Home Drug Guide Hydrocodone Bitartrate

Drug Guide

Generic Name

Hydrocodone Bitartrate

Brand Names Zohydro ER, Hysingla ER, Vantrela ER

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/A

Nursing 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.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.