What is Watson 853?

Watson 853 is a yellow colored, oval shaped pill with imprint of 853 on side. It is a combination of two effective analgesics namely acetaminophen and hydrocodone bitartarate. A single pill of Watson 853 contains 325 mg of acetaminophen and 10 milligram of hydrocodone bitartarate. It is category C drug in pregnancy with moderate abuse potential and risk of dependence on prolonged use.

Two different pain killing medicine in a single pill of Watson 853 make it more powerful analgesic than either of the medicines present in it. Acetaminophen present in Watson 853 acts by inhibition of nitric oxide pathway that is mediated by neurotransmitters like substance P and N-methyl-D-aspartate. Acetaminophen also is an effective anti-pyretic medicine and brings down temperature by inhibiting synthesis of prostaglandins. Hydrocodone on the other hand is a narcotic analgesic that controls pain by activating opioid receptors present in the central nervous system of the body. Additional effect of hydrocodone is that it is also an effective remedy in relieving cough.

Watson 853 is available on prescription only in many countries of the world. In United States of America, Watson international pharmaceutical company prepares and markets this combination of acetaminophen and hydrocodone. Other preparations of acetaminophen and hydrocodone bitartarate include, Watson 353(acetaminophen 500 mg and hydrocodone bitartarate 5 mg) and Watson 385 (acetaminophen 500 mg and hydrocodone 7.5 mg)

Watson 853 is very effective remedy, used to relieve moderate to severe pain in a variety of conditions. it is superior to commonly used pain killers in several aspects. Watson 853 unlike non-steroidal anti-inflammatory does not cause gastric irritation and inflammation on even prolonged use. Gastric safety and efficacy in moderate to severe pain, makes Watson 853 a better choice than non-steroidal anti-inflammatory drugs or NSAIDs. there is no doubt about effectiveness of Watson 853 in relieving moderate to severe pain but overdose of this drug should be avoided otherwise serious outcome may result. Over dosage of Watson 853 should be avoided particularly in elderly population otherwise serious outcome may result.


What is this medicine for?

Watson 853 is a potent pain killer used effectively in management of moderate to moderately severe pain in a variety of medical conditions. Due to gastric safety of this drug it can be used safely even in patients where use of non-steroidal anti-inflammatory drug is contraindicated due to gastric erosions. Watson 853 can be used on short-term, long-term and as per need basis. Some of the common indications for use of Watson 853 are,

  • Osteoarthritis of small and big joints like knee, back, shoulder, wrist, ankle, finger, toe, foot and other joints. Osteoarthritis is a chronic condition and the sufferer of this condition usually needs pain killers frequently even daily. Use of non-steroidal anti-inflammatory drugs on daily basis is not safe so Watson 853 can be used safely with fewer side effects.
  • Rheumatoid arthritis: a debilitating disease of joints that affects middle aged women commonly. Pain management poses special issues in rheumatoid arthritis because sufferers of this condition need long-term use of pain killers. Watson 853 is used adjunctive to NSAIDS proves quite handy and minimizes dosage of NSAIDs as well as gastric side effects.
  • Pain of arthralgia or arthritis in systemic lupus erythromatosis (SLE), sacro-iliitis, psoriatic arthritis and other musculoskeletal disorders
  • Watson 853 is also useful in acute back pain/ chronic back pain and pain arising from neuropathies
  • Migraine, tension headaches and cluster headaches are other indications for Watson 853.
  • Pain management in cancer palliation therapy is also an important indication for Watson 853. Pain due to cancer of different organs particularly cancer spread to bones is a difficult to manage and usually not remitted by ordinary analgesics. In such situation Watson 853 is very good choice due to less side effects and effectiveness.

Above mentioned are some of the indications in which Watson 853 has proven efficacy. In addition this is also used in many other conditions udder the prescription of physicians.

Side effects on Watson 853

Watson 853 is a combination of two drugs and side effects with its use actually may result from any of the drug contained in it. Acetaminophen present in Watson 853 is usually safe and free from side effects on usual dosage while hydrocodone causes most of the side effects appearing with the use of Watson 853. Some of the common side effects of Watson 853 are,

  • Nausea and vomiting: due to hydrocodone content of Watson 853; usually troublesome earlier on use but settle with time. if nausea and vomiting is severe anti-emetic medicine may need to be taken with Watson 853.
  • Blurring of vision
  • Constipation is again a side effect of hydrocodone present in Watson 853
  • Dizziness, drowsiness, light headedness and sleepiness all are due to hydrocodone moiety of Watson 853. Due to these side effects use of this drug in elderly population should be with caution otherwise risk of fall and fracture neck of femur increase.
  • Breathing problems and respiratory depression particularly on over dosage of Watson 853, is due to hydrocodone content of Watson 853.
  • Breathing problems and respiratory depression due to Hydrocodone hydrochloride component and appears most in case of over dosage of Watson 853
  • Mental changes, depressed mood and other mood changes may appear with use of Watson 853 in some patients. These side effects are particularly evident on withdrawal of Watson 853.
  • Flushing of face
  • Liver toxicity or liver damage occurs particularly in patients having previous liver disease or due to over dosage of the Watson 853. Liver damage may range from mild hepatitis to sever liver injury leading to liver failure. This side effect is due to acetaminophen content of Watson 853.

