The yellow, round pill stamped with “230” on one side and an Alvogen “C” logo on the reverse is a generic combination formulation of Oxycodone Hydrochloride 10 mg and Acetaminophen 325 mg. Commonly known as a generic equivalent of Percocet, this medication is a Schedule II controlled substance prescribed to manage moderate to severe acute pain when alternative, non-opioid treatments are inadequate.
Pill Identification
Physical Property – Specification
- Active Ingredients – Oxycodone Hydrochloride (10 mg) & Acetaminophen (325 mg)
- Imprint Code –
230on one side; Alvogen “C” logo on the reverse - Color – Yellow
- Shape – Round
- Manufacturer – Alvogen, Inc.
- Drug Class – Narcotic Analgesic Combination (Opioid + Non-Opioid Analgesic)
- Controlled Status – DEA Schedule II Controlled Substance
- Note: While the
230yellow round pill is most frequently identified as Oxycodone/Acetaminophen 10 mg/325 mg by Alvogen, older or alternative formulations with similar imprints exist (e.g., Oxymorphone ER 40 mg or Bisacodyl). Visual identification must always be verified by a pharmacist or licensed healthcare professional.
Mechanism of Action
This medication operates through a dual-action synergistic pathway:
- Oxycodone Hydrochloride (Central Opioid Agonist): Oxycodone is a full agonist at the opioid receptors in the central nervous system (CNS). Upon binding, it hyperpolarizes neuronal membranes by inhibiting presynaptic neurotransmitter release (such as Substance P and glutamate). This interrupts pain signal transmission along the spinal cord and alters the emotional response to pain in the brain.
- Acetaminophen (Non-Opioid Analgesic & Antipyretic): Acetaminophen provides complementary pain relief primarily by inhibiting cyclooxygenase (COX) enzymes in the central nervous system, reducing prostaglandin synthesis. It also acts on the hypothalamic heat-regulating center to reduce fever.
Dosage & Administration
Due to the potent nature of oxycodone and the liver toxicity risks of acetaminophen, dosing must be strictly monitored by a prescribing physician.
- Standard Adult Dosing: Typically 1 tablet taken orally every 6 hours as needed for severe pain.
- Maximum Daily Limit (Acetaminophen): Total daily acetaminophen intake from all sources must not exceed 4,000 mg per 24 hours to prevent severe hepatotoxicity (liver damage). Taking more than 12 tablets of the 230 pill per day would exceed this safety threshold based on acetaminophen content alone, though oxycodone limitations restrict dosing much further.
- Maximum Daily Limit (Oxycodone): Dosing should be titrated to the lowest effective dose for the shortest necessary duration.
Side Effects
Common Side Effects
- Gastrointestinal: Nausea, vomiting, severe constipation, abdominal distress, dry mouth.
- Central Nervous System: Drowsiness, dizziness, lightheadedness, confusion, euphoria, or sedation.
- Dermatologic: Pruritus (severe itching), flushing, or sweating.
Serious Adverse Reactions
- Severe Respiratory Depression: Dangerously slow, shallow, or irregular breathing.
- Hepatotoxicity (Liver Damage): Yellowing of skin or eyes (jaundice), dark urine, or extreme upper-right abdominal pain resulting from acetaminophen toxicity.
- Adrenal Insufficiency: Long-term use can impair adrenal hormone production, leading to persistent fatigue, dizziness, and low blood pressure.
- Serotonin Syndrome: High fever, twitching, severe agitation, and fast heart rate when combined with serotonergic drugs.
Boxed Warnings & Safety Precautions
FDA Black Box Warnings
- Addiction, Abuse, and Misuse: Oxycodone carries a high risk of opioid addiction, abuse, and misuse, which can lead to overdose and death.
- Life-Threatening Respiratory Depression: Fatal respiratory depression may occur, especially during initiation or after an increase in dose.
- Accidental Ingestion: Ingestion of even one dose by anyone – especially children – can cause a fatal overdose.
- Hepatotoxicity: Acetaminophen has been associated with cases of acute liver failure, sometimes resulting in liver transplant or death.
- Concomitant Use with CNS Depressants: Combining opioids with benzodiazepines, alcohol, or other sedative-hypnotics causes severe sedation, respiratory depression, coma, and death.
Key Precautions
- Alcohol Avoidance: Do not consume alcohol or take medications containing alcohol while using this drug. Alcohol amplifies both the CNS-depressant effects of oxycodone and the liver toxicity of acetaminophen.
- Counterfeit Risk: Because 10 mg/325 mg prescription opioids are widely sought after, counterfeit pills mimicking the yellow
230imprint are occasionally sold illegally. Counterfeit tablets often contain lethal doses of illicit fentanyl. Only accept medications dispensed directly by a licensed pharmacy. - Pregnancy: Prolonged use during pregnancy can cause Neonatal Opioid Withdrawal Syndrome (NOWS), which can be life-threatening if unmanaged.
Drug Interactions & Emergency Management
Drug Interactions
- Other Acetaminophen Products: Avoid over-the-counter cold, flu, or pain medications containing acetaminophen to prevent accidental overdose.
- CYP3A4 / CYP2D6 Inhibitors: Concomitant use with drugs like ketoconazole or erythromycin can elevate oxycodone plasma levels, worsening toxic effects.
- MAO Inhibitors: Do not use within 14 days of taking Monoamine Oxidase Inhibitors due to unpredictable serotonin toxicity or severe hypotension.
Overdose Signs & Immediate Action
- Overdose Symptoms: The “opioid triad” consisting of pinpoint pupils, severe respiratory depression (slow/stopped breathing), and loss of consciousness, alongside cold/clammy skin or bluish lips.
- Emergency Response: Call 911 immediately. Promptly administer Naloxone (Narcan), an emergency opioid antagonist that temporarily reverses oxycodone toxicity.