Product Elements:
Hydrocodone bitartrate and acetaminophen hydrocodone bitartrate and acetaminophen hydrocodone bitartrate hydrocodone acetaminophen acetaminophen crospovidone (15 mpa.s at 5%) povidone, unspecified starch, corn stearic acid off-white ip;109
Boxed Warning:
Hepatotoxicity acetaminophen has been associated with cases of acute liver failure, at times resulting in liver transplant and death. most of the cases of liver injury are associated with the use of acetaminophen at doses that exceed 4000 milligrams per day, and often involve more than one acetaminophen-containing product.
Indications and Usage:
Indications and usage hydrocodone bitartrate and acetaminophen tablets, usp are indicated for the relief of moderate to moderately severe pain.
Warnings:
Warnings hepatotoxicity acetaminophen has been associated with cases of acute liver failure, at times resulting in liver transplant and death. most of the cases of liver injury are associated with the use of acetaminophen at doses that exceed 4000 milligrams per day, and often involve more than one acetaminophen-containing product. the excessive intake of acetaminophen may be intentional to cause self-harm or unintentional as patients attempt to obtain more pain relief or unknowingly take other acetaminophen-containing products. the risk of acute liver failure is higher in individuals with underlying liver disease and in individuals who ingest alcohol while taking acetaminophen. instruct patients to look for acetaminophen or apap on package labels and not to use more than one product that contains acetaminophen. instruct patients to seek medical attention immediately upon ingestion of more than 4000 milligrams of acetaminophen per day, even if they feel well. serious skin reactions rar
Read more...ely, acetaminophen may cause serious skin reactions such as acute generalized exanthematous pustulosis (agep), stevens-johnson syndrome (sjs), and toxic epidermal necrolysis (ten), which can be fatal. patients should be informed about the signs of serious skin reactions, and use of the drug should be discontinued at the first appearance of skin rash or any other sign of hypersensitivity. hypersensitivity/ anaphylaxis there have been post-marketing reports of hypersensitivity and anaphylaxis associated with use of acetaminophen. clinical signs include swelling of the face, mouth, and throat, respiratory distress, urticaria, rash, pruritis, and vomiting. there were infrequent reports of life-threatening anaphylaxis requiring emergency medical attention. instruct patients to discontinue hydrocodone bitartrate and acetaminophen tablets, usp immediately and seek medical care if they experience these symptoms. do not prescribe hydrocodone bitartrate and acetaminophen tablets, usp for patients with acetaminophen allergy. respiratory depression at high doses or in sensitive patients, hydrocodone may produce dose-related respiratory depression by acting directly on the brain stem respiratory center. hydrocodone also affects the center that controls respiratory rhythm, and may produce irregular and periodic breathing. 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. furthermore, narcotics produce adverse reactions which may obscure the clinical course of patients with head injuries. acute abdominal conditions the administration of narcotics may obscure the diagnosis or clinical course of patients with acute abdominal conditions. misuse, abuse, and diversion of opioids hydrocodone bitartrate and acetaminophen tablets contain hydrocodone, an opioid agonist, and is a schedule ii controlled substance. opioid agonists have the potential for being abused and are sought by abusers and people with addiction disorders, and are subject to diversion. hydrocodone bitartrate and acetaminophen tablets can be abused in a manner similar to other opioid agonists, legal or illicit. this should be considered when prescribing or dispensing hydrocodone bitartrate and acetaminophen tablets in situations where the physician or pharmacist is concerned about an increased risk of misuse, abuse or diversion (see drug abuse and dependence ).
Dosage and Administration:
Dosage and administration dosage should be adjusted according to the severity of the pain and the response of the patient. however, it should be kept in mind that tolerance to hydrocodone can develop with continued use and that the incidence of untoward effects is dose related. the usual adult dosage is one or two tablets every four to six hours as needed for pain. the total daily dose should not exceed 8 tablets.
Contraindications:
Contraindications this product should not be administered to patients who have previously exhibited hypersensitivity to hydrocodone or acetaminophen, or any other component of this product. patients known to be hypersensitive to other opioids may exhibit cross sensitivity to hydrocodone.
