Hydrocodone has a black box warning of opioid addiction, misuse, and abuse. It can also cause life-threatening respiratory depression. Accidental ingestion of hydrocodone in children can be fatal. Long-term use in pregnancy can cause opioid withdrawal syndrome. Concomitant use of central nervous system (CNS) depressants such as benzodiazepines with hydrocodone can result in profound sedation, respiratory depression, and coma or death. Moreover, concomitant administration of Cytochrome P450 3A4 can increase the concentration and effect of hydrocodone.
Hydrocodone works by binding to receptors in the CNS, hence reducing the pain intensity that comes from the stimuli from sensory nerve endings. It also alters pain perception and emotional response to pain. Moreover, hydrocodone also suppresses the cough reflex and, therefore, sometimes may be used as an antitussive agent.
When given orally for analgesic purposes, hydrocodone's onset of action occurs in 10 to 20 minutes, with a peak occurring in 30 to 60 minutes. Its duration of action is 4 to 6 hours. Hydrocodone is metabolized primarily in the liver and excreted in urine. Its half-life is 3.8 hours, which may be increased in older adults.
Contraindications and Precautions
Hydrocodone use is contraindicated when the patient is hypersensitive to it and has significant respiratory depression or gastrointestinal obstruction, especially with known or suspected paralytic ileus, acute or severe bronchial asthma, or hypercarbia.
Administer hydrocodone with caution in patients with adrenal insufficiency, pancreatitis, biliary tract disease, CNS depression, coma, hypothyroidism, acute alcohol ingestion, severe hepatic or renal impairment, respiratory depression or impairment, benign prostatic hypertrophy, urinary stricture, older adults, seizures, debilitated, with other CNS depressant therapy and history of substance abuse.
When given to a pregnant woman, hydrocodone readily crosses the placenta and is distributed in breast milk. If administered in the latent phase of first-stage labor or before cervical dilation of 4 to 5 cm, the labor may get prolonged. Moreover, if the mother receives opiates during labor, the neonate can have respiratory depression. When used regularly during pregnancy, it can produce withdrawal symptoms in the neonate, such as excessive crying, irritability, hyperactive reflexes, tremors, yawning, vomiting, diarrhea, and sneezing.
Patients younger than two years are more susceptible to respiratory depression with hydrocodone. Older adults are also at risk of developing respiratory depression because of opioids. Hydrocodone may also cause paradoxical excitement in older adults. Therefore, dosage adjustment is required in older adults and children younger than two years. Renal impairment because of increased age, prostatic hypertrophy, or obstruction of the urinary tract can increase the risk of urinary retention with hydrocodone therapy.
Drug Interactions of Hydrocodone
Hydrocodone is an opioid agonist that can interact with other CNS depressants such as morphine, alcohol, oxycodone, zolpidem, and benzodiazepines; it may result in increased sedation and CNS depression. Monoamine oxidase inhibitors such as selegiline, phenelzine, and others may increase the adverse effects of hydrocodone. Cytochrome P450 3A4, such as ketoconazole, ritonavir, and clarithromycin, may increase or prolong the effects of opioids.
When given with herbals having sedative properties, such as chamomile, kava, and valerian, the sedative effects of opioids are potentiated. With St.Johns wort, the effects of hydrocodone may decrease.
Hydrocodone may increase serum lipase and amylase. Therefore, monitor them closely.
Availability, Administration, and Handling
Hydrocodone is available in the capsule dosage form in extended-release preparations by the name Zohydro ER, in the strengths of 10 mg, 15 mg, 20 mg, 30 mg, 40 mg, and 50 mg. It is also available as extended-release tablets by the brand name of Hysingla ER in the strengths 20 mg, 30 mg, 40 mg, 60 mg, 80 mg, 100 mg, and 120 mg.
When given orally, it can be given without food. Make sure the patient swallows the extended-release preparations whole, and do not crush or dissolve them.
Dosage
When given for analgesia, the dose of hydrocodone in adults or children weighing 50 kilograms (kg) or more, given orally, is initially 2.5 to 10 mg every 3 to 4 hours, as required. For children under 50 kgs of weight, it is initially 0.1 to 0.2 mg/kg given every 4 to 6 hours as required. For older adults, the dose of hydrocodone is 2.5 to 5 mg every 4 to 6 hours.
Hydrocodone should be given with caution in patients with hepatic impairment. However, dose adjustment may not required in renal-impaired patients.
Side Effects
The common side effects of hydrocodone involve hypotension, lethargy, facial flushing, diaphoresis, and drowsiness. Sometimes, it can also cause urine retention, constipation, blurred vision, dry mouth, headache, nausea, vomiting, euphoria, dysphoria, and painful urination.
Adverse Effects
When given in higher than recommended doses, hydrocodone results in skeletal muscle flaccidity, cold and clammy skin, cyanosis, extreme sedation, and drowsiness that progresses to seizures, stupor, and coma.
When given in high doses, tolerance can develop to analgesic effects and physical dependence with long-term use. In patients with hepatic and renal impairment, the duration of action is prolonged.
The antidote for hydrocodone is naloxone. It is used to treat opioid overdose and toxicity.
Nursing Consideration
Baseline Assessment
Before starting hydrocodone therapy, obtain vital signs. If a patient's respiratory rate is 12 per minute or less in adults and 20 per minute or less in children, withhold medication and contact the physician promptly.
If hydrocodone is given for analgesic effects, assess the pain onset, type, location, and duration. Moreover, if it is given to achieve antitussive effects, assess the type of cough, its severity, and frequency.
Nursing Intervention
With hydrocodone therapy, make sure to palpate the bladder for urinary retention. Check the pattern of bowel activity and stool consistency. Inquire if the patient has diarrhea or constipation and treat accordingly. Make the patient initiate deep breathing and coughing exercises, especially for patients with respiratory impairment. Assess the patient for pain reduction. Keep a record of pain onset and relief and cough frequency. With opioid therapy, monitor the patients level of consciousness closely.
Patient Teaching
Tell the patient that hydrocodone can cause a reduction in blood pressure. Therefore, go from lying to standing slowly to avoid the occurrence of orthostatic hypotension. Educate the patient to avoid doing things that require alertness and motor skills with opioid therapy. With opioid therapy, patients should avoid alcohol.
The Bottom Line
Hydrocodone is a Schedule II opioid drug that should be given in the minimum possible doses for the shortest possible time. If given in high doses for a long time, it is better to taper off the drug. Compel the patient to report any adverse effects such as nausea, vomiting, constipation, difficulty breathing, and shortness of breath.
About the Author:
Mariya Rizwan is an experienced pharmacist who has been working as a medical writer for four years. Her passion lies in crafting articles on topics ranging from Pharmacology, General Medicine, Pathology to Pharmacognosy.
Mariya is an independent contributor to CEUfast's Nursing Blog Program. Please note that the views, thoughts, and opinions expressed in this blog post are solely of the independent contributor and do not necessarily represent those of CEUfast. This blog post is not medical advice. Always consult with your personal healthcare provider for any health-related questions or concerns.
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