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Hydrocodone (Oral route)

Pronunciation:

hye-droe-KOE-done bye-TAR-trate

Brand Names:

  • Zohydro ER
  • Hycodan
  • Robidone

Dosage Forms:

  • Capsule, Extended Release
  • Liquid
  • Syrup
  • Tablet

Warnings:

Oral route(Capsule, Extended Release)

Prior to prescribing hydrocodone, assess each patient's risk for opioid addiction, abuse, and misuse and regularly monitor all patients for opioid addiction behaviors or conditions. Monitor for respiratory depression, which can be serious, life-threatening, or fatal, especially during initiation or following a dose increase, and instruct patients to swallow extended release capsules whole to avoid potentially fatal overdose. Fatal overdose can occur in children with accidental ingestion of just 1 dose of hydrocodone. If prolonged opioid use is necessary during pregnancy, advise the patient of the risk of life-threatening neonatal opioid withdrawal syndrome and arrange for appropriate treatment during and after delivery. Instruct patients to avoid alcoholic beverages or medications that contain alcohol to avoid a potentially fatal overdose. Concomitant use of a CYP3A4 inhibitor or discontinuation of a CYP3A4 inducer may increase or prolong adverse drug effects or cause potentially fatal respiratory depression .

Classifications:

Therapeutic—

Analgesic

Chemical—

Hydrocodone

Uses of This Medicine:

Hydrocodone is used to treat severe pain. It belongs to the group of medicines called narcotic analgesics (pain medicines). It acts on the central nervous system (CNS) to relieve pain.

When hydrocodone is used for a long time, it may become habit-forming, causing mental or physical dependence. Physical dependence may lead to withdrawal side effects if treatment is stopped suddenly.

This medicine is available only with your doctor's prescription.

Before Using This Medicine:

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies—

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Children—

Appropriate studies have not been performed on the relationship of age to the effects of hydrocodone in the pediatric population. Safety and efficacy have not been established.

Older adults—

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of hydrocodone in the elderly. However, elderly patients are more likely to have confusion and severe drowsiness and age-related kidney problems, which may require caution and an adjustment in the dose for patients receiving hydrocodone.

Pregnancy—

Pregnancy CategoryExplanation
All TrimestersCAnimal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast-feeding—

