The T257 pill is a white, capsule/oblong tablet imprinted “T 257,” identified as hydrocodone bitartrate 5 mg combined with acetaminophen 325 mg, a prescription-only opioid analgesic combination for moderate to severe pain management under careful medical supervision. It is manufactured by Ascent Pharmaceuticals for Camber Pharmaceuticals and is classified as a Schedule II controlled substance due to high abuse potential and risk of dependence.
Identification
- Appearance: white or off‑white, capsule/oblong, approx. 13 mm, debossed “T 257” on one face and plain with a bisect on the other.
- Ingredients: hydrocodone bitartrate 5 mg plus acetaminophen 325 mg per tablet.
- Supply and storage: supplied in bottles (commonly 100 or 500); store at 20–25°C (USP controlled room temperature) in a tight, light‑resistant, child‑resistant container.
What it contains and how it works
- Hydrocodone is a full µ‑opioid receptor agonist with no analgesic ceiling, producing analgesia but also dose‑dependent risks like respiratory depression and sedation.
- Acetaminophen is a central analgesic/antipyretic; in excess it can cause acute liver failure, especially when total daily acetaminophen exceeds 4,000 mg or multiple acetaminophen‑containing products are combined.
Approved uses
- Indicated for pain severe enough to require an opioid and for which alternatives (e.g., NSAIDs, acetaminophen alone) are inadequate or not tolerated, with treatment reserved for the lowest effective dose and shortest duration.
Dosage and limits
- Usual adult dose for 5/325: 1–2 tablets every 4–6 hours as needed; maximum 8 tablets per day to respect the acetaminophen and opioid limits.
- Higher strengths (7.5/325 or 10/325) are typically 1 tablet every 4–6 hours, max 6 tablets/day; dosing must be individualized and closely monitored, particularly during initiation and titration.
Boxed warnings and critical safety
- Addiction, abuse, and misuse: increased risk even at recommended doses; prescribers should assess risk, educate, and monitor continuously.
- Life‑threatening respiratory depression: highest risk during initiation or dose increases; monitor especially in elderly, debilitated, or pulmonary disease patients.
- CYP3A4 interactions: inhibitors can raise hydrocodone levels causing dangerous respiratory depression; inducers can lower levels and precipitate withdrawal or reduce analgesia—monitor and adjust carefully.
- Concomitant CNS depressants: benzodiazepines, alcohol, and similar agents can cause profound sedation, respiratory depression, coma, and death—avoid or limit and monitor closely.
- Hepatotoxicity: acetaminophen is linked to acute liver failure (sometimes fatal), especially above 4,000 mg/day or with multiple acetaminophen products; counsel on label checking for “APAP/acetaminophen”.
- Accidental ingestion: a single dose can be fatal to children; store securely and dispose safely per FDA guidance.
Common side effects
- Frequently reported: lightheadedness, dizziness, sedation, nausea, and vomiting; constipation is common with opioid use.
- Other reactions include pruritus, orthostatic hypotension, urinary retention, mood changes, and rare serious skin reactions from acetaminophen (e.g., SJS/TEN); seek urgent care for rash, swelling, or breathing difficulty.
Drug interactions to avoid or monitor
- CYP3A4 inhibitors (e.g., macrolides, azole antifungals, protease inhibitors) can increase hydrocodone exposure and respiratory risk; inducers (e.g., rifampin, carbamazepine, phenytoin) can reduce effect—close monitoring and dose adjustments are required.
- Benzodiazepines, alcohol, sedative‑hypnotics, antipsychotics, and other opioids markedly increase CNS/respiratory depression; use only if alternatives are inadequate and with strict limits and monitoring.
- Serotonergic drugs: rare serotonin syndrome has been reported with opioid combinations; monitor if combining with SSRIs/SNRIs/MAOIs or triptans.
Contraindications
- Significant respiratory depression, acute/severe bronchial asthma in unmonitored settings, known or suspected GI obstruction (including ileus), or hypersensitivity to hydrocodone/acetaminophen.