Adverse Reactions:
Adverse reactions the most frequently reported adverse reactions are light-headedness, dizziness, sedation, nausea and vomiting. these effects seem to be more prominent in ambulatory than in non-ambulatory patients, and some of these adverse reactions may be alleviated if the patient lies down. other adverse reactions include: central nervous system: drowsiness, mental clouding, lethargy, impairment of mental and physical performance, anxiety, fear, dysphoria, psychic dependence, mood changes. gastrointestinal system: prolonged administration of hydrocodone bitartrate and acetaminophen tablets may produce constipation. genitourinary system: ureteral spasm, spasm of vesical sphincters and urinary retention have been reported with opiates. respiratory depression: hydrocodone bitartrate may produce dose-related respiratory depression by acting directly on the brain stem respiratory centers (see overdosage ). special senses: cases of hearing impairment or permanent loss have been reported
Read more...predominantly in patients with chronic overdose. dermatological: skin rash, pruritus. the following adverse drug events may be borne in mind as potential effects of acetaminophen: allergic reactions, rash, thrombocytopenia, agranulocytosis. potential effects of high dosage are listed in the overdosage section.
Overdosage:
Overdosage following an acute overdosage, toxicity may result from hydrocodone or acetaminophen. signs and symptoms hydrocodone: serious overdose with hydrocodone is characterized by respiratory depression (a decrease in respiratory rate and/or tidal volume, cheyne-stokes respiration, cyanosis), extreme somnolence progressing to stupor or coma, skeletal muscle flaccidity, cold and clammy skin, and sometimes bradycardia and hypotension. in severe overdosage, apnea, circulatory collapse, cardiac arrest and death may occur. acetaminophen: in acetaminophen overdosage: dose-dependent, potentially fatal hepatic necrosis is the most serious adverse effect. renal tubular necrosis, hypoglycemic coma and coagulation defects may also occur. early symptoms following a potentially hepatotoxic overdose may include: nausea, vomiting, diaphoresis and general malaise. clinical and laboratory evidence of hepatic toxicity may not be apparent until 48 to 72 hours post-ingestion. treatment a single or multiple drug overdose with hydrocodone and acetaminophen is a potentially lethal polydrug overdose, and consultation with a regional poison control center is recommended. immediate treatment includes support of cardiorespiratory function and measures to reduce drug absorption. oxygen, intravenous fluids, vasopressors, and other supportive measures should be employed as indicated. assisted or controlled ventilation should also be considered. for hydrocodone overdose, primary attention should be given to the reestablishment of adequate respiratory exchange through provision of a patent airway and the institution of assisted or controlled ventilation. the narcotic antagonist naloxone hydrochloride is a specific antidote against respiratory depression which may result from overdosage or unusual sensitivity to narcotics, including hydrocodone. since the duration of action of hydrocodone may exceed that of the antagonist, the patient should be kept under continued surveillance, and repeated doses of the antagonist should be administered as needed to maintain adequate respiration. a narcotic antagonist should not be administered in the absence of clinically significant respiratory or cardiovascular depression. gastric decontamination with activated charcoal should be administered just prior to n-acetylcysteine (nac) to decrease systemic absorption if acetaminophen ingestion is known or suspected to have occurred within a few hours of presentation. serum acetaminophen levels should be obtained immediately if the patient presents 4 hours or more after ingestion to assess potential risk of hepatotoxicity; acetaminophen levels drawn less than 4 hours post-ingestion may be misleading. to obtain the best possible outcome, nac should be administered as soon as possible where impending or evolving liver injury is suspected. intravenous nac may be administered when circumstances preclude oral administration. vigorous supportive therapy is required in severe intoxication. procedures to limit the continuing absorption of the drug must be readily performed since the hepatic injury is dose dependent and occurs early in the course of intoxication.
Description:
Description hydrocodone bitartrate and acetaminophen tablets, usp are supplied in tablet form for oral administration. hydrocodone bitartrate is an opioid analgesic and antitussive and occurs as fine, white crystals or as a crystalline powder. it is affected by light. the chemical name is: 4,5α-epoxy-3-methoxy-17-methylmorphinan-6-one tartrate (1:1) hydrate (2:5). it has the following structural formula: acetaminophen, 4'-hydroxyacetanilide, a slightly bitter, white, odorless, crystalline powder, is a non-opiate, non-salicylate analgesic and antipyretic. it has the following structural formula: each hydrocodone bitartrate and acetaminophen tablet, usp contains: hydrocodone bitartrate, usp ........................... 5 mg acetaminophen, usp .................................... 325 mg in addition, each tablet contains the following inactive ingredients: colloidal silicon dioxide, crospovidone, magnesium stearate, microcrystalline cellulose, povidone, pregelatinized starch and stearic acid. meets usp dissolution test 1. this is an image of the structural formula of hydrocodone bitartrate. this is an image of the