Hydrocodone Bitartrate/Acetaminophen

A to Z Drug Facts

Hydrocodone Bitartrate/Acetaminophen

	Action
	Indications
	Contraindications
	Route/Dosage
	Assessment/Interventions
	Interactions
	Lab Test Interferences
	Adverse Reactions
	Precautions
Patient Care Considerations
	Administration/Storage
	Patient/Family Education

(HIGH-droe-KOE-dohn by-TAR-trate/ass-eet-ah-MEE-noe-fen)

Anexsia 5/500, Anexsia 7.5/650, Anexsia 10/660, Bancap-HC, Ceta-Plus, Co-Gesic, Duocet, Dolacet, Duradyne DHC, Hydrocet, Hydrogesic, Hy-Phen, Lorcet 10/650, Lorcet-HD, Lorcet Plus, Lortab 5/500, Lortab 7.5/500, Lortab 10/500, Margesic H, Norco, Panacet 5/500, Stagesic, T-Gesic, Vicodin, Vicodin ES, Vicodin HP, Zydone

Class: Narcotic analgesic

Action Inhibits synthesis of prostaglandins and binds to opiate receptors in CNS and peripherally blocks pain impulse generation; produces antipyresis by direct action on hypothalamic heat-regulating center; causes cough suppression by direct central action in medulla; may produce generalized CNS depression.

Indications Management of mild-to-moderate pain.

Contraindications Hypersensitivity to acetaminophen, hydrocodone, or similar compounds.

Route/Dosage

Varies according to product and strength. ADULTS: PO 1 to 2 tablets or capsules (hydrocodone 2.5 to 10 mg; acetaminophen 500 to 1000 mg) q 4 to 6 hr or 5 to 10 ml (elixir, 15 ml) q 4 to 6 hr prn. CHILDREN < 12 YR: PO 10 to 15 mg acetaminophen/kg/dose q 4 hr to maximum of 2.6 g/24 hr.

Interactions

Anticholinergics: May produce paralytic ileus. Carbamazepine, hydantoins, sulfinpyrazone: May result in increased risk of hepatotoxicity from acetaminophen. CNS depressants (eg, barbiturates, ethyl alcohol, other narcotics): May cause CNS toxicity. MAO inhibitors: May cause additive CNS toxicity; may cause decreased BP. Tricyclic antidepressants, phenzothiazines: May cause additive CNS toxicity.

Lab Test Interferences With Chemstrip bG, Dextrostix, and Visidex II home blood glucose systems, may cause false decrease in mean glucose values. May give false-positive urinary 5-hydroxyindoleacetic acid test. Amylase or lipase may be increased for 24 hours due to narcotic-induced increase in biliary tract pressure.

Adverse Reactions

CV: Hypotension; bradycardia. CNS: Lightheadedness; dizziness; sedation; drowsiness; weakness; anxiety; fear; fatigue; dysphoria; psychological dependence; confusion. GI: Nausea; vomiting; constipation. GU: Decreased urination; urethral spasm. RESP: Dyspnea; respiratory depression; irregular breathing.

Precautions

Pregnancy: Category C. Lactation: Excreted in breast milk. Children: Safety and effectiveness in children have not been established. Special risk patients: Closely monitor elderly, debilitated patients, and those with conditions accompanied by hypoxia or hypercapnia to avoid decrease in pulmonary ventilation. Also use caution in patients sensitive to CNS depressants. Due to cough suppressant effects, exercise caution when using postoperatively or in patients with pulmonary disease. Hepatic impairment: Chronic alcoholics should limit acetaminophen intake to < 2 g/day. Sulfite sensitivity: Use caution in sulfite-sensitive individuals; some commercial preparations contain sodium bisulfite.

PATIENT CARE CONSIDERATIONS

Administration/Storage

Administer before pain becomes severe.
Give medication with food.
Store at room temperature and protect from light.

Assessment/Interventions

Obtain complete patient history, including drug history and any known allergies.
Assess vital signs before and periodically after administration. If hypotension, bradycardia, bradypnea, or difficulty in breathing occurs, notify health care provider.
Monitor for orthostatic hypotension and supervise ambulation.
Encourage coughing and deep breathing in patients with pulmonary problems.
Monitor bowel and hepatic function. If decreased bowel sounds or abdominal distention, jaundice, or dark urine occurs, notify health care provider.
If confusion or blurred vision occur, institute safety measures and notify health care provider.
Check for reduced dosage if another CNS depressant medication is being administered concurrently.

OVERDOSAGE: SIGNS & SYMPTOMS
	Blood dyscrasias, respiratory depression, and hepatic necrosis (all may occur up to several days after overdose); renal tubular necrosis, hypoglycemic coma, nausea, vomiting, diaphoresis, malaise, somnolence, skeletal muscle flaccidity, bradycardia, hypotension, apnea, cardiac arrest

Patient/Family Education

Instruct patient to take before pain becomes severe.
Advise patient to take with food or milk.
When medication is being used for acute pain, advise patient of possible addiction and explain that drug should be used for short term only.
Advise patient to change position slowly and to use caution when ambulating and performing other activities requiring mental alertness such as driving or operating machinery.
Instruct patient to eat high-fiber diet, maintain adequate fluid intake, and use stool softener or bulk laxative to prevent constipation.
Advise patient to avoid alcohol and any other drug that causes drowsiness such as sleeping aids and antihistamines.
Instruct patient to discontinue drug and notify health care provider if blurred vision, rash, or yellowing of skin occurs.
If lightheadedness, dizziness, drowsiness, nausea, or vomiting occur, advise patient to lie down until symptoms subside and to notify health care provider if symptoms persist.