Hydrocodone / ibuprofen Side Effects
Some side effects of hydrocodone / ibuprofen may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.
For the Consumer
Applies to hydrocodone / ibuprofen: oral tablet
Along with its needed effects, hydrocodone / ibuprofen may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur while taking hydrocodone / ibuprofen:Less common or rare
- Bloody stools
- burning feeling in the chest or stomach
- congestion in the chest
- changes in facial skin color
- difficulty with swallowing
- fast or irregular breathing
- frequent urge to urinate
- inability to urinate
- irregular heartbeat
- lightheadedness or dizziness
- loss of bladder control
- puffiness or swelling of the eyelids or around the eyes
- ringing or buzzing in the ears
- shortness of breath, troubled breathing, tightness in the chest or wheezing
- skin rash, hives, or itching
- stomach pain
- tenderness in the stomach
Get emergency help immediately if any of the following symptoms of overdose occur while taking hydrocodone / ibuprofen:Symptoms of overdose
- Blurred vision
- cold or clammy skin
- difficulty hearing or ringing or buzzing in the ears
- general feeling of illness
- mood or mental changes
- nausea or vomiting
- severe drowsiness
- severe stomach pain
- skin rash
- slow heartbeat
- slow or troubled breathing
- stiff neck or back
- swelling of the face, fingers, feet, or lower legs
Some side effects of hydrocodone / ibuprofen may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:More common
- dry mouth
- increased sweating
- pounding heartbeat
- trouble in sleeping
- unusual tiredness or weakness
- Decreased appetite
- decrease in sexual ability
- increased thirst
- mood or mental changes
- mouth ulcers
- pain or burning in the throat
- runny nose
- sensation of burning, warmth, heat, numbness, tightness, or tingling
- slurred speech
- stomach upset
- thinking abnormalities
- trembling or shaking of the hands or feet
- unexplained weight loss
- unusual feeling of well-being
- visual disturbances
For Healthcare Professionals
Applies to hydrocodone / ibuprofen: oral tablet
Nervous system side effects of hydrocodone have included mental depression, dizziness, lightheadedness, respiratory depression (which is sometimes fatal), stupor, delirium, somnolence, agitation, and dysphoria.
Central nervous system side effects of ibuprofen including headache, drowsiness, and dizziness have been reported rarely. Aseptic meningitis associated with ibuprofen has been described in several case reports. In addition, paresthesias and pseudotumor cerebri have been reported, although causality is unknown.
One study has suggested that the respiratory depression caused by hydrocodone may be of benefit in the treatment of dyspnea related to chronic obstructive pulmonary disease and restrictive lung disease. However, the potential for the precipitation of respiratory insufficiency makes such use of hydrocodone hazardous and such use should be undertaken, if at all, only with extreme caution.
The incidence of aseptic meningitis associated with ibuprofen is higher in patients with systemic lupus erythematosus and other connective tissue diseases although it has been reported in patients without such underlying disease states.
Other side effects reported with ibuprofen have included tinnitus (1% to 3%) and vertigo.
Like other narcotic analgesics, hydrocodone may be habit forming. Withdrawal symptoms after either abrupt cessation or fast tapering of narcotic analgesics may occur. Such symptoms may include agitation, restlessness, anxiety, insomnia, tremor, abdominal cramps, blurred vision, vomiting and sweating.
The incidence of gastrointestinal blood loss with ibuprofen is dose-related, occurring in up to 17% of patients receiving 1,600 mg per day and in 23% of patients receiving 2,400 mg of ibuprofen per day.
Patients with a history of serious gastrointestinal events or alcohol abuse are at increased risk for severe gastrointestinal side effects. Ibuprofen should be used with caution in these patients.
Gastrointestinal side effects of ibuprofen have usually been mild and transient, and have included dyspepsia, nausea, diarrhea, abdominal pain, and flatulence. More serious gastrointestinal effects are uncommon but include occult blood loss, ulcer, gastrointestinal hemorrhage with or without perforation, and pancreatitis. In addition, small bowel enteropathies and ibuprofen-associated colitis have been reported. Bloody vomiting has occurred in overdose. Colonic and pyloric channel strictures have also been reported.
Nausea, vomiting, constipation, and dry mouth are relatively common effects of narcotic analgesics.