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Other medicines—

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Naltrexone

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Abiraterone Acetate
  • Acetophenazine
  • Alfentanil
  • Alprazolam
  • Amobarbital
  • Amprenavir
  • Anileridine
  • Aprepitant
  • Atazanavir
  • Baclofen
  • Bosentan
  • Bromazepam
  • Brotizolam
  • Buprenorphine
  • Buspirone
  • Butabarbital
  • Butalbital
  • Butorphanol
  • Carbamazepine
  • Carbinoxamine
  • Carisoprodol
  • Ceritinib
  • Chloral Hydrate
  • Chlordiazepoxide
  • Chlorpromazine
  • Chlorzoxazone
  • Ciprofloxacin
  • Clarithromycin
  • Clobazam
  • Clonazepam
  • Clorazepate
  • Codeine
  • Conivaptan
  • Crizotinib
  • Cyclobenzaprine
  • Dabrafenib
  • Dantrolene
  • Darunavir
  • Delavirdine
  • Dexamethasone
  • Dexmedetomidine
  • Dezocine
  • Diacetylmorphine
  • Diazepam
  • Difenoxin
  • Dihydrocodeine
  • Diltiazem
  • Diphenhydramine
  • Diphenoxylate
  • Dixyrazine
  • Doxylamine
  • Efavirenz
  • Enzalutamide
  • Erythromycin
  • Eslicarbazepine Acetate
  • Estazolam
  • Eszopiclone
  • Ethchlorvynol
  • Ethopropazine
  • Ethylmorphine
  • Etravirine
  • Fentanyl
  • Fluconazole
  • Flunitrazepam
  • Fluphenazine
  • Flurazepam
  • Fosamprenavir
  • Fosaprepitant
  • Fosphenytoin
  • Fospropofol
  • Furazolidone
  • Halazepam
  • Hexobarbital
  • Hydromorphone
  • Hydroxyzine
  • Idelalisib
  • Imatinib
  • Indinavir
  • Iproniazid
  • Isocarboxazid
  • Itraconazole
  • Ketazolam
  • Ketobemidone
  • Ketoconazole
  • Levorphanol
  • Linezolid
  • Lomitapide
  • Lopinavir
  • Lorazepam
  • Lormetazepam
  • Loxapine
  • Meclizine
  • Medazepam
  • Meperidine
  • Mephenesin
  • Mephobarbital
  • Meprobamate
  • Meptazinol
  • Mesoridazine
  • Metaxalone
  • Methadone
  • Methdilazine
  • Methocarbamol
  • Methohexital
  • Methotrimeprazine
  • Methylene Blue
  • Metopimazine
  • Miconazole
  • Midazolam
  • Mifepristone
  • Mitotane
  • Moclobemide
  • Modafinil
  • Morphine
  • Morphine Sulfate Liposome
  • Nafcillin
  • Nalbuphine
  • Nefazodone
  • Nelfinavir
  • Nevirapine
  • Nicomorphine
  • Nitrazepam
  • Opium
  • Opium Alkaloids
  • Orphenadrine
  • Oxazepam
  • Oxcarbazepine
  • Oxycodone
  • Oxymorphone
  • Papaveretum
  • Paregoric
  • Pentazocine
  • Pentobarbital
  • Perampanel
  • Perazine
  • Periciazine
  • Perphenazine
  • Phenelzine
  • Phenytoin
  • Piperaquine
  • Pipotiazine
  • Piritramide
  • Posaconazole
  • Prazepam
  • Procarbazine
  • Prochlorperazine
  • Promazine
  • Promethazine
  • Propiomazine
  • Propofol
  • Quazepam
  • Ramelteon
  • Rasagiline
  • Regorafenib
  • Remifentanil
  • Rifabutin
  • Rifampin
  • Rifapentine
  • Ritonavir
  • Saquinavir
  • Secobarbital
  • Selegiline
  • Siltuximab
  • Sodium Oxybate
  • St John's Wort
  • Sufentanil
  • Suvorexant
  • Tapentadol
  • Telaprevir
  • Telithromycin
  • Temazepam
  • Thiethylperazine
  • Thiopental
  • Thiopropazate
  • Thioproperazine
  • Thioridazine
  • Ticagrelor
  • Tilidine
  • Tipranavir
  • Tizanidine
  • Topiramate
  • Tramadol
  • Tranylcypromine
  • Triazolam
  • Triflupromazine
  • Trimeprazine
  • Verapamil
  • Voriconazole
  • Zaleplon
  • Zolpidem
  • Zopiclone

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Escitalopram

Other interactions—

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.

  • Ethanol

Other medical problems—

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Asthma, severe or
  • Breathing problems, severe (eg, hypercarbia) or
  • Paralytic ileus (intestine stops working and may be blocked), known or suspected or
  • Respiratory depression (very slow breathing)—Should not be used in patients with these conditions.
  • Brain tumor or
  • Head injuries or
  • Increased pressure in the head—Hydrocodone can cause serious problems in people who have these medical problems.
  • Breathing problems (eg, chronic obstructive pulmonary disease [COPD], cor pulmonale, hypoxia) or
  • Depression, history of or
  • Drug dependence, especially with narcotics, or history of or
  • Gallbladder problems or
  • Mental illness, history of or
  • Pancreatitis (inflammation or swelling of the pancreas) or
  • Stomach or bowel problems or
  • Weakened immune system—Use with caution. May increase risk for more serious side effects.
  • Hypotension (low blood pressure) or
  • Seizures, history of—Use with caution. May make these conditions worse.
  • Kidney disease or
  • Liver disease, severe—Use with caution. The effects may be increased because of slower removal of the medicine from the body.

Proper Use of This Medicine:

Take this medicine only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. This is especially important for elderly patients, who may be more sensitive to the effects of pain medicines. If too much of this medicine is taken for a long time, it may become habit-forming (causing mental or physical dependence) or cause an overdose.

This medicine should come with a Medication Guide. Read and follow these instructions carefully. Ask your doctor if you have any questions.

Swallow the extended-release capsule whole with water. Do not crush, break, chew, or dissolve it.

