Home Drug Guide Homatropine Methylbromide; Hydrocodone Bitartrate

Drug Guide

Generic Name

Homatropine Methylbromide; Hydrocodone Bitartrate

Brand Names Hycodan, Hydrocodone Bitartrate And Homatropine Methylbromide, Homatropine Methylbromide And Hydrocodone Bitartrate, Hydropane, Tussigon

Classification

Therapeutic: Antitussive, Anticholinergic, Opioid analgesic

Pharmacological: Anticholinergic agent, Mu-opioid receptor agonist

FDA Approved Indications

Cough suppression related to respiratory conditions (for Hydrocodone Bitartrate combination)

Mechanism of Action

Hydrocodone acts as a mu-opioid receptor agonist, suppressing cough reflex in the brainstem; Homatropine Methylbromide is an anticholinergic that decreases secretions and may contribute to cough suppression by drying mucous membranes.

Dosage and Administration

Adult: Dosage varies; typically, 5-10 mL of syrup every 4-6 hours as needed. Adjust for severity and response.

Pediatric: Use with caution; pediatric dosing is usually lower and based on weight, under physician guidance.

Geriatric: Start at lower end of dosing range due to increased sensitivity to opioid and anticholinergic effects.

Renal Impairment: Use cautiously; dose adjustments may be necessary.

Hepatic Impairment: Use cautiously; monitor for increased effects.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Distributed widely, crosses blood-brain barrier.

Metabolism: Metabolized in the liver.

Excretion: Excreted primarily via urine.

Half Life: Hydrocodone approximately 3-4 hours; Homatropine Methylbromide varies dependent on individual metabolism.

Contraindications

Hypersensitivity to opioids or anticholinergic agents.
Respiratory depression.
Acute asthma.

Precautions

Use cautiously in elderly, patients with head injury, increased intracranial pressure, or urinary retention.
Potential for dependence and misuse with opioids.
Caution in patients with liver impairment.

Adverse Reactions - Common

Drowsiness, dizziness (Common)
Constipation (Common)
Dry mouth, blurred vision (Common)

Adverse Reactions - Serious

Respiratory depression (Serious)
ALLERGIC REACTIONS (rash, pruritus) (Serious)
Addiction, abuse, and misuse (Serious)

Drug-Drug Interactions

CNS depressants, other opioids, sedatives, benzodiazepines
MAO inhibitors

Drug-Food Interactions

Alcohol

Drug-Herb Interactions

St. John’s Wort

Nursing Implications

Assessment: Monitor respiratory status, level of consciousness, and pain management.

Diagnoses:

Risk for respiratory depression
Risk for constipation

Implementation: Administer with food or milk if GI upset occurs; monitor for signs of respiratory depression.

Evaluation: Assess effectiveness in cough suppression and monitor for adverse effects.

Patient/Family Teaching

Advise on potential for drowsiness and impairment of mental/physical ability.
Warn about dependence and need to avoid alcohol.
Instruct to report difficulty breathing, excessive drowsiness, or allergic reactions.

Special Considerations

Black Box Warnings:

Potential for addiction, abuse, and misuse leading to overdose and death.
Respiratory depression risk.

Genetic Factors: Genetic variations in CYP2D6 enzyme can affect metabolism of hydrocodone, influencing efficacy and risk.

Lab Test Interference: None significant.

Overdose Management

Signs/Symptoms: Respiratory depression, pinpoint pupils, unconsciousness.

Treatment: Administer naloxone as an opioid antagonist; support respiration and circulation; ensure airway patency.

Storage and Handling

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

Stability: Stable when stored properly, check expiration date on packaging.