Nurses Compass
Drug Guide
Hydrocodone Bitartrate and Ibuprofen
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.