A white oblong pill imprinted with “IP 109” (or “IP109”) is a combination prescription pain medication containing Hydrocodone Bitartrate (5 mg) and Acetaminophen (325 mg).
Manufactured generically by Amneal Pharmaceuticals (formerly Interpharm), this medication is classified as a Schedule II controlled substance in the United States due to its potential for misuse, physical dependence, and addiction. It is commonly prescribed for the short-term management of acute, moderate-to-severely painful conditions.
Physical Pill Identification
To confirm the identity of this specific tablet, verify its visual details:
- Imprint:
IP 109on one side - Bisect/Score Line: Scored on the reverse side (allowing the pill to be split if directed by a physician)
- Color: White to off-white
- Shape: Oblong / Capsule-shaped
- Active Ingredients: Hydrocodone bitartrate (5 mg) + Acetaminophen (325 mg)
- Equivalent Brand Formulations: Generic equivalent of Norco 5/325, Vicodin 5/325, and Lortab 5/325.
- Pill Identification Safety: Never consume unidentified pills. Other strength ratios (such as 7.5 mg or 10 mg of hydrocodone) have different imprint numbers. Always verify your medication with a licensed pharmacist.
Mechanism of Action
The IP 109 tablet leverages dual-action pain relief by combining an opioid analgesic with a non-opioid pain reliever and fever reducer:
- Hydrocodone Bitartrate (Opioid Component): Hydrocodone is a semi-synthetic opioid agonist that binds to (mu-opioid) receptors in the brain and spinal cord. This action blocks the transmission of pain signals to the central nervous system, effectively altering both the physical sensation of pain and the emotional response to it.
- Acetaminophen / APAP (Non-Opioid Component): Acetaminophen acts primarily by inhibiting prostaglandin synthesis in the central nervous system and acting on the heat-regulating center in the hypothalamus.
- Analgesic Synergy: Combining these two compounds creates a synergistic effect: the acetaminophen boosts the pain-relieving efficacy of hydrocodone, allowing for a lower required dose of the opioid component.
Side Effects
Because IP 109 acts on both the central nervous system and the gastrointestinal tract, side effects can range from mild to life-threatening.
Common Side Effects
- Lightheadedness, dizziness, or drowsiness
- Nausea and vomiting
- Constipation (a standard side effect of opioids)
- Dry mouth, itching, or mild sweating
Serious Side Effects (Seek Immediate Medical Care)
- Severe Respiratory Depression: Dangerously slow, shallow, or irregular breathing.
- Acute Hepatotoxicity (Liver Damage): Upper abdominal pain, dark urine, pale stools, or yellowing of the skin/eyes (jaundice).
- Central Nervous System Collapse: Extreme sedation, inability to wake up, or confusion.
- Hypotension: Severe drop in blood pressure causing fainting or extreme dizziness.
- Serotonin Syndrome: High heart rate, agitation, fever, or muscle twitching (especially if combined with antidepressants).
Black Box Warnings & Safety Precautions
FDA-mandated Boxed Warnings highlight critical safety hazards associated with hydrocodone/acetaminophen combination drugs:
Warning Category Clinical Details
- Addiction, Abuse & Misuse Hydrocodone exposes users to the risk of opioid addiction and misuse, which can lead to overdose and death. Physical dependence can develop after just a few days of continuous use.
- Life-Threatening Respiratory Depression Serious or fatal respiratory depression can occur, particularly during initiation or dose increases.
- Accidental Ingestion Accidental exposure by anyone -especially children -can result in a fatal overdose.
- Neonatal Opioid Withdrawal Syndrome (NOWS) Prolonged use during pregnancy can cause life-threatening opioid withdrawal in newborns.
- Hepatotoxicity (Liver Injury) Acetaminophen is associated with acute liver failure. Exceeding recommended dosages or combining with other acetaminophen products drastically increases liver failure risks.
- Concomitant CNS Depressant Use Combining this drug with benzodiazepines, alcohol, or other sedatives can cause profound sedation, coma, or death.
Key Interactions & Contraindications
- Alcohol & Central Nervous System (CNS) Depressants: Do not drink alcohol while taking IP 109. Combining it with alcohol, sleep aids, muscle relaxants, or anti-anxiety meds (like Xanax or Valium) amplifies respiratory suppression risks.
- MAO Inhibitors (MAOIs): Concurrent use or use within 14 days of taking MAOIs is contraindicated due to unpredictable serotonin toxicity risks.
- Pregnancy & Breastfeeding: Hydrocodone crosses the placenta and passes into human breast milk. Avoid use during pregnancy unless strictly managed by an obstetric provider.
- Pre-existing Conditions: Use with extreme caution in patients with asthma, chronic obstructive pulmonary disease (COPD), severe liver failure, kidney dysfunction, or a history of substance use disorder.