8/26/2023 0 Comments Hydromorphone antidoteInfants are susceptible to even low dosages of opioids. īreastfeeding Considerations: Maternal hydrocodone use during breastfeeding can cause neonatal drowsiness, depression of the central nervous system, and even death of the newborn. Appropriate respiratory monitoring should be done due to the risk of apneic episodes. Remifentanil ultrashort-acting opioid is given intravenously by patient-controlled analgesia, providing better pain relief during labor. According to ACOG(American college of obstetricians and gynecologists) guidelines, if the use of opioids is essential, short-acting agents which are easy to titrate during labor and have decreased risk of respiratory depression in the newborn are preferred. In the United States, fentanyl, remifentanil, morphine, butorphanol, and nalbuphine are used for peripartum analgesia. Patients taking hydrocodone should receive counseling on the risks associated with opioid use during pregnancy with such documentation in the medical record. Pregnancy Considerations: The use of hydrocodone is not contraindicated in pregnancy but is listed as a US FDA boxed warning since opioids cross the placenta, and prolonged use during pregnancy may cause neonatal opioid withdrawal syndrome(NOWS). According to prescriber information, initiate hydrocodone therapy with 50% of the initial dose in end-stage renal disease (ESRD) patients. Patients with Renal Impairment: According to a study, systemic exposure to hydrocodone (AUC) was 70% higher with moderate to severe renal impairment compared to patients with normal renal function. Patients with Hepatic Impairment: Clinicians should initiate hydrocodone therapy with 50% of the initial dose in patients with severe hepatic impairment. Patients should receive instruction to discontinue all other opioids when starting on a hydrocodone ER medication unless specifically directed by a physician. Depending on the product, the initial dose of hydrocodone ER formulations in patients who are not opioid-tolerant or are opioid-naïve is between 10 mg to 20 mg every 12 hours to 24 hours. Single-entity hydrocodone is only available in extended-release (ER) formulations. Hydrocodone ER formulations are available in both tablets and capsules. In hydrocodone formulations combined with acetaminophen, the dosage of acetaminophen should not exceed 4 gm/day. ![]() Hydrocodone IR combination product dosages typically range from 2.5 mo 10 mg every 4 to 6 hours as needed. Immediate-release (IR) hydrocodone is a combination product (combined with acetaminophen and ibuprofen). Tablets and capsules are not to be crushed, chewed, or dissolved, as this can lead to uncontrolled rapid medication delivery and overdose. Hydrocodone is pharmaceutically available as an oral medication with formulations, including tablets, capsules, and oral solutions. Hydrocodone and its metabolites are excreted primarily by the renal route. ![]() Įxcretion: The half-life elimination of hydrocodone IR and ER is approximately 4 hours and 7 to 9 hours, respectively. ![]() Hydrocodone is also metabolized to an inactive metabolite, norhydrocodone, by CYP3A4. Studies have shown that pain relief correlates with plasma concentrations of hydromorphone rather than hydrocodone. Hydrocodone converts to its active metabolite, hydromorphone, through O-demethylation catalyzed by the CYP2D6 enzyme. Metabolism: Hydrocodone is metabolized in the liver primarily via the cytochrome P450 enzymes CYP2D6 and CYP3A4. ĭistribution: The apparent volume of distribution after hydrocodone ER administration is 402 Liter (for an adult of 70 kg), suggesting extensive tissue distribution. Following an oral dose of hydrocodone ER (extended-release), peak plasma concentration(Tmax) is attained at 14–16 hours for the different doses (range is 6 to 30 hours). Ībsorption: After single oral ingestion, hydrocodone IR (immediate-release) reaches maximum serum concentrations within one hour. Opioids depress the cough reflex by directly affecting a cough center in the medulla and causing respiratory depression at higher doses. Modulation of mu and kappa-opioid receptors possibly contributes to the antitussive activity of opioids. Coughs mediated by mechanical stimulation cough receptors are attenuated by narcotic antitussives primarily at the nucleus tractus solitarius(NTS) level via repression of glutamatergic transmission. Cough is a protective reflex evoked by airway stimulation.
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