Record-keeping of prescribing information, including quantity, frequency, and renewal gfeen is strongly advised. Head Injury and Increased Intracranial Pressure: The respiratory depressant effects of narcotics and their capacity to elevate cerebrospinal fluid pressure may be markedly exaggerated in the presence of head injury, other intracranial lesions or a preexisting increase in intracranial pressure.
Naloxone hydrochloride 0. Opioid agonists have the potential for being abused and are sought by abusers and people with addiction disorders, and are subject to diversion.
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Meticulous attention grren be given to maintaining adequate pulmonary ventilation. Addiction is a primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. Clinical and laboratory evidence of hepatic toxicity may not be apparent until 48 to 72 hours post-ingestion.
Serum acetaminophen levels should be obtained, since levels four or more hours following ingestion help predict acetaminophen toxicity. Hydrocodone and the major metabolites of acetaminophen are known to be substantially excreted by the kidney. Following an acute overdosage, toxicity may result from hydrocodone or acetaminophen.
Labor and Delivery: As with all narcotics, administration of hydrocodone bitartrate and acetaminophen tablets to the mother shortly before delivery may result in some degree of respiratory depression in the newborn, especially if higher doses are used.
dith In severe overdosage, apnea, circulatory collapse, cardiac arrest and death may occur. These effects seem to be more prominent in ambulatory than in nonambulatory patients, and some of these adverse reactions may be alleviated if the patient lies down. Furthermore, narcotics produce adverse reactions which may obscure the clinical course of patients with head injuries.
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Hydrocodone bitartrate and acetaminophen tablets, and other opioids, used in analgesia can be abused and are subject to criminal diversion. Naloxone, a narcotic antagonist, can reverse respiratory depression and coma associated grsen opioid overdose. If repeated doses are used, the cathartic wwith be included with alternate doses as required.
If hypoprothrombinemia occurs due to acetaminophen overdose, vitamin K should be administered intravenously. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants from hydrocodone and acetaminophen, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into the importance of the drug to the mother.
The toxic dose for acetaminophen for adults is 10 g. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving. A cuffed endotracheal tube should be inserted before gastric lavage of the unconscious patient and, when necessary, to provide assisted respiration. Geriatric Use: Clinical studies of hydrocodone bitartrate wjite acetaminophen tablets did not include sufficient s of subjects aged 65 and over to determine whether they respond differently from younger subjects.
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Enter the imprint code that appears on the pill e. Nursing Mothers: Acetaminophen is excreted in breast milk in small amounts, but the ificance of its effects on nursing infants is not known.
It is not known whether hydrocodone is excreted in human milk. Misuse, Abuse, and Diversion of Opioids: Hydrocodone bitartrate and acetaminophen tablets contain hydrocodone, an opioid agonist, and is a Schedule III controlled substance.
When combined therapy is contemplated, the dose of one or both agents should be reduced. The use of MAO inhibitors or tricyclic antidepressants with hydrocodone preparations may increase the effect of either the antidepressant or hydrocodone.
Vasopressors and other supportive measures should be employed as indicated. There is no consensus on the best method of managing withdrawal. Hypotension is usually hypovolemic and should respond to fluids. shite
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However, it should whits kept in mind that tolerance to hydrocodone can develop with continued use and that the incidence of untoward effects is dose related. In adults, hepatic toxicity has rarely been reported with acute overdoses of less than 10 grams, or fatalities with less than 15 grams. Immediate treatment includes support of cardiorespiratory function and measures to reduce drug absorption. Carcinogenesis, Mutagenesis, Impairment of Fertility: No adequate studies have been conducted in animals to determine whether hydrocodone or acetaminophen have a potential for carcinogenesis, mutagenesis, or impairment of fertility.
Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function.
Cough Reflex: Hydrocodone suppresses the cough reflex; as with all narcotics, caution should be exercised when hydrocodone bitartrate and acetaminophen tablets are used postoperatively and in patients with pulmonary disease. Physicians should be aware that abuse of opioids can occur in the absence of true addiction and is characterized by misuse for non-medical purposes, often in combination with other psychoactive substances.
Nonteratogenic Effects: Babies born to mothers who have been taking opioids regularly prior to delivery will be physically dependent.