HYDROCODONE BITARTRATE

HYDROCODONE BITARTRATE
(hye-droe-koe'done)
Dihydrocodeinone Bitartrate, Hycodan, Robidone A, Vicodin (with acetaminophen)
Classifications: narcotic (opiate) agonist analgesic; antitussive;
Therapeutic: narcotic analgesic

Prototype: Morphine
Pregnancy Category: C
Controlled Substance: Schedule III

Availability

5 mg hydrocodone usually with 500 mg or more acetaminophen

Action

Morphine derivative similar to codeine but more addicting and with slightly greater antitussive activity, and analgesic effect. CNS depressant with moderate to severe relief of pain. Available in the United States only in combination with other drugs.

Therapeutic Effect

Suppresses cough reflex by direct action on cough center in medulla. CNS depressant with moderate to severe relief of pain.

Uses

Symptomatic relief of hyperactive or nonproductive cough and for relief of moderate to moderately severe pain. A common ingredient in a variety of proprietary mixtures.

Contraindications

Hypersensitivity to hydrocodone; children <2 y; pregnancy (category C); acute or severe asthmatic bronchitis; COPD; upper airway obstruction; lactation.

Cautious Use

Respiratory depression, asthma, emphysema; history of drug abuse or dependence; postoperative patients; hepatic or renal disease; renal impairment or failure; older adults, debilitated patients; children <1 y; patients; children weighing <50 kg; G6PD deficiency; GI disease; patients with preexisting increased intracranial pressure.

Route & Dosage

Mild to Moderate Pain, Cough
Adult: PO 5–10 mg q4–6h prn (max: 15 mg/dose)
Child (2–12 y): PO 1.25–5 mg q4–6h (max: 10 mg/dose)

Administration

Oral
  • Give with food or milk to prevent GI irritation.
  • Preserve in tight, light-resistant containers.

Adverse Effects (≥1%)

GI: Dry mouth, constipation, nausea, vomiting. CNS: Light-headedness, sedation, dizziness, drowsiness, euphoria, dysphoria. Respiratory: Respiratory depression. Skin: Urticaria, rash, pruritus.

Interactions

Drug: Alcohol and other cns depressants compound sedation and CNS depression. Herbal: St. John's wort increases sedation.

Pharmacokinetics

Onset: 10–20 min. Duration: 3–6 h. Distribution: Crosses placenta; distributed into breast milk. Metabolism: In liver. Elimination: In urine. Half-Life: 3.8 h.

Nursing Implications

Assessment & Drug Effects

  • Monitor for effectiveness of drug for pain relief.
  • Monitor for nausea and vomiting, especially in ambulatory patients.
  • Monitor respiratory status and bowel elimination.

Patient & Family Education

  • Avoid hazardous activities until response to drug is determined.
  • Do not use alcohol or other CNS depressants; may cause additive CNS depression.
  • Drink plenty of liquids for adequate hydration.
  • Do not take larger doses than prescribed since abuse potential is high.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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