| Hydrocodone Bitartrate and Acetaminophen
 
 (Most common brand names are: Vicodin, Lortab, and Lorcet. Other brand names are: Anexsia, Azdone, Bancap HC, Ceta-Plus, Co-Gesic, Damason-P, Duocet, Dolacet, Hydrocet, Hy-Phen, Margesic H, Medipain 5, Lorcet HD, Lorcet Plus, Lortab Elixir, Panacet, Stagesic, T- Gesic, Vicodin HP, Zydone).
 
 Health Care Professional Version
 
 Cynthia Kreutzer RN & Jo Eland PhD RN
 Every attempt has been made to insure the accuracy of this material, however, medical science is constantly changing. If the information on this page differs from what you have been told by a nurse, pharmacist or physician, consult the person who told you differently or the manufacturer.
 
 
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 Classification: Narcotic Analgesic with Acetaminophen
 
 Use: Used as short-term treatment to relieve moderate to severe pain; also, used as an antitussive. It is a prescription drug and can be addictive due to the narcotic component.
 
 Usual dose: Vicodin 5mg/500mg tablet 1-2 every 4-6 hours not to exceed 8 in 24 hours. Vicodin ES 7.5mg/750mg tablet 1-2 every 4-6 hours not to exceed 5 in 24 hours.
 
 Pediatrics: PO 0.15 mg/kg/dose q 6 hours
 
 Dosages vary according to brand names.
 
 Lortab Elixer: 2.5/167 mg 15 ml Lortab: 2.5/500 mg tablet
 Anexsia: 5/500 mg tablet mg Lortab: 5/500 mg tablet
 Panacet: 5/500 mg tablet Lorcet: 5/500 mg tablet
 Stagesic 5/500 capsule Bancap HC: 5/500 mg capsule
 T-Gesic: 5/500 mg capsule Ceta-Plus: 5/500 mg capsule
 Zydone: 5/500 mg capsule Co-gesic: 5/500 mg capsule
 Azdone: 5/500 mg tablet Duocet: 5/500 mg capsule
 Damason-P: 5/500 mg tablet Dolacet: 5/500 mg capsule
 Medipain 5: 5/500 mg tablet Hydrocet: 5/500 mg capsule
 Lorcet HD: 5/500 mg capsule Hy-Phen: 5/500 mg tablet
 Margesic H: 5/500 mg capsule
 Lortab: 7.5/500 mg tablet Anexsia: 7.5/650 mg tablet
 Lorcet Plus: 7.5/ 650 mg tablet Vicodin ES: 7.5/750 mg tablet
 Lortab: 10/500 mg tablet Lorcet: 10/650 mg tablet
 Anexsia: 10/660 mg tablet Vicodin HP: 10/660 mg tablet
 Route: Oral
 
 Action: Hydrocodone is similar to codeine in its action, working on the central nervous system and smooth muscle. It is believed to relate to opiate receptors in the central nervous system. Acetaminophen works in the periphery as an analgesic but also has antipyretic effects. It is absorbed rapidly in the GI tract and is distributed to most tissue areas in the body. Acetaminophen inhibits the production of prostaglandin which then may cause irritation to the stomach.
 
 Onset: approximately 30 minutes
 
 Peak: 1.3 + 0.3 hours
 
 Steady State: After repeated doses at 4-6 hour intervals, a steady state is reached after the 5th dose (20  30 hours).
 
 Metabolism: Hydrocodone is metabolized in the liver and excreted by the kidney.
 
 Half Life: Hydrocodone 3.8 + 0.3 hours. Acetaminophen 1.25-3 hours
 
 Contraindications: Hypersensitivity to hydrocodone or acetaminophen.
 
 Warning: Use of Vicodin with MAO inhibitors or tricyclic antidepressants may increase the effect of either the antidepressant or the hydrocodone. Using Vicodin with other narcotics, antihistamines, anti-psychotic, anti-anxiety, other central nervous system (CNS) depressants, or alcohol may increase CNS depression.
 
 Precautions: Use with caution in patients with a head injury. Narcotics tend to increase intracranial pressure. Narcotics such as Vicodin may interfere with the diagnosis and treatment of patients with abdominal conditions. Use with caution in patients with liver, kidney disorder, underactive thyroid gland, Addisons disease, enlarged prostate or urethral stricture.The effects of Vicodin in pregnancy have not been established. Pregnant women must consult their physician before taking Vicodin. Drug dependence occurs in newborns when the mother has been taking this drug prior to delivery. If taken shortly before delivery, it may cause respiratory depression in the infant. Acetaminophen is present in breast milk and Hydrocodone may be present in breast milk; therefore, it is not advised to be administered to nursing mothers.
 
 Drug Interactions: Use caution in combination with following drugs:
 
 Sedatives: Halcion, Restoril
 Tranquilizers: Thorazine, Haldol
 Antidepressants: Elavil, Nardil,Tofranol
 Carbamazepine: Tegretol
 Other analgesics: Demerol
 Antihistamine: Tavist
 Anti-anxiety: Valium, Librium
 Anti-spasmodic: Cogentin
 Ceiling: Because of the acetaminophen content, there is a ceiling. Doses of acetaminophen should not exceed 4000 mg in 24 hours.
 
 Administration: Do not administer to pediatric patients. Use with caution in elderly patients or those with impaired renal or hepatic function. Use with caution during pregnancy or nursing mothers.
 
 Effectiveness: Pain level will decrease and patient will report less pain.
 
 Side Effects: Most common from Vicodin: dizziness, sedation, nausea, vomiting, constipation. Less common: Mood changes, mental cloudiness, anxiety, lethargy, urine retention, ureteral spasm, lightheadedness, irregular breathing, respiratory depression, pruritus, skin rash, impaired mental and physical performance. Side effects of acetaminophen are allergic reaction, rash, thrombocytopenia (decreased number of platelets), agranulocytosis (decreased number of agranular white blood cells).
 
 Overdose: Symptoms of overdose include: blood disorders, cyanotic skin color, cold clammy skin, increasing sedation progressing to unresponsiveness, diaphoresis, irregular heartbeat, decreased heart rate, weakness, low blood pressure, nausea, vomiting, irregular or depressed respirations. Treatment is administration of Nalaxone.
 
 Storage: Store at room temperature away from sunlight and moisture.
 
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