Side effects on prolonged use of Watson 853

Although long-term use of Watson 853 is relatively safe but some particular side effects appear on extended use. Some of the common side effects of Watson 853 on prolonged use are,

  • Dependence: patients using Watson 853 for prolonged period of time develop physical dependence on the medicine. He or she feels craving to take the drug; this may lead to addiction for Watson 853.
  • Analgesic abuse nephropathy appears on prolonged use of acetaminophen on high doses for 2-3 years. This may lead to renal failure.
  • Withdrawal symptoms appear on discontinuing the drug suddenly in patients who use Watson 853 for long period of time. Withdrawal symptoms include hallucinations (seeing, feeling or smelling objects in the absence of any thing) abnormal skin sensations (feeling crawling of insects on the skin), diarrhea, disturbed sleep, increased heart rate, vomiting, increased sweating, tremors, etc.

Precautions 0n Watson 853

Watson 853 is relatively safe analgesic but its use in some conditions is not risk free. Patients should be inquired about all the conditions in which Watson 853 use can be dangerous. These conditions are,

  • know allergy to acetaminophen or hydrocodone bitartarate, narcotic analgesics or other medication and foods
  • head injury (particularly recent head injury with signs of raised intracranial pressure), hydrocephalus or other central nervous system disorders
  • Space occupying lesion of the brain including brain tumor, brain abscess, tuberculoma, etc.
  • Renal disease especially declined renal functions and renal failure, because in this situation Watson 853 may result in deep coma
  • drug abuse/drug addiction
  • inflammatory bowel disease (IBD) both ulcerative colitis and Crohn’s disease
  • alcohol binging
  • liver disease (including acute and chronic hepatitis or cirrhosis of liver)
  • advanced lung disease, bronchial asthma, obstructive sleep apnea or other breathing disorders
  • heart disease and other cardiovascular problems
  • breast feeding mothers
  • pregnancy or anyone who is trying to conceive
  • Taking other drugs both prescribed and un-prescribed including herbal remedies.
  • Previous suicidal attempts or suicidal ideation
  • intestinal or gastric problems, intestinal obstruction, recent abdominal surgery, chronic inflammation or ulceration of the gut, problems of adrenal gland and prostate gland enlargement

Concomitant use of Watson 853 is not safe with some medications and patient should be enquired if he or she is taking following medicines,

  • tricyclic antidepressants or TCAs e.g., amitriptyline, nortryptaline, etc
  • Naltrexone
  • alcohol or medicines that contain alcohol
  • cimetidine and other enzyme inhibitors may prolong the effect of Watson 853
  • antihistamines or anti-allergy drugs
  • medicines for depression, anxiety, schizophrenia or other mental disorders
  • Other opiod analgesics including buprenorphine, butorphanol, pentazocine, tramadol, propoxyphene and nalbuphine.
  • sleeping aid pills
  • ritonavir
  • phenobarbital
  • muscle relaxants
  • Barbiturates
  • monoamine oxidase inhibitors(MAOIs) for example phenelzine
  • isoniazid- anti-tuberculous medicine

Conditions that are not suitable for Watson 853 use

Use of Watson 853 is not safe in some medical conditions and if anyone has any of the following conditions should not use Watson 853.

  • Known allergy to acetaminophen, hydrocodone bitartarate or any other opioid analgesic, this is an absolute contra-indication to use of Watson 853.
  • Binging drinking: use of Watson 853 may lead to deep coma and liver injury (in severe cases liver failure)
  • Persons in high risk professions like operators at moving machinery, drivers and other professionals to avoid accident
  • Concomitant use of sleeping pills/ muscle relaxants and other medications that causes drowsiness, increased sleep or respiratory depression because toxicity of Watson 853 increases. Before starting Watson 853, if patient is taking any of such medications, he or she should inform his/her doctor or pharmacist.
  • Use of Watson 853 in elderly population is not safe due to the potential side effects of drowsiness, dizziness and light-headedness. All these side effect increase the chances of fall and fracture of femur.
  • Severe liver disease is a contraindication to use of Watson 853 because of risk of developing hepatic encephalopathy. Even mild liver disease should be reported to the doctor for safety of its use.
  • Children and infants are not good candidate for use of Watson 853 and this drug should be kept out of reach to this age group.
  • Watson 853 is an absolutely contraindicated in advanced lung disease. Use of Watson 853 is not suitable in COPD (chronic obstructive pulmonary disease), bronchial asthma, obstructive sleep apnea (OSA) and respiratory failure (both type 1 and type 2)
  • Renal failure, analgesic abuse nephropathy and other disease of kidney with compromised kidney function-all are contraindication to use of Watson 853. This group of patient may go into deep coma with use of Watson 853 that may remains for days.
  • Acute liver failure or acute fulminant hepatic failure is a contraindication to use of Watson 853
  • Watson 853 is a category C drug in pregnancy so its use in pregnancy is not safe in the same way Watson 853 in breast feeding ladies is also relatively contraindicated.

