Generic Name

Hydrocodone Bitartrate with Guaifenesin

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Classification

FDA Approved Indications

• Cough suppression associated with cold, bronchitis, or other respiratory conditions

Mechanism of Action

Hydrocodone binds to opioid receptors in the central nervous system to suppress cough reflex; Guaifenesin increases mucus expulsion by thinning airway secretions.

Dosage and Administration

Adult: Typically 10 mL every 4-6 hours as needed, not exceeding 60 mL per day.

Pediatric: Careful dosing based on age and weight, generally not recommended under age 6.

Geriatric: Dose adjustments may be necessary due to increased sensitivity and potential for respiratory depression.

Renal Impairment: Use with caution; consider dose adjustments.

Hepatic Impairment: Use with caution; monitor closely, as metabolism may be impaired.

Pharmacokinetics

Absorption: Rapid gastric absorption.

Distribution: Widely distributed; crosses blood-brain barrier.

Metabolism: Metabolized in liver, primarily via phase I and phase II reactions.

Excretion: Renal elimination of metabolites.

Half Life: Hydrocodone: approximately 3.5 hours; Guaifenesin: about 1 hour.

Contraindications

• Hypersensitivity to hydrocodone or guaifenesin.
• Use in cases of respiratory depression, severe asthma, or gastrointestinal obstruction.

Precautions

• Use with caution in elderly, patients with head injury, respiratory depression, or hepatic impairment.
• Potential for dependence and abuse.

Adverse Reactions - Common

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

Adverse Reactions - Serious

• Respiratory depression (Rare)
• Allergic reactions, including rash or swelling (Rare)
• Seizures (Rare)

Drug-Drug Interactions

• Other central nervous system depressants, including alcohol, benzodiazepines, and sedatives.
• MAO inhibitors – risk of serotonin syndrome or respiratory depression.

Drug-Food Interactions

• Alcohol may increase sedative effects.

Drug-Herb Interactions

• Use caution with herbs that cause sedation, such as kava or valerian.

Nursing Implications

Patient/Family Teaching

• Advise against activities requiring alertness until response to medication is known.
• Warn about potential drowsiness and dizziness.
• Ensure adequate hydration to loosen mucus.

Special Considerations

Black Box Warnings:

• Potential for addiction, abuse, and misuse, leading to serious side effects including death.
• Respiratory depression risks, especially in children and opioid-naïve individuals.

Genetic Factors: Genetic variations in CYP2D6 enzyme may affect metabolism and response.

Lab Test Interference: May interfere with certain assessments of respiratory function.

Overdose Management

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

Treatment: Airway management, naloxone administration for respiratory depression, supportive measures.

Storage and Handling

Storage: Store at controlled room temperature, 20-25°C (68-77°F).

Stability: Stable when stored properly; check expiration dates.