Home Drug Guide Hydrocodone Bitartrate and Ibuprofen

Drug Guide

Generic Name

Hydrocodone Bitartrate and Ibuprofen

Brand Names Vicoprofen, Reprexain

Classification

Therapeutic: Analgesic, Opioid and NSAID combination

Pharmacological: Opioid analgesic and nonsteroidal anti-inflammatory drug (NSAID)

FDA Approved Indications

  • Short-term management of acute pain severe enough to require an opioid analgesic and where alternative treatments are inadequate.

Mechanism of Action

Hydrocodone binds to mu-opioid receptors in the central nervous system, altering the perception of and response to pain. Ibuprofen inhibits cyclooxygenase (COX-1 and COX-2), decreasing prostaglandin synthesis, which results in anti-inflammatory, analgesic, and antipyretic effects.

Dosage and Administration

Adult: Text varies; typically, 7.5 mg hydrocodone with 200 mg ibuprofen every 4-6 hours as needed, not exceeding 120 mg hydrocodone per day.

Pediatric: Recommeded only if prescribed by a healthcare provider; specific dosing varies by age and weight.

Geriatric: Use with caution; start at lower end of dosing range due to increased sensitivity and risk of adverse effects.

Renal Impairment: Use with caution; dosage adjustments may be necessary.

Hepatic Impairment: Use with caution; careful dose titration and monitoring are advised.

Pharmacokinetics

Absorption: Rapid after oral administration.

Distribution: Widely distributed; crosses the blood-brain barrier.

Metabolism: Hydrocodone undergoes hepatic metabolism; ibuprofen metabolized primarily in the liver.

Excretion: Renal and biliary pathways.

Half Life: Hydrocodone: approximately 3.8 hours; Ibuprofen: about 2 hours.

Contraindications

  • History of hypersensitivity to hydrocodone, ibuprofen, or other NSAIDs.
  • Use in patients with biliary tract disease.
  • Signs of severe respiratory depression.

Precautions

  • Use cautiously in patients with existing respiratory depression, head injury, or increased intracranial pressure.
  • Caution in elderly, frail, or debilitated patients.

Adverse Reactions - Common

  • Drowsiness (Common)
  • Dizziness (Common)
  • Nausea (Common)
  • Constipation (Common)

Adverse Reactions - Serious

  • Respiratory depression (Serious, though rare)
  • Hepatotoxicity (due to ibuprofen, especially in overdose or chronic use) (Serious)
  • Gastrointestinal bleeding (Serious)
  • Allergic reactions (Serious)

Drug-Drug Interactions

  • CNS depressants, other opioids, alcohol, anticoagulants, other NSAIDs

Drug-Food Interactions

  • Alcohol (increased risk of GI bleeding, central depression)

Drug-Herb Interactions

  • St. John’s Wort, Kava, Valerian (may increase CNS depressant effects)

Nursing Implications

Assessment: Assess pain characteristics, respiratory status, allergic reactions, and GI function.

Diagnoses:

  • Acute pain related to tissue injury.
  • Risk for respiratory depression.

Implementation: Administer with food or milk to reduce GI irritation. Monitor for effectiveness and adverse effects.

Evaluation: Pain relief within expected timeframe, absence of adverse effects.

Patient/Family Teaching

  • Never exceed prescribed dose.
  • Avoid alcohol and other CNS depressants.
  • Report any signs of allergic reaction, respiratory difficulty, or severe GI bleeding.

Special Considerations

Black Box Warnings:

  • Respiratory depression, addiction, and overdose risk associated with opioids.

Genetic Factors: Genetic polymorphisms may affect metabolism of hydrocodone.

Lab Test Interference: NSAIDs can affect renal function tests and may cause elevated liver enzymes.

Overdose Management

Signs/Symptoms: Respiratory depression, pinpoint pupils, sedation, hypotension, coma.

Treatment: Naloxone administration for opioid overdose; supportive care including ventilatory support and monitoring.

Storage and Handling

Storage: Store at room temperature, away from moisture and heat.

Stability: Stable under proper 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.