Names and pronunciation
Lorcet Plus, Lortab, Norco, Verdrocet, Vicodin, Vicodin ES, Vicodin HP, Xodol 10/300, Xodol 5/300, Xodol 7.5/300
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Drug reference
Lorcet Plus, Lortab, Norco, Verdrocet, Vicodin, Vicodin ES, Vicodin HP, Xodol 10/300, Xodol 5/300, Xodol 7.5/300
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Func. class.: Antitussive opioid analgesic/nonopioid analgesic Controlled Substance Schedule II
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Do not confuse: HYDROcodone/hydrocortisone/ oxycodone/HYDROmorphone
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ACTION: Binds to opiate receptors in CNS to reduce pain
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USES: Moderate to severe pain
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CONTRAINDICATIONS: Abrupt discontinuation; hypersensitivity to this product, benzyl; GI obstruction; status asthmaticus
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Black Box Warning: Respiratory depres- sion Precautions: Pregnancy, breastfeeding, neonates, addictive personality, increased intracranial pressure, MI (acute), severe heart disease, renal/hepatic disease, bowel impaction, urinary retention, viral infection, ulcerative colitis, seizures, sul- fite hypersensitivity, psychosis, hyperten- sion, hyperthyroidism Black Box Warning: Accidental exposure; neonatal opioid withdrawal syndrome; potential for overdose or poisoning, substance abuse, ethanol ingestion, ben- zodiazepines Black Box Warning: Do not exceed 4 g acetaminophen with combination product • Give with food or milk to prevent gas- tric upset • Store in light-resistant area at room temperature Extended-release route • May need short- or rapid-acting opi- oid for breakthrough pain • Swallow caps whole, do not crush or chew Black Box Warning: Increase: anticho- linergic effects—anticholinergics Black Box Warning: Increase: CNS depression—alcohol, opioids, sedative/ hypnotics, phenothiazines, skeletal muscle relaxants, general anesthetics, tricyclics Black Box Warning: Increase hydroco- done effect—CYP3A4 inhibitors Increase: Serotonin syndrome—SNRIs, SSRIs, TCAs, traZODone, vilazodone, mon- itor for serotonin syndrome Increase: Severe reactions—MAOIs, sep- arate by ≥14 days Black Box Warning: Decrease: hydroco done effect—CYP3A4 inducers Drug/Herb Increase: CNS depression—lavender, valerian, chamomile, Kava Decrease: hydrocodone effect—St. John’s wort Drug/Lab Test Increase: cholesterol, GGT Decrease: potassium Black Box Warning: Respiratory depression: do not use in those with respiratory depression; monitor for de- creased respiratory rate, reduced urge to breathe, sighing breathing pattern; CO2 retention, respiratory depression may worsen, sedation; an opioid an- tagonist may be needed • Hypersensitivity: Assess for reactions in those with hypersensitivity to other opiates Black Box Warning: Accidental expo- sure: may cause fatal overdose; do not use with ethanol; check all medications for alcohol content • Opioid addiction: identify opioid ad- diction or use before starting product; if product has been used by snorting, fatal reactions have occurred • B/P, pulse, respirations before, periodi- cally; if respirations <10/min, dose may need to be reduced, oversedation may occur • May decrease sex hormone levels after long-term use • Bowel status: constipation; provide fluids, fiber in diet; may need stimulant laxatives if opioid use exceeds 3 days Black Box Warning: Neonatal opioid withdrawal syndrome: monitor neonate for withdrawal (irritability, hyperactivity, abnormal sleep patterns, high-pitched crying, tremor, vomiting, diarrhea) • Allergic reactions: rash, urticaria; stop product • Cough and respiratory dysfunction: res piratory depression, character, rate, rhythm • Beers: avoid in older adults unless safer alternative is unavailable; may cause ataxia, impaired psychomotor function Black Box Warning: Pregnancy/breast- feeding: use only if benefits outweigh fetal risk; neonatal withdrawal syndrome may occur if used for prolonged periods in pregnancy; do not use in breastfeed- ing, excretion in breast milk Black Box Warning: Not to exceed 4000 mg in combination product with aceta- minophen; check all other products that may contain acetaminophen Black Box Warning: Ethanol ingestion: that a patient’s use with ethanol can lead to serious overdose or death; not to use with other medications contain- ing ethanol unless directed by prescriber Black Box Warning: Neonatal opioid withdrawal syndrome: that this syndrome can be fatal; that it results from prolonged maternal use of long-acting opioids • To notify prescriber if pregnancy is planned or suspected