Allergy symptoms of Watson 853

Hypersensitivity or allergic reaction to Watson 853 can occur in anyone especially those who have history of allergy to acetaminophen, hydrocodone or other opioid analgesics. Allergy symptoms may be mild or sever/life threatening. If anybody develops symptoms of hypersensitivity, he or she should inform the doctor or emergency medical service as severe allergic symptoms should only be managed in medical emergency or intensive care setting to anticipate any grave happening.

Mild symptoms of allergy to Watson 853 

Mild allergic symptoms to use of Watson 853 include itching, hives and redness of the skin. Breathing problem or respiratory depression doesn’t occur with mild allergy. Mild allergy symptoms settle on withdrawing the medicine; anti-histamine are effective in controlling the symptoms of hives and itching. Even mild hypersensitivity should be conveyed to doctor to avoid any serious effects.

Severe allergy symptoms of Watson 853

Severe hypersensitivity reactions to Watson 853 or anaphylaxis may occur within minutes after using this medicine particularly in patients with previous history of sensitivity. Anaphylaxis or severe hypersensitivity reaction to Watson 853 presents with following symptoms,

  • Symptoms of angioedema: swelling of throat, lips and face, chest tightness and difficulty in breathing due to airway obstruction. In severe cases airway is completely obstructed due to edema and patients needs tracheostomy to relieve the airway obstruction.
  • Changes or loss of hearing
  • Drowsiness leading to unconsciousness
  • Skin rash and redness
  • Hives and urticaria
  • Severe anxiety, mood and mental changes
  • Fear
  • Oliguria (Decreased urine output)

Anaphylaxis or severe hypersensitivity reaction to Watson 853 should be managed urgently in medical emergency otherwise it may prove fatal. Management of severe hypersensitive includes administering subcutaneous adrenaline, anti-histamines and intravenous steroids. In case of respiratory depression/airway obstruction emergency tracheostomy should be done and patient needs artificial respiration on ventilator. All this management should be done in an intensive care unit to provide timely treatment and save life of the patient.

Dosage of Watson 853

Watson 853 should only be used in prescribed dosage by the doctor or pharmacist for the specific duration told. Initial starting dose of Watson 853 is one tablet every 6-8 hourly that can be increased to a maximum dose of six tablets in 24 hours. Exceeding the upper dose may lead to serious side effects. Watson 853 can be taken empty stomach or with meals. Patients who have intractable nausea and vomiting should use Watson 853 with meal to avoid these side effects.

If a dose of Watson 853 is missed

In case of missing a dose of Watson 853, patient should take the due dose as soon as remembered but if the time for next dose has reached only the usual next dose of Watson 853 should be taken. No two doses of the drugs should be taken together to avoid side effects.

Over dosage of Watson 853

Over dosage of Watson 853 usually occurs in an attempt to relieve sever pain. Over dosage of the drug should immediately be reported to local poison control service or doctor particularly if symptoms of drug toxicity appear. Symptoms of over dosage of Watson 853 depend upon how much quantity of tablet is taken and health status of the individual. A single or two tablets above the prescribed dose in a normal health person causes only sedation but even this much over dosage in an elderly person may cause respiratory depression.

Symptoms of over dosage of Watson 853 include sleepiness or deep coma, cold and clammy skin, bluish discoloration of the skin, difficulty in breathing or slow breathing(respiratory depression), excessive perspiration(sweating), disturbed functions of cardiovascular system, nausea or vomiting, convulsion(seizures) pain abdomen and bilateral constricted pupils(pin point pupils).

Management of over dosage of Watson 853 include following measures,

  • Gastric lavage and decontamination with administration of activated charcoal, this is much more effective earlier after ingestion of pills.
  • Administration of nalaxone as an anti-dote to hydrocodone. It reverses coma and respiratory depression.
  • Administration of N-acetyl cystein or methionine in case acetaminophen is ingested above 4000 milligrams.
  • Ventilatory support and cardiovascular support in intensive care setting in case respiratory or cardiovascular dysfunction.

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