Home Drug Guide Hydrocodone Bitartrate and Pseudoephedrine Hydrochloride

Drug Guide

Generic Name

Hydrocodone Bitartrate and Pseudoephedrine Hydrochloride

Brand Names Rezira

Classification

Therapeutic: Narcotic analgesic and decongestant combination

Pharmacological: Hydrocodone: Opioid receptor agonist; Pseudoephedrine: Sympathomimetic decongestant

FDA Approved Indications

  • Relief of cough and nasal congestion associated with upper respiratory infections

Mechanism of Action

Hydrocodone binds to mu-opioid receptors in the central nervous system, altering the response to pain and suppressing cough. Pseudoephedrine stimulates alpha-adrenergic receptors causing vasoconstriction in the nasal mucosa, leading to decongestion.

Dosage and Administration

Adult: Dose varies; typically 5-10 mg hydrocodone and 60 mg pseudoephedrine every 4-6 hours as needed, not to exceed recommended daily limits.

Pediatric: Use is not generally recommended; consult specific pediatric guidelines.

Geriatric: Start at lower doses; monitor closely for adverse reactions and accumulation.

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

Hepatic Impairment: Use with caution; dose adjustments may be necessary.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Hydrocodone: extensive distribution; pseudoephedrine: moderate distribution.

Metabolism: Hydrocodone extensively metabolized in the liver; pseudoephedrine minimally metabolized, primarily excreted unchanged.

Excretion: Renal; elimination half-life approximately 3-4 hours for hydrocodone, 5-8 hours for pseudoephedrine.

Half Life: Hydrocodone: 3-4 hours; pseudoephedrine: 5-8 hours.

Contraindications

  • Severe respiratory depression
  • Acute or severe bronchial asthma
  • Known hypersensitivity to hydrocodone or pseudoephedrine

Precautions

  • Use with caution in patients with head injury, increased intracranial pressure, or mood disorders; risk of dependence and abuse; monitor for respiratory depression.

Adverse Reactions - Common

  • Drowsiness, dizziness (Common)
  • Nausea, constipation (Common)

Adverse Reactions - Serious

  • Respiratory depression (Serious (rare))
  • Addiction, overdose (Serious (rare))

Drug-Drug Interactions

  • CNS depressants, other opioid analgesics, monoamine oxidase inhibitors

Drug-Food Interactions

  • Alcohol (enhances sedative effects)

Drug-Herb Interactions

  • St. John's Wort (may increase CNS depression)

Nursing Implications

Assessment: Monitor respiratory status, level of consciousness, effectiveness of cough and congestion relief.

Diagnoses:

  • Risk for respiratory depression
  • Impaired comfort related to cough and congestion

Implementation: Administer with food to decrease gastrointestinal upset; monitor for signs of abuse or misuse.

Evaluation: Assess for effective relief of cough and congestion, and monitor for adverse effects.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Do not operate heavy machinery or drive until effects are known.
  • Be aware of potential for dependence.
  • Avoid alcohol and other CNS depressants.
  • Report any signs of respiratory depression or allergic reactions.

Special Considerations

Black Box Warnings:

  • Respiratory depression, addiction, accidental ingestion by children leading to overdose and death.

Genetic Factors: Genetic polymorphisms may affect metabolism of hydrocodone, influencing efficacy and risk of adverse effects.

Lab Test Interference: Pseudoephedrine can cause false positives in urine drug screenings for amphetamines.

Overdose Management

Signs/Symptoms: Drowsiness, respiratory depression, pinpoint pupils, unconsciousness.

Treatment: Supportive care including respiratory support; naloxone for hydrocodone overdose; manage symptoms and provide symptomatic treatment.

Storage and Handling

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

Stability: Stable under recommended storage conditions for the duration of the shelf life.

🛡️ 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.