual fatigue or weakness, or vomiting.
• Liver Issues: Consult your doctor immediately if you experience pain or discomfort in the upper abdomen, pale stools, dark urine, decreased appetite, nausea, unusual fatigue or weakness, or yellowing of the eyes or skin. These may indicate a significant liver issue.
• Skin Reactions: This medication could lead to severe skin reactions like blistering, peeling, or loosening skin, itching, red skin sores frequently with a purple center, and sores, ulcers, or white patches in the mouth or on the lips.
• Serotonin Syndrome: Contact your doctor immediately if you experience anxiety, restlessness, rapid heartbeat, fever, sweating, muscle spasms, twitching, nausea, vomiting, diarrhea, or perceive things that aren’t present. These could be indicators of a severe disorder known as serotonin syndrome.
• Infertility Issues: Excessive use of this medication could lead to infertility (the inability to conceive). Consult your doctor prior to using this medication if you intend to conceive.

Lastly, do not alter your dosage or abruptly discontinue this medication without consulting your physician first. Abrupt discontinuation could lead to Anexisa withdrawal. Now, let’s look at other drug interactions to be mindful of when taking Anexisa or other hydrocodone/acetaminophen-based medications.

Anexsia Drug Interactions

Several products that could negatively interact with this medication include:

• Specific pain relievers (combined opioid agonist/antagonists like butorphanol, nalbuphine, pentazocine)
• Naltrexone
• Samidorphan

Moreover, the chance of experiencing serious side effects could be heightened if this medication is used alongside other products that cause drowsiness or respiratory issues. Inform your doctor or pharmacist if you are using additional products like:

• Other opioid pain or cough medications (like codeine, oxycodone)
• Alcohol
• Marijuana (cannabis)
• Medication for sleep or anxiety (such as alprazolam, lorazepam, zolpidem)
• Muscle relaxants (such as carisoprodol, cyclobenzaprine)
• Antihistamines (like cetirizine, diphenhydramine)

Lastly, different medications can influence the elimination of hydrocodone/acetaminophen from your system, potentially impacting its effectiveness. Examples include:

• Azole antifungals (like ketoconazole)
• Macrolide antibiotics (erythromycin)
• Levoketoconazole
• Mifepristone
• HIV treatments (such as tipranavir)
• Rifamycins (including rifabutin, rifampin)
• Ritonavir
• Specific medications for seizures (such as carbamazepine, phenytoin)

Anexsia Withdrawal

You must not discontinue using an opioid suddenly or “cold turkey,” as this raises the chances of facing more intense withdrawal symptoms. In certain situations, you may need to enroll in a medically-supervised detox program to withdraw from Anexsia safely.

Anexsia Withdrawal Symptoms

The symptoms of withdrawal from Anexsia resemble those of other opioid medications. Managing these drugs without the support of a specialized detox center can be challenging since they can have a significant impact on an individual’s physical and mental health [4].

A few of these symptoms include:

• Vomiting
• Muscle aches
• Nausea
• Abdominal cramping
• Agitation
• Insomnia
• Nervousness
• Muscle and bone aches
• Yawning
• Runny nose
• Dilated pupils
• Goosebumps
• Anxiety
• Headaches
• Diarrhea
• Sweating

Anexsia Withdrawal Timeline

Because any Anexsia medication still circulating today is likely expired or counterfeit, predicting the exact withdrawal timeline and symptoms can be difficult. However, as a general rule, if you’ve been taking a medication regularly, withdrawal symptoms typically begin around the time your next dose would have been due.

Within 24-48 hours, physical symptoms of withdrawal will present (e.g., vomiting, nausea, agitation, etc.). The height of physical and emotional discomfort typically occurs within the first week. By week 1-2, most physical symptoms decrease, but psychological and mood-related symptoms can persist for several weeks after cessation.

Overdose

Constricted pupils, lowered consciousness, and greatly diminished respiration are known as the “**opioid overdose triad** [5].” Besides these three main signs, patients experiencing an overdose might show symptoms such as:

• Pale complexion
• Limpness
• Muscle weakness
• Jaundice
• Cold and clammy skin
• Nausea and vomiting
• Lips and fingers that are purple or blue

Naloxone, often referred to by its brand name Narcan, is an opioid reversal agent available in the form of a nasal spray or injectable solution. It must be administered immediately if someone is experiencing an overdose, along with contacting emergency health services. Naloxone begins to take effect in three minutes, but the effects diminish after 90 minutes.

Treatment for Opioid Addiction at Gratitude Lodge

As mentioned, managing withdrawal from opioids can be challenging without medical assistance, which is why medical detox is beneficial for numerous individuals [4].

If you or someone you care about requires Anexsia withdrawal assistance, contact Gratitude Lodge in Southern California. We provide compassionate, high-quality rehabilitation in Long Beach and Newport Beach.

Our medical detox program ensures that the process is safer and more manageable for our patients. You will receive 24/7 clinical and emotional support as you detox and get ready for inpatient treatment at one of our beachside homes.

We understand that every addiction comes with its own challenges, so all our treatment plans are tailored to meet your specific needs. Treatments include:

• Holistic treatments
• Motivational therapy
• Group therapy
• Aftercare
• Talk therapy
• Medication-assisted treatment
• Family therapy

It’s time to get your life back. Break free from opioid addiction today. Call us at 844-576-0144.

Sources

1. https://medlineplus.gov/ency/article/000949.htm
2. https://medlineplus.gov/opioidoverdose.htm