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hydrocodone/pseudoephedrine

General

Pronunciation:
hye-droe-koe-done/soo-doe-e-fed-rin


Trade Name(s)

  • Rezira

Pregnancy Category
Category C

Ther. Class.
allergy, cold and cough remedies

Controlled Substance Schedule: III

Indications

Relief of cough/nasal congestion associated with the common cold.

Action

  • Consists of an antitussive (hydrocodone) and a nasal decongestant (pseudoephedrine).
  • Hydrocodone– Binds to opiate receptors in the CNS; suppress the cough reflex via a direct central action.
  • Pseudoephedrine– Stimulates alpha- and beta-adrenergic receptors; produces vasoconstriction in the respiratory tract mucosa (alpha-adrenergic stimulation) and possibly bronchodilation (beta2 -adrenergic stimulation).

Therapeutic Effect(s):

Decreased cough and nasal congestion associated with the common cold.

Pharmacokinetics

hydrocodone

Absorption: Well absorbed following oral administration.

Distribution: Enters breast milk.

Metabolism and Excretion: Mostly metabolized by the liver; eliminated in the urine (50–60% as metabolites, 15% as unchanged drug).

Half-life: 2.2 hr.

pseudoephedrine

Absorption: Well absorbed after oral administration.

Distribution: Appears to enter the CSF; probably crosses the placenta and enters breast milk.

Metabolism and Excretion: Partially metabolized by the liver. 55–75% excreted unchanged by the kidneys (depends on urine pH).

Half-life: Adults: 9–16 hr (depends on urine pH).

TIME/ACTION PROFILE (cough suppression/nasal decongestion)

ROUTEONSETPEAKDURATION
POunknownunknown4–6 hr

Contraindication/Precautions

Contraindicated in:

  • Hypersensitivity to hydrocodone or pseudoephedrine
  • Concurrent or history of recent (within 14 days) MAOI therapy
  • Narrow angle glaucoma, urinary retention, severe hypertension or severe coronary artery disease
  • Lactation:Avoid use during lactation.

Use Cautiously in:

  • Head injury, increased intracranial pressure, intracranial injuries
  • Acute abdominal conditions
  • Diabetes, cardiovascular disease, thyroid disease, Addison's disease, prostatic hypertrophy, urethral stricture or asthma
  • Severe hepatic/renal impairment
  • History of substance abuse
  • OB: Use in pregnancy only if the benefit justifies potential risk to fetus;
  • Pedi: Safe and effective use in children <18 yr not established.

Adverse Reactions/Side Effects

hydrocodone

CNS: confusion, dizziness, sedation, euphoria, hallucinations, headache, unusual dreams

EENT: blurred vision, diplopia, miosis

Resp: respiratory depression

CV: hypotension, bradycardia

GI: constipation, dyspepsia, nausea, vomiting

GU: urinary retention

Derm: sweating

Misc: physical dependence, psychological dependence, tolerance

pseudoephedrine

CNS: SEIZURES, anxiety, nervousness, dizziness, drowsiness, excitability, fear, hallucinations, headache, insomnia, restlessness, weakness

Resp: respiratory difficulty

CV: CARDIOVASCULAR COLLAPSE, palpitations, hypertension, tachycardia

GI: anorexia, dry mouth

GU: dysuria

Misc: diaphoresis

CNS: anxiety, dizziness, drowsiness, dysphoria, fear, lethargy, mental clouding, mental/physical performance impairment, mood changes, nervousness, sedation, sleeplessness

Resp: RESPIRATORY DEPRESSION

CV: arrhythmia, hypertension, hypotension, palpitation, shock-like state, syncope

GI: constipation, nausea, vomiting (↑ in ambulatory patients

GU: spasm of vesicle sphincters, ureteral spasm, urinary retention

Derm: pruritus, rash

Neuro: tremor

Misc: physical dependence, psychological dependence

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

  • Concurrent use with MAOIs or tricyclic antidepressantsmay ↑ effect of hydrocodone or antidepressants; may also ↑ BP; avoid concurrent use.
  • ↑ CNS depression with antihistamines, antipsychotics, anti-anxiety agents, and some antidepressants; avoid concurrent use.
  • Concurrent use with anticholinergics may ↑ risk of paralytic ileus and other anticholinergic adverse reactions.

Route/Dosage

PO: (Adults) 5 mL every 4–6 hr as needed (not to exceed 4 doses [20 mL]) in 24 hr.

Availability

Oral solution (grape): hydrocodone 5 mg and pseudoephedrine 60 mg/5 mL

Assessment

  • Assess BP, pulse, and respirations before and periodically during administration. If respiratory rate is <10/min, assess level of sedation. Physical stimulation may be sufficient to prevent significant hypoventilation.
  • Assess cough and lung sounds periodically during therapy.
  • Assess bowel function routinely. Prevention of constipation should be instituted with increased intake of fluids and bulk, and laxatives to minimize constipating effects. Stimulant laxatives should be administered routinely if opioid use exceeds 2–3 days, unless contraindicated.
  • Prolonged use may lead to physical and psychological dependence and tolerance.

Potential Diagnoses

Implementation

  • Administer using a accurate mL measuring device.
    • May be administered with food or milk to minimize GI irritation.

Patient/Family Teaching

  • Instruct patient to take medication as directed and not to take more than the recommended amount. Use an accurate mL measuring device to measure dose; household teaspoon is not accurate and may result in overdose.
  • May cause drowsiness or dizziness. Caution patient to avoid driving or other activities requiring alertness until response to the medication is known.
  • Caution patient to avoid concurrent use of alcohol or other CNS depressants with this medication.
  • Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking other Rx, OTC, or herbal products.
  • Advise patient to increase fluids, maintain rest and treat other symptoms as needed.

Evaluation/Desired Outcomes

Decreased cough and congestion associated with the common cold.

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Citation

Quiring, Courtney, et al. "Hydrocodone/pseudoephedrine." Davis's Drug Guide, 16th ed., F.A. Davis Company, 2019. Nursing Central, nursing.unboundmedicine.com/nursingcentral/view/Davis-Drug-Guide/110534/all/hydrocodone_pseudoephedrine.
Quiring C, Sanoski CA, Vallerand AH. Hydrocodone/pseudoephedrine. Davis's Drug Guide. 16th ed. F.A. Davis Company; 2019. https://nursing.unboundmedicine.com/nursingcentral/view/Davis-Drug-Guide/110534/all/hydrocodone_pseudoephedrine. Accessed April 19, 2019.
Quiring, C., Sanoski, C. A., & Vallerand, A. H. (2019). Hydrocodone/pseudoephedrine. In Davis's Drug Guide. Available from https://nursing.unboundmedicine.com/nursingcentral/view/Davis-Drug-Guide/110534/all/hydrocodone_pseudoephedrine
Quiring C, Sanoski CA, Vallerand AH. Hydrocodone/pseudoephedrine [Internet]. In: Davis's Drug Guide. F.A. Davis Company; 2019. [cited 2019 April 19]. Available from: https://nursing.unboundmedicine.com/nursingcentral/view/Davis-Drug-Guide/110534/all/hydrocodone_pseudoephedrine.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - hydrocodone/pseudoephedrine ID - 110534 A1 - Quiring,Courtney, AU - Sanoski,Cynthia A, AU - Vallerand,April Hazard, BT - Davis's Drug Guide UR - https://nursing.unboundmedicine.com/nursingcentral/view/Davis-Drug-Guide/110534/all/hydrocodone_pseudoephedrine PB - F.A. Davis Company ET - 16 DB - Nursing Central DP - Unbound Medicine ER -