Yes

Analgesic, Narcotic

Dental: Treatment of postoperative pain

Medical: Relief of moderate to severe pain; antitussive (hydrocodone)

C-III

C

CNS depression, hypersensitivity to hydrocodone, acetaminophen or any component; severe respiratory depression

Use with caution in patients with hypersensitivity reactions to other phenanthrene derivative opioid agonists (morphine, hydrocodone, hydromorphone, levorphanol, oxycodone, oxymorphone); tablets contain metabisulfite which may cause allergic reactions; tolerance or drug dependence may result from extended use

>10%:

Cardiovascular: Hypotension

Central nervous system: Lightheadedness, dizziness, sedation, drowsiness, fatigue

Neuromuscular & skeletal: Weakness

1% to 10%:

Cardiovascular: Bradycardia

Central nervous system: Confusion

Gastrointestinal: Nausea, vomiting

Genitourinary: Decreased urination

Respiratory: Shortness of breath, dyspnea

<1%: Hypertension, hallucinations, xerostomia, anorexia, biliary tract spasm, urinary tract spasm, diplopia, miosis, histamine release, physical and psychological dependence with prolonged use

Symptoms of overdose include hepatic necrosis, blood dyscrasias, respiratory depression

Acetylcysteine 140 mg/kg orally (loading) followed by 70 mg/kg every 4 hours for 17 doses. Therapy should be initiated based upon laboratory analysis suggesting high probability of hepatotoxic potential. Naloxone (2 mg I.V.) can also be used to reverse the toxic effects of the opiate. Activated charcoal is effective at binding certain chemicals, and this is especially true for acetaminophen.

Decreased effect with phenothiazines

Increased effect with dextroamphetamine

Increased toxicity with CNS depressants, TCAs; effect of warfarin may be enhanced

See individual agents

Onset of narcotic analgesia: Within 10-20 minutes

Duration: 3-6 hours

Distribution: Crosses the placenta

Metabolism: In the liver

Half-life: 3.8 hours

Elimination: In urine

Oral (doses should be titrated to appropriate analgesic effect):

Antitussive (hydrocodone): 0.6 mg/kg/day in 3-4 divided doses

A single dose should not exceed 10 mg in children >12 years, 5 mg in children 2-12 years, and 1.25 mg in children <2 years of age

Analgesic (acetaminophen): Refer to Acetaminophen monograph

Adults: Analgesic: 1-2 tablets or capsules every 4-6 hours or 5-10 mL solution every 4-6 hours as needed for pain

No data reported

Pain relief, respiratory and mental status, blood pressure

Sedation is common; may cause confusion; may rarely cause hallucinations

May result in loss of pain control when used in combination with SSRIs (especially paroxetine and fluoxetine); concurrent use with psychotropics may produce additive sedation

No information available to require special precautions

<1% of patients experience dry mouth

If self-administered, use exactly as directed (do not increase dose or frequency); may cause physical and/or psychological dependence. Take with food or milk. While using this medication, do not use alcohol and other prescription or OTC medications (especially sedatives, tranquilizers, antihistamines, or pain medications) without consulting prescriber. Maintain adequate hydration (2-3 L/day of fluids unless instructed to restrict fluid intake). May cause dizziness, lightheadedness, confusion, or drowsiness (use caution when driving, climbing stairs, or changing position - rising from sitting or lying to standing, or when engaging in tasks requiring alertness until response to drug is known); nausea or vomiting (frequent mouth care, frequent sips of fluids, chewing gum, or sucking lozenges may help). Report chest pain or palpitations; persistent dizziness, shortness of breath, or difficulty breathing; unusual bleeding or bruising; or unusual fatigue and weakness. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to be pregnant. Do not breast-feed.

Observe patient for excessive sedation, respiratory depression

Capsule:

Bancap HC®, Dolacet®, Hydrocet®, Hydrogesic®, Lorcet®-HD, Margesic® H, Medipain 5®, Norcet®, Stagesic®, T-Gesic®, Zydone®: Hydrocodone bitartrate 5 mg and acetaminophen 500 mg

Elixir (tropical fruit punch flavor) (Lortab®): Hydrocodone bitartrate 2.5 mg and acetaminophen 167 mg per 5 mL with alcohol 7% (480 mL)

Solution, oral (tropical fruit punch flavor) (Lortab®): Hydrocodone bitartrate 2.5 mg and acetaminophen 167 mg per 5 mL with alcohol 7% (480 mL)

Tablet: Hydrocodone bitartrate 5 mg and acetaminophen 400 mg; hydrocodone bitartrate 7.5 mg and acetaminophen 400 mg; hydrocodone bitartrate 10 mg and acetaminophen 400 mg; hydrocodone bitartrate 5 mg and acetaminophen 500 mg; hydrocodone bitartrate 7.5 mg and acetaminophen 750 mg; hydrocodone bitartrate 7.5 mg and acetaminophen 500 mg; hydrocodone bitartrate 7.5 mg and acetaminophen 650 mg; hydrocodone bitartrate 10 mg and acetaminophen 650 mg

Lortab® 2.5/500: Hydrocodone bitartrate 2.5 mg and acetaminophen 500 mg

Anexsia® 5/500, Anodynos-DHC®, Co-Gesic®, DuoCet™, DHC®; Hy-Phen®, Lorcet®, Lortab®® 5/500, Vicodin®: Hydrocodone bitartrate 5 mg and acetaminophen 500 mg

Lortab® 7.5/500: Hydrocodone bitartrate 7.5 mg and acetaminophen 500 mg

Anexsia® 7.5/650, Lorcet® Plus: Hydrocodone bitartrate 7.5 mg and acetaminophen 650 mg

Vicodin® ES: Hydrocodone bitartrate 7.5 mg and acetaminophen 750 mg

Norco®: Hydrocodone bitartrate 10 mg and acetaminophen 325 mg

Lortab® 10/500: Hydrocodone bitartrate 10 mg and acetaminophen 500 mg

Lorcet® 10/650: Hydrocodone bitartrate 10 mg and acetaminophen 650 mg

Vicodin® HP: Hydrocodone bitartrate 10 mg and acetaminophen 660 mg

Zydone®: Hydrocodone bitartrate 5 mg and acetaminophen 400 mg; hydrocodone bitartrate 7.5 mg and acetaminophen 400 mg; Hydrocodone bitartrate 10 mg and acetaminophen 400 mg

Dionne RA, "New Approaches to Preventing and Treating Postoperative Pain," J Am Dent Assoc, 1992, 123(6):26-34.

Gobetti JP, "Controlling Dental Pain," J Am Dent Assoc, 1992, 123(6):47-52.