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SIDE EFFECTS CNS: Drowsiness, dizziness, light-headed- H ness, confusion, headache, sedation, eupho- ria, dysphoria, weakness, hallucinations, mood changes, dependence, seizures CV: Tachycardia, bradycardia, QT prolon- gation (Hysingla) EENT: Blurred vision, miosis, diplopia GI: Nausea, vomiting, anorexia, consti- pation, esophageal obstruction, choking GU: Urinary retention INTEG: Rash, sweating, flushing, pruritus META: Dehydration RESP: Respiratory depression, cough, respiratory arrest (child), pulmonary edema
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INTERACTIONS
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TREATMENT OF OVERDOSE: Naloxone HCl (Narcan) 0.2-0.8 mg IV, O2, IV fluids, vasopressors
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DOSAGE AND ROUTES Analgesic • Adult: PO 2.5-10 mg q3-6hr as needed; if using with acetaminophen max 4 g/day, total of 5 tablets with ibuprofen combination tablets; ext rel (Zohydro ER) 10 mg q12hr, may increase by 10 mg q12hr q3-7days as needed; ext rel (Hysingla) 20 mg daily, may increase by 10-20 mg q3-5day • Child 1-3 yr: PO 0.1-0.2 mg/kg q3- 4hr Antitussive • Adult: PO 5 mg q4-6hr as needed • Child: PO 0.6 mg/kg/day divided q6- 8hr, max <2 yr, 1.25 mg/dose; 2-12 yr, 5 mg/dose; >12 yr, 10 mg/dose Renal dose • Adult: PO CCr <45 mL/min-Hysingla decrease dose by 50% initially Hepatic dose • Adult: PO Hysingla decrease by 50% initially Hydrocodone: forms: Available Extended release (Zohydro ER) 10, 15, 20, 30, 40, 50 mg; (Hysingla ER) 20, 30, 40, 60, 80, 100, 120 mg; syrup: 1 mg/mL Tablet Hydrocodone/acetaminophen: 2.5 mg hydrocodone/325 acetaminophen; 5 mg hydrocodone/325 acetaminophen; 7.5 mg hydrocodone/325 acetaminophen; 15 mg hydrocodone/325 acetaminophen; 10 mg hydrocodone/325 acetaminophen; oral solution 7.5 mg hydrocodone/325 acetaminophen/15 mL, 10 mg hydroco- done/325 acetaminophen/15 mL
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Administer: • Check product carefully before using; fatalities have occurred using wrong dose, wrong product, given only by those knowledgable in use of opioids • Do not break, crush, or chew tabs; only scored tabs can be broken • With antiemetic after meals if nausea or vomiting occurs
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Assess: • Pain: intensity, type, location, other characteristics before, 1 hr after giving product; titrate upward by 25% until pain reduced by half; need for pain medica- tion, physical dependence; opioid is more effective before pain is severe • CNS changes: dizziness, drowsiness, hallucinations, euphoria, LOC, pupil re- action
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Evaluate: • Therapeutic response: decrease in pain or cough
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To report any symptoms of CNS changes, allergic reactions • That physical dependency may result when used for extended periods • That withdrawal symptoms may occur: nausea, vomiting, cramps, fever, faint- ness, anorexia • To avoid driving, other hazardous ac- tivities because drowsiness occurs • To avoid other CNS depressants; they will enhance sedating properties of this product • To change positions slowly to reduce orthostatic hypotension • To take as directed, not to double doses or exceed doses, not to discontinue abruptly, taper, there is a high abuse potential • To notify provider if pain is not ade- quately controlled • For dry mouth, use sugarless gum, frequent sips of water, use food, good oral hygiene • To notify prescriber of relief of pain
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PHARMACOKINETICS Hydrocodone: Onset unknown, peak 6-30 hr (Hysingla ER), 5 hr (Zohydro ER), duration unknown, half-life 7-9 hr Onset Hydrocodone/acetaminophen: 10 min, peak 1-1.6 hr (hydrocodone), 0.5-1 hr (acetaminophen); duration 4-8 hr, half-life 3.3-4.4 hr, metabolized in liver, excreted in urine, crosses pla- centa
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• Child 1-3 yr: PO 0.1-0.2 mg/kg q3- 4hr Antitussive
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• Child: PO 0.6 mg/kg/day divided q6- 8hr, max <2 yr, 1.25 mg/dose; 2-12 yr, 5 mg/dose; >12 yr, 10 mg/dose Renal dose
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