Special populations
- Pregnancy: prolonged opioid use can cause neonatal opioid withdrawal syndrome requiring specialized treatment; use only if benefits outweigh risks and with careful planning.
- Elderly/debilitated or chronic lung disease: higher risk of dangerous respiratory depression—consider non‑opioid options or enhanced monitoring where appropriate.
Dependence, misuse, and legal status
- Hydrocodone/acetaminophen is Schedule II (CII) with high potential for abuse and dependence; careful prescribing, storage, and periodic reassessment are essential.
- Tolerance and physical dependence can develop with chronic use; do not discontinue abruptly—taper gradually under supervision to mitigate withdrawal and destabilization of pain control.
Overdose and emergency guidance
- Hydrocodone overdose: respiratory depression, stupor/coma, pinpoint pupils (or mydriasis with hypoxia), cold clammy skin, bradycardia, hypotension; treat with airway support and opioid antagonists such as naloxone, and monitor as antagonist effects may wear off before opioid effects.
- Acetaminophen overdose: dose‑dependent hepatotoxicity; early NAC treatment is critical, with charcoal if recent ingestion and serum acetaminophen level–guided management.
Authenticity and identification tips
- Confirm “T 257” imprint, color, and shape against trusted identifiers and the official label; reputable tools include Drugs.com Pill Identifier, Medicine.com, and WellRx images for hydrocodone‑acetaminophen 5/325 with T 257 imprint.
- For professional lookups, clinical databases like Medscape’s Pill Identifier can assist when imprint/shape/color are known.
Not tramadol: debunking a common mix‑up
- Some websites incorrectly label “T257” as tramadol 50 mg; authoritative identifiers and the FDA label confirm T 257 is hydrocodone 5 mg with acetaminophen 325 mg, not tramadol.
- Rely on official labeling and established pill ID databases rather than unverified sources when identifying imprints.
How it compares to related products
| Imprint | Strength | Color/Shape | Brand/Generic context |
|---|---|---|---|
| T 257 | 5 mg hydrocodone / 325 mg acetaminophen | White, oblong | Generic hydrocodone‑APAP by Camber/Ascent; Schedule II |
| IP 109 | 5 mg hydrocodone / 325 mg acetaminophen | White, oblong | Common generic equivalent of Norco 5/325 |
| M366 | 7.5 mg hydrocodone / 325 mg acetaminophen | White, oblong | Common generic equivalent of Norco 7.5/325 |
| M367 | 10 mg hydrocodone / 325 mg acetaminophen | White, oblong | Common generic equivalent of Norco 10/325 |
Practical counseling points
- Use only as directed at the lowest effective dose and shortest duration; never exceed a total of 4,0004{,}0004,000 mg/day of acetaminophen from all sources to avoid liver injury.
- Avoid alcohol and sedatives unless explicitly coordinated by a clinician due to additive CNS/respiratory depression risks; do not drive or operate machinery until individual effects are known.
- Store securely out of sight and reach, and dispose of unused tablets via take‑back or, if unavailable, by FDA‑recommended flushing for this product class to prevent accidental ingestion or diversion.
Quick FAQs
- Is T257 the same as Norco 5/325? Functionally yes—T 257 is a generic hydrocodone 5 mg/acetaminophen 325 mg equivalent to the Norco 5/325 strength formulation.
- Who makes T257? Manufactured by Ascent Pharmaceuticals and distributed by Camber Pharmaceuticals per the FDA label and pill identifiers.
- Maximum daily amount? For 5/325, up to 8 tablets/day if clinically necessary, under supervision, to keep total acetaminophen within limits; clinicians individualize lower totals when possible.
Sources to verify
- Official FDA/DailyMed label for hydrocodone bitartrate and acetaminophen, including “T 257” tablet description, boxed warnings, dosing, and storage.
- Pill ID references confirming imprint, strength, and appearance for T 257.
- Clinical dosing and safety summaries for hydrocodone/acetaminophen combinations.