The yellow, round pill debossed with 230 (typically bearing C on one side and 230 on the reverse) is a prescription combination pain medication containing Oxycodone Hydrochloride (10 mg) and Acetaminophen (325 mg). It is a generic formulation equivalent to brand-name Percocet 10/325.
Pill Identification
Attribute – Specification
- Active Ingredients – Oxycodone Hydrochloride, USP (10 mg) / Acetaminophen, USP (325 mg)
- Imprint – C on one side, 230 on the reverse
- Color & Shape – Yellow, round tablet
- Diameter – Approximately 10 mm
- Manufacturer – Alvogen, Inc.
- Drug Class – Opioid analgesic / Non-opioid analgesic combination
- Controlled Substance Schedule – DEA Schedule II (C-II)
- (Note: Other less common yellow round pills with “230” include 5 mg bisacodyl laxative tablets or specific oral contraceptives; however, the debossed “C 230” round tablet is the Schedule II oxycodone/acetaminophen formulation).
Mechanism of Action
This formulation achieves pain relief through two synergistic mechanisms:
- Oxycodone Component:
- Opioid Agonism: Oxycodone selectively binds to (mu)-opioid receptors in the brain, spinal cord, and peripheral nerve endings.
- Neuronal Inhibition: Binding activates G-protein-coupled signaling pathways, closing presynaptic voltage-gated calcium channels and opening postsynaptic inwardly rectifying potassium channels. This hyperpolarizes neuronal membranes and inhibits the release of excitatory neurotransmitters (substance P, glutamate), blocking ascending nociceptive pain signals.
- Acetaminophen Component:
- Central Prostaglandin Inhibition: Acetaminophen acts primarily in the central nervous system to inhibit cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis in the brain.
- Pain Threshold Modulation: It enhances descending serotonergic inhibitory pathways and modulates cannabinoid/vanilloid receptors, raising the overall pain threshold and lowering fever.
Indications and Clinical Uses
- Moderate to Severe Acute Pain: Indicated for acute pain management (e.g., post-operative recovery, acute orthopedic trauma) when non-opioid monotherapies fail or cannot be tolerated.
- Severe Breakthrough or Chronic Pain: Reserved for severe pain conditions (such as oncological pain) requiring combination analgesia under regular medical monitoring.
Dosage and Administration
- Dosing must be maintained at the lowest effective dose for the shortest duration necessary.
- Standard Adult Dosing: 1 tablet orally every 6 hours as needed for pain.
- Maximum Daily Limits:
- Oxycodone Component: Daily dosage is limited by clinical assessment of tolerance and respiratory status.
- Acetaminophen Component: Total daily intake of acetaminophen from all sources must not exceed 4,000 mg/24 hours (many clinicians advise a maximum of 3,000 mg/day to reduce the risk of hepatotoxicity).
- Administration: Swallow whole with water. Can be taken with or without food; taking with food helps reduce nausea.
- Discontinuation: If taken continuously for more than a few days, gradual tapering is required to prevent acute opioid withdrawal syndrome.
Side Effects
Common Adverse Reactions:
- Central Nervous System: Drowsiness, sedation, dizziness, lightheadedness, headache
- Gastrointestinal: Constipation, nausea, vomiting, abdominal discomfort, dry mouth
- Dermatologic: Pruritus (itching), flushing, sweating
Serious Adverse Reactions:
- Life-Threatening Respiratory Depression: Severe bradypnea, hypoventilation, apnea, respiratory arrest
- Acute Hepatotoxicity: Severe liver injury or acute liver failure (primarily associated with acetaminophen overdoses exceeding recommended daily limits)
- Circulatory Depression: Hypotension, orthostatic syncope, bradycardia
- Serotonin Syndrome: When co-administered with other serotonergic agents (manifesting as hyperreflexia, clonus, tremor, hyperthermia, and confusion)
- Severe Dermatologic Reactions: Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) linked to acetaminophen hypersensitivity
Key Drug Interactions
- CNS Depressants and Alcohol: Combining with alcohol, benzodiazepines, tranquilizers, or sleep aids produces additive central nervous system depression, leading to severe sedation, respiratory arrest, coma, and death.
- CYP3A4 Inhibitors and Inducers: Strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin) increase oxycodone plasma concentrations; CYP3A4 inducers (e.g., rifampin, carbamazepine) decrease efficacy or precipitate withdrawal.
- Other Acetaminophen Products: Over-the-counter cold/flu medications and prescription pain relievers containing acetaminophen must be avoided to prevent accidental cumulative overdose.
- MAO Inhibitors: Opioids should not be used within 14 days of taking monoamine oxidase inhibitors (MAOIs).
Boxed Warnings and Precautions
- Addiction, Abuse, and Misuse: Oxycodone carries a high potential for substance use disorder, physical dependence, and diversion.
- Life-Threatening Respiratory Depression: Serious or fatal respiratory depression can occur at therapeutic doses, with the highest vulnerability during therapy initiation or dosage escalation.
- Hepatotoxicity Risk: Acetaminophen has been associated with acute liver failure, occasionally resulting in liver transplantation or death, almost always secondary to doses exceeding 4,000 mg/day or co-ingestion with alcohol.
- Accidental Ingestion: Even a single accidental dose, particularly by pediatric patients, can result in fatal overdose.
- Neonatal Opioid Withdrawal Syndrome (NOWS): Prolonged maternal use during pregnancy can result in life-threatening neonatal withdrawal requiring intensive pediatric care.
- Contraindications: Severe respiratory depression; acute or severe bronchial asthma in unmonitored settings; known or suspected gastrointestinal obstruction, including paralytic ileus; hypersensitivity to oxycodone or acetaminophen.