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Pronunciation:

(hye droe KOE done & hoe MA troe peen)

U.S. Brand Names:

Hycodan®; Hydromet®; Hydropane®; Tussigon®

Synonyms:

Homatropine and Hydrocodone

Generic Available:

Yes: Syrup

Use:

Symptomatic relief of cough

Restrictions:

C-III

Pregnancy Risk Factor:

Lactation:

Excretion in breast milk unknown/contraindicated

Contraindications:

Hypersensitivity to hydrocodone, homatropine, or any component of the formulation; increased intracranial pressure, narrow-angle glaucoma, depressed ventilation

Warnings/Precautions:

Based on hydrocodone component: Use with caution in patients with hypersensitivity reactions to other phenanthrene derivative opioid agonists (morphine, codeine, hydromorphone, levorphanol, oxycodone, oxymorphone); should be used with caution in elderly or debilitated patients, and those with severe impairment of hepatic or renal function, prostatic hyperplasia, or urethral stricture. Also use caution in patients with head injury, increased intracranial pressure, acute abdomen, or impaired thyroid function. Hydrocodone suppresses the cough reflex; caution should be exercised when this agent is used postoperatively and in patients with pulmonary diseases (including asthma, emphysema, COPD); tolerance or drug dependence may result from extended use

Based on homatropine component: Use with caution in patients with hypertension, cardiac disease, or increased intraocular pressure; safety and efficacy not established in infants and young children, therefore, use with extreme caution due to susceptibility of systemic effects; use with caution in obstructive uropathy, paralytic ileus, ulcerative colitis, unstable cardiovascular status in acute hemorrhage; use with caution in children with spastic paralysis, in the elderly, and in patients with prostatic hyperplasia

Adverse Reactions:

Cardiovascular: Bradycardia, tachycardia, hyper-/hypotension

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

Gastrointestinal: Nausea, vomiting, xerostomia, anorexia, impaired GI motility

Genitourinary: Decreased urination, urinary tract spasm

Hepatic: Biliary tract spasm

Neuromuscular & skeletal: Weakness

Ocular: Diplopia, miosis, mydriasis, blurred vision

Respiratory: Dyspnea

Miscellaneous: Histamine release, physical and psychological dependence with prolonged use

Overdosage/Toxicology:

Symptoms of overdose include CNS and respiratory depression; gastrointestinal cramping; dilated, unreactive pupils; blurred vision; hot, dry flushed skin; dryness of mucous membranes; difficulty in swallowing, foul breath, diminished or absent bowel sounds, urinary retention, tachycardia, hyperthermia, hypertension, increased respiratory rate

CNS depression is an extension of pharmacologic effect; treatment is supportive; naloxone 0.4 mg I.V. (0.01 mg/kg for children) with repeat administrations as necessary; anticholinergic toxicity is caused by strong binding of the drug to cholinergic receptors. For anticholinergic overdose with severe life-threatening symptoms, physostigmine 1-2 mg (0.5 or 0.02 mg/kg for children) SubQ or I.V., slowly may be given to reverse these effects.

Drug Interactions:

Based on hydrocodone component: Substrate of CYP2D6 (major)

CNS depressants, MAO inhibitors, general anesthetics, and tricyclic antidepressants: May potentiate the effects of opiate agonists; dextroamphetamine may enhance the analgesic effect of opiate agonists

CYP2D6 inhibitors: May decrease the effects of hydrocodone. Example inhibitors include chlorpromazine, delavirdine, fluoxetine, miconazole, paroxetine, pergolide, quinidine, quinine, ritonavir, and ropinirole.

Based on homatropine component:

Phenothiazine and TCAs may increase anticholinergic effects when used concurrently.

Sympathomimetic amines may cause tachyarrhythmias; avoid concurrent use.

Ethanol/Nutrition/Herb Interactions:

Ethanol: Avoid or limit ethanol (may increase CNS depression). Watch for sedation.

Mechanism of Action:

Based on hydrocodone component: Binds to opiate receptors in the CNS, altering the perception of and response to pain; suppresses cough in medullary center; produces generalized CNS depression

Based on homatropine component: Blocks response of iris sphincter muscle and the accommodative muscle of the ciliary body to cholinergic stimulation resulting in dilation and loss of accommodation

Pharmacodynamics/Kinetics:

Duration: Hydrocodone: 4-6 hours

Dosage:

Oral (based on hydrocodone component):

Children: 0.6 mg/kg/day in 3-4 divided doses; do not administer more frequently than every 4 hours

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

Adults: 10 mg every 4-6 hours, a single dose should not exceed 15 mg; do not administer more frequently than every 4 hours

Test Interactions:

Increased ALT, AST (S)

Patient Education:

Take only as prescribed; do not exceed prescribed dose or frequency. May be habit-forming. Maintain adequate hydration (2-3 L/day of fluids) unless instructed to restrict fluid intake. Avoid use of other depressants, alcohol, or sleep-inducing medications, or tranquilizers or pain medications unless approved by prescriber. You may experience orthostatic hypotension (change position slowly when rising from sitting or lying or when climbing stairs); drowsiness, impaired coordination, or blurred vision (use caution when driving or engaging in tasks requiring alertness until response to drug is known); nausea or vomiting (small, frequent meals, frequent mouth care, chewing gum, or sucking hard candy may help); or constipation (increased exercise, fluids, fruit, or fiber may help). Report persistent CNS changes (dizziness, sedation, tremor, or agitation), respiratory difficulty, persistent abdominal cramping, visual changes, or lack of improvement or worsening or condition. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to become pregnant; contraceptives may be recommended. Do not breast-feed.

Nursing Implications:

Dispense in light-resistant container; observe patient for excessive sedation, respiratory depression, implement safety measures, assist with ambulation

Dental Health: Effects on Dental Treatment:

Key adverse event(s) related to dental treatment: Xerostomia (normal salivary flow resumes upon discontinuation).

Dental Health: Vasoconstrictor/Local Anesthetic Precautions:

No information available to require special precautions

Mental Health: Effects on Mental Status:

Lightheadedness, dizziness, sedation, drowsiness, and fatigue are common; may cause confusion; may rarely cause hallucinations

Mental Health: Effects on Psychiatric Treatment:

Concurrent use with psychotropics may produce additive sedation

Dosage Forms:

Syrup (Hycodan®, Hydromet®, Hydropane®): Hydrocodone bitartrate 5 mg and homatropine methylbromide 1.5 mg per 5 mL (480 mL) [cherry flavor]

Tablet (Hycodan®, Tussigon®): Hydrocodone bitartrate 5 mg and homatropine methylbromide 1.5 mg

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