Home Drug Guide Hydrocodone Bitartrate and Acetaminophen

Drug Guide

Generic Name

Hydrocodone Bitartrate and Acetaminophen

Brand Names Norco, Lortab, Vicodin Hp, Zydone, Anexsia 7.5/325, Anexsia 5/325, Anexsia, Vicodin, Lorcet-hd, Hy-phen, Co-gesic, Duradyne Dhc, Bancap Hc, Norcet, Acetaminophen and Hydrocodone Bitartrate, Tycolet, Anexsia 7.5/650, Vicodin Es, Allay, Zyfrel

Classification

Therapeutic: Analgesic and Antipyretic

Pharmacological: Opioid Agonist and NSAID combination (acetaminophen as NSAID)

FDA Approved Indications

Moderate to severe pain

Mechanism of Action

Hydrocodone binds to opioid receptors in the central nervous system to provide analgesia and sedation. Acetaminophen acts centrally to inhibit prostaglandin synthesis, reducing pain and fever.

Dosage and Administration

Adult: As prescribed, typically every 4-6 hours as needed. Do not exceed 4 grams of acetaminophen per day to avoid toxicity.

Pediatric: Use only under medical supervision; dosage based on weight and age.

Geriatric: Start with lower dose due to increased sensitivity and monitor closely.

Renal Impairment: Adjust dose cautiously; regular monitoring recommended.

Hepatic Impairment: Use with caution; dose adjustment may be necessary due to increased risk of toxicity.

Pharmacokinetics

Absorption: Rapidly absorbed from gastrointestinal tract.

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

Metabolism: Hydrocodone metabolized in the liver via CYP3A4 and CYP2D6 pathways; acetaminophen metabolized in the liver.

Excretion: Renal excretion of metabolites.

Half Life: Hydrocodone approximately 3.3 hours; acetaminophen approximately 2-3 hours.

Contraindications

Severe respiratory depression
Acute or severe bronchial asthma in an unmonitored setting
Use of monoamine oxidase inhibitors within 14 days

Precautions

History of hypersensitivity to opioids, hepatic impairment, addiction history, respiratory depression, head injury, increased intracranial pressure

Adverse Reactions - Common

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

Adverse Reactions - Serious

Respiratory depression (Serious)
Hepatotoxicity (from acetaminophen overdose) (Serious)
Allergic reactions, including rash and pruritus (Less common)

Drug-Drug Interactions

CNS depressants, alcohol, other acetaminophen-containing products, CYP3A4 inhibitors and inducers

Drug-Food Interactions

Alcohol can increase hepatotoxicity risk

Drug-Herb Interactions

St. John’s Wort may affect metabolism

Nursing Implications

Assessment: Monitor pain relief, respiratory status, hepatic function, signs of opioid misuse.

Diagnoses:

Pain, Acute
Risk for Respiratory Depression
Impaired Liver Function

Implementation: Administer with food if GI upset occurs; monitor for signs of overdose or toxicity; check LFTs periodically.

Evaluation: Effective pain relief without adverse effects; hepatic function remains stable.

Patient/Family Teaching

Take as prescribed; do not exceed recommended dose.
Avoid alcohol and other CNS depressants.
Report signs of allergic reactions or difficulty breathing.
Be aware of potential for addiction and misuse.

Special Considerations

Black Box Warnings:

Addiction, abuse, and misuse; respiratory depression leading to death

Genetic Factors: Metabolism varies with CYP2D6 polymorphisms, affecting opioid efficacy.

Lab Test Interference: May cause elevated liver enzymes or interfere with tests of liver function.

Overdose Management

Signs/Symptoms: Respiratory depression, somnolence, cyanosis, pin-point pupils, hypothermia, coma.

Treatment: Administer naloxone promptly; support airway and breathing; provide supportive care and monitoring for hepatic toxicity.

Storage and Handling

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

Stability: Stable under recommended conditions; check manufacturer instructions.