Genitourinary side effects including ureteral spasm, spasm of vesicle sphincters, and urinary retention have been reported with the use of hydrocodone.
Dermatologic side effects have been uncommon with the use of ibuprofen. They have included maculopapular rash, pruritus, vesiculobullous eruptions, erythema multiforme, vasculitis, Stevens-Johnson syndrome, and alopecia. Toxic epidermal necrolysis as well as photosensitivity reactions are reported as well, although causality is unknown.
Narcotic-induced rashes have been reported.
Elevations in liver function tests three times normal values occur in less than 1% of patients. Ibuprofen-induced hepatitis has been associated with a fatal outcome in some cases.
Vanishing bile duct syndrome has been associated with ibuprofen use. A 29-year-old male patient presented with right upper quadrant pain, jaundice, pruritus and dark urine. He had been taking ibuprofen 600 mg/day for body aches and tension related headaches three weeks prior to the onset of symptoms. The patient remained jaundiced, with xanthomatosis, and complained of fatigue and pruritus 12 months following ibuprofen ingestion. He was eventually referred to an institution for liver transplantation evaluation. The patient was diagnosed with vanishing bile duct syndrome attributed to ibuprofen use.
Hepatic side effects including elevations in liver function tests, jaundice, hepatitis, liver necrosis, and hepatic failure (some of them with fatal outcomes) have been reported.
Ibuprofen may impair the ability of the kidney to cope with low renal blood flow states due to inhibition of prostaglandin-dependent afferent arteriolar vasodilation. Renal function may be further compromised in patients with heart failure, hypovolemia, cirrhosis, nephrotic syndrome, or hypoalbuminemia. Additional risk factors for ibuprofen-induced renal insufficiency are advanced age and concomitant use of diuretics.
A case-controlled study suggested that patients who consumed 5000 or more pills containing NSAIDs during their lifetime may be at increased risk of end-stage renal disease.
Renal side effects of ibuprofen have included mild renal insufficiency as well as nephrotic syndrome with and without renal failure, and acute renal failure due to tubulointerstitial nephritis, papillary necrosis, and acute tubular necrosis.
Metabolic side effects from ibuprofen have included hyponatremia and syndrome of inappropriate antidiuretic hormone (SIADH). In addition, gynecomastia, hypoglycemia, and acidosis have been reported, although causality is unknown. Hyperkalemia has occurred in overdose.
A rare case of painful, persistent peripheral cyanosis and swelling of the fingers and toes which progressed to desquamation and digital pitting infarctions has been associated with ibuprofen.
Nonsteroidal anti-inflammatory drugs (NSAIDs) may elevate blood pressure and increase the risk for the initiation of antihypertensive therapy. Furthermore, NSAIDs may antagonize the blood pressure lowering effect of antihypertensive medications in patients already being treated with antihypertensive drugs.
Cardiovascular side effects of ibuprofen have included peripheral edema (1% to 3%) and elevated blood pressure (< 1%). This may be important in some patients with preexisting hypertension or congestive heart failure.
Hypersensitivity side effect of ibuprofen have included erythematous or urticarial rashes, pruritus, angioedema, bronchospasm, and anaphylactoid reactions, particularly in patients with the syndrome of asthma, nasal polyps, and angioedema and/or bronchospastic reactivity to aspirin. Rare cases of systemic reactions, including interstitial nephritis and diffuse pulmonary infiltrates, have also been reported.
Hematologic side effects of ibuprofen have included platelet dysfunction, neutropenia, agranulocytosis, aplastic anemia, hemolytic anemia, thrombocytopenia, eosinophilia, and decreases in hemoglobin and hematocrit.
Reductions in serum hemoglobin concentrations are uncommon and are usually associated with occult gastrointestinal blood loss. Rare cases of ibuprofen-associated hemolytic anemia, autoimmune thrombocytopenia, and leukopenia have been reported.
Acute noncardiogenic pulmonary edema developed on two occasions in an HIV-positive patient. Infectious as well as cardiac etiologies were excluded. A close temporal relationship with the administration of ibuprofen and onset of symptoms was noted.
Respiratory side effects including noncardiogenic pulmonary edema associated with ibuprofen therapy has been reported.
Ocular side effects from the use of ibuprofen have included blurred vision (<1%), scotomata, and diplopia. In addition, at least one case of corneal verticillata has been reported.
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