Take this medicine at the same time each day.

Hydrocodone should only be used by patients who have already been taking narcotic pain medicines, also called opioids. These patients are called opioid-tolerant. If you are uncertain whether or not you are opioid-tolerant, check with your doctor before using this medicine.

Dosing—

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (extended-release capsule):
    • For severe pain:
      • Patients who are not taking narcotic medicines:
        • Adults—At first, 10 milligrams (mg) every 12 hours. Your doctor may adjust your dose as needed.
        • Children—Use and dose must be determined by your doctor.
      • Patients switching from other narcotic medicines:
        • Adults—The capsule is given every 12 hours. Your doctor will determine your dose and may increase the dose as needed. For patients switching from fentanyl transdermal patches, this medicine should be started at least 18 hours after the removal of the fentanyl patch.
        • Children—Use and dose must be determined by your doctor.

Missed dose—

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage—

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Flush any unused capsules down the toilet.

Precautions While Using This Medicine:

It is very important that your doctor check your progress while you are taking this medicine. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to take it.

This medicine may cause a serious type of allergic reaction called anaphylaxis. Anaphylaxis can be life-threatening and requires immediate medical attention. Call your doctor right away if you or your child have a rash, itching, hoarseness, trouble breathing, trouble swallowing, or any swelling of your hands, face, or mouth while you are using this medicine.

Do not use this medicine if you have used an MAO inhibitor (MAOI) such as Eldepryl®, Marplan®, Nardil®, or Parnate® within the past 14 days.

This medicine may be habit-forming. If you feel that the medicine is not working as well, do not use more than your prescribed dose. Call your doctor for instructions.

This medicine will add to the effects of alcohol and other CNS depressants (medicines that can make you drowsy or less alert). Some examples of CNS depressants are antihistamines or medicine for allergies or colds, sedatives, tranquilizers, or sleeping medicine, other prescription pain medicine or narcotics, medicine for seizures or barbiturates, muscle relaxants, or anesthetics, including some dental anesthetics. Check with your doctor before taking any of these medicines while you are using this medicine.

This medicine may make you dizzy, drowsy, or lightheaded. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are dizzy or not alert. Stand or sit up slowly if you are dizzy.

If you think you or someone else may have taken an overdose of this medicine, get emergency help at once. Signs of an overdose include dark urine, difficult or troubled breathing, irregular, fast or slow, or shallow breathing, nausea or vomiting, pain in the upper stomach, pale or blue lips, fingernails, or skin, pinpoint pupils of the eyes, or yellow eyes or skin.

Using narcotics for a long time can cause severe constipation. To prevent this, your doctor may direct you to take laxatives, drink a lot of fluids, or increase the amount of fiber in your diet. Be sure to follow the directions carefully, because continuing constipation can lead to more serious problems.

Do not suddenly stop or change your dose without first checking with your doctor.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Side Effects of This Medicine:

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Less common
Bloating or swelling of the face, arms, hands, lower legs, or feet
body aches or pain
chills
cough
depression
difficult or labored breathing
ear congestion
fear or nervousness
fever
headache
loss of voice
nasal congestion
rapid weight gain
runny nose
sneezing
sore throat
tightness in the chest
tingling of the hands or feet
unusual tiredness or weakness
unusual weight gain or loss

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose
Blue lips and fingernails
blurred vision
change in consciousness
chest pain or discomfort
cold and clammy skin
confusion
constricted pupil (black part of the eye)
coughing that sometimes produces a pink frothy sputum
decreased awareness or responsiveness
difficult, fast, noisy breathing, sometimes with wheezing
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
increased sweating
irregular, fast or slow, or shallow breathing
lightheadedness, dizziness, or fainting
loss of consciousness
no muscle tone or movement
pale skin
severe sleepiness
sleepiness or unusual drowsiness
slow or irregular heartbeat

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
Difficulty having a bowel movement (stool)
nausea
Less common
Abdominal or stomach pain or discomfort
back pain
bladder pain
bloody or cloudy urine
difficult, burning, or painful urination
dry mouth
frequent urge to urinate
heartburn
itching skin
lower back or side pain
muscle spasms
vomiting

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.


Last Updated: 11/4/2014

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