Hydrocodone Bitartrate / Guaifenesin

Pronunciation: (hye-droe-KOE-done bye-TAR-trate/gwye-FEN-e-sin)
Class: Antitussive and expectorant combination

Trade Names

CodiClear DH
- Syrup hydrocodone bitartrate 3.5 mg and guaifenesin 300 mg per 5 mL

Maxi-Tuss HCG
- Liquid hydrocodone bitartrate 6 mg and guaifenesin 200 mg per 5 mL

Pharmacology

Hydrocodone

Suppresses cough reflex; stimulates opiate receptors in the CNS and peripherally blocks pain impulse generation.

Guaifenesin

May enhance output of respiratory tract fluid by reducing adhesiveness and surface tension, enhancing removal of viscous mucus, and making nonproductive coughs more productive and less frequent.

Indications and Usage

Symptomatic relief of irritating, dry, nonproductive cough associated with upper and lower respiratory congestion.

Contraindications

Hypersensitivity to any component of product; known hypersensitivity to other opioids; increased intracranial pressure; depressed ventilatory function.

Dosage and Administration

Maximum dose
Adults

Hydrocodone 60 mg/day or a max single dose of 15 mg; guaifenesin 2,400 mg/day.

Children older than 12 y of age

Hydrocodone 45 mg/day or a max single dose of 10 mg; guaifenesin 2,400 mg/day.

Children 6 to 12 y of age

Hydrocodone 15 mg/day or a max single dose of 5 mg; guaifenesin 1,200 mg/day.

Cough

For specific dosing by product, refer to the individual manufacturer's prescribing information.

Adults Usual dosage

Hydrocodone 2.5 to 7.5 mg every 4 to 6 h.

Maximum dose

Hydrocodone 60 mg/day or a max single dose of 15 mg; guaifenesin 2,400 mg/day.

Children older than 12 y of age Maximum dose

Hydrocodone 45 mg/day or a max single dose of 10 mg; guaifenesin 2,400 mg/day.

Initial dose

Hydrocodone 2.5 to 7.5 mg every 4 to 6 h.

Children 6 to 12 y of age Maximum dose

Hydrocodone 15 mg/day or a max single dose of 5 mg; guaifenesin 1,200 mg/day.

Initial dose

Hydrocodone 1.75 to 3.75 mg every 4 to 6 h.

General Advice

• Measure and administer prescribed dose of syrup/liquid using dosing syringe, dosing spoon, or dosing cup.

Storage/Stability

Store at 59° to 86°F.

Drug Interactions

Alcohol, CNS depressants, general anesthetics, MAOIs, other narcotic analgesics, phenothiazines, sedative-hypnotics, tranquilizers, tricyclic antidepressants

CNS depression may be increased.

Anticholinergics

Concurrent use with hydrocodone may produce paralytic ileus.

Laboratory Test Interactions

Guaifenesin may interfere with the interpretation of the test for urinary 5-hydroxyindoleacetic acid for the diagnosis of carcinoid syndrome. Guaifenesin may lower serum uric acid levels and falsely elevated vanillylmandelic acid test for catechols.

Adverse Reactions

Cardiovascular

Hypertension, palpitations, postural hypotension.

CNS

Anxiety, dizziness, drowsiness, dysphoria, fear, giddiness, impairment of mental or physical performance, lassitude, lethargy, light-headedness, mental clouding, mood change, psychic dependence, sedation.

GI

Constipation, nausea, vomiting.

Genitourinary

Spasm of vesical sphincters, urethral spasms, urinary retention.

Respiratory

Respiratory depression.

Miscellaneous

Addiction, blurred vision.

Precautions

Pregnancy

Category C .

Lactation

Undetermined.

Children

Not recommended for children younger than 6 y of age.

Elderly

Use with caution at reduced doses.

Special Risk Patients

Use with caution in patients with COPD, hypothyroidism, head injury, asthma, glaucoma, Addison disease, prostatic hypertrophy, gallbladder disease, urinary retention, epilepsy, urethral stricture, acute abdominal conditions, or severe impairment of renal or hepatic function, or in debilitated patients.

Dependence

Hydrocodone has abuse potential; may be habit-forming.

Diarrhea

Do not use when diarrhea associated with pseudomembranous colitis caused by cephalosporins, lincomycins, or penicillin exists or when diarrhea is caused by poisoning.

Overdosage

Symptoms

Apnea, bradycardia, cardiac arrest, circulatory collapse, cold and clammy skin, extreme somnolence progressing to stupor and coma, hypotension, respiratory depression, skeletal muscle flaccidity.

Patient Information

• Advise caregiver to use dosing spoon or syringe when giving liquid to children.
• Advise patient to take with food or milk if GI upset occurs.
• Advise patient that if a dose is missed to take it as soon as remembered unless it is nearing time for the next dose. Caution patient not to double the dose to catch up.
• Advise patient that if cough is not controlled, not to increase the dose of medication but to inform health care provider.
• Advise patient to inform health care provider if any of the following occur: cough associated with fever, rash, persistent headache, or bothersome adverse reactions.
• Caution patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness until tolerance is determined.
• Advise patient to avoid alcohol and other CNS depressants because of risk of excessive sedation.

Copyright © 2009 Wolters Kluwer Health.