Nurses Compass
Drug Guide
Hydrocodone Bitartrate
Classification
Therapeutic: Analgesic, Opioid
Pharmacological: Opioid Agonist
FDA Approved Indications
- Severe pain management
Mechanism of Action
Hydrocodone binds to mu-opioid receptors in the central nervous system, altering the perception and response to pain.
Dosage and Administration
Adult: Dose varies; typically, extended-release formulations titrate based on pain severity and patient response. Usually, 20 mg every 12 hours, but must be individualized.
Pediatric: Not approved for children.
Geriatric: Start at lower doses due to increased sensitivity; monitor closely.
Renal Impairment: Careful dose titration recommended; reduced clearance may occur.
Hepatic Impairment: Adjust dosage; hepatic impairment can decrease metabolism leading to increased effects.
Pharmacokinetics
Absorption: Well absorbed orally.
Distribution: Widely distributed in tissues; crosses the blood-brain barrier.
Metabolism: Metabolized in the liver primarily via CYP3A4 and CYP2D6 to norhydrocodone and other metabolites.
Excretion: Excreted mainly in urine, via metabolites.
Half Life: Approx. 4-6 hours for hydrocodone; extended-release formulations vary.
Contraindications
- Significant respiratory depression
- acute or severe bronchial asthma in an unmonitored setting
- hypersensitivity to hydrocodone
Precautions
- History of substance abuse, head injury, increased intracranial pressure, biliary tract disease, pregnancy, lactation, older adults, hepatic or renal impairment, concomitant CNS depressant use
Adverse Reactions - Common
- Drowsiness (Common)
- Dizziness (Common)
- Nausea (Common)
- Constipation (Common)
Adverse Reactions - Serious
- Respiratory depression (Rare but serious)
- Hypotension (Less common)
- Allergic reactions (rash, pruritus, swelling) (Uncommon)
Drug-Drug Interactions
- CNS depressants (benzodiazepines, alcohol), other opioids, monoamine oxidase inhibitors
Drug-Food Interactions
- Alcohol enhances sedative effects
Drug-Herb Interactions
N/ANursing Implications
Assessment: Monitor pain relief, respiratory status, level of sedation, bowel function.
Diagnoses:
- Risk for respiratory depression
- Ineffective airway clearance
- Risk for constipation
Implementation: Administer with food to reduce nausea; assess pain relief and sedation levels regularly; monitor respiratory rate.
Evaluation: Pain relief achieved without significant respiratory depression or excessive sedation.
Patient/Family Teaching
- Do not operate heavy machinery or drive until response is known.
- Avoid alcohol and other CNS depressants.
- Report signs of overdose or adverse reactions immediately.
- Take medication exactly as prescribed.
Special Considerations
Black Box Warnings:
- Addiction, abuse, and misuse; accidental ingestion, especially in children, can be fatal; respiratory depression.
Genetic Factors: Metabolism partly CYP2D6-dependent; ultra-rapid metabolizers may have increased risk of adverse effects.
Lab Test Interference: May affect liver function tests.
Overdose Management
Signs/Symptoms: Respiratory depression, extreme sedation, muscle flaccidity, cold and clammy skin, pinpoint pupils, confusion, coma.
Treatment: Administer naloxone promptly; support respiratory and cardiovascular function; consider activated charcoal and supportive care.
Storage and Handling
Storage: Store at room temperature, away from moisture, heat, and light.
Stability: Stable under recommended storage conditions.