Hydrocodone

DEA Class; Rx

Common Brand Names; Zohydro ER, Hysingla ER, Vantrela ER

Extended-release, oral semisynthetic opioid agonist similar to other phenanthrene derivatives such as codeine
Used for severe pain requiring daily, around-the-clock, long-term opioid treatment for which alternative treatment options are inadequate
Abuse deterrent properties

Indicated for the management of pain severe enough to require daily, around-the-clock, long-term treatment and for which alternative treatment options are inadequate

Hypersensitivity

Significant respiratory depression

Acute or severe bronchial asthma or hypercarbia

Suspected paralytic ileus

Zohydro ER

• Constipation (8-11%)
• Nausea (7-10%)
• Vomiting (3-5%)
• Somnolence (1-5%)
• UTI (1-5%)
• Headache (4%)
• Fatigue (1-4%)
• Back pain (1-4%)
• Dry mouth (3%)
• Pruritus (3%)
• Tremor (3%)
• Dizziness (2-3%)
• Peripheral edema (1-3%)
• URI infection (1-3%)
• Muscle spasms (1-3%)

Hysingla ER

• Nausea (8%)
• Constipation (3%)
• Vomiting (6%)
• Dizziness (3%)
• Insomnia (3%)
• Influenza (3%)
• Decreased appetite (2%)
• Headache (2%)
• Tinnitus (2%)
• Somnolence (1%)
• Fatigue (1%)

Do not prescribe for acute pain or as needed (prn) pain relief; only for severe chronic pain requiring continuous, around-the-clock opioid analgesia

Hydrocodone is an opioid agonist and a Schedule II controlled substance with a high potential for abuse similar to fentanyl, methadone, morphine, oxycodone, and oxymorphone

Profound sedation, respiratory depression, coma, and death may result from concomitant administration with benzodiazepines or other CNS depressants (e.g., non-benzodiazepine sedatives/hypnotics, anxiolytics, tranquilizers, muscle relaxants, general anesthetics, antipsychotics, other opioids, alcohol); because of these risks, reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate; if concomitant use with benzodiazepine is warranted, consider prescribing naloxone for the emergency treatment of opioid overdose

If an opioid analgesic is initiated in a patient already taking a benzodiazepine or other CNS depressant, prescribe a lower initial dose of the opioid analgesic, and titrate based on clinical response; follow patients closely for signs and symptoms of respiratory depression and sedation

Opioids can cause sleep-related breathing disorders including central sleep apnea (CSA) and sleep-related hypoxemia; opioid use increases risk of CSA in a dose-dependent fashion; in patients who present with CSA, consider decreasing opioid dosage using best practices for opioid taper

Monitor carefully in elderly, cachectic, debilitated patients, and those with chronic pulmonary disease because of increased risk for life-threatening respiratory depression

Monitor patients with head injury or increased ICP for sedation and respiratory depression; avoid use in patients with impaired consciousness or coma susceptible to intracranial effects of CO2 retention

Prolonged use of opioid analgesics during pregnancy can cause neonatal opioid withdrawal syndrome

Drug is present in breast milk; published lactation studies report variable concentrations of drug in breast milk with administration of immediate-release formulation to nursing mothers in early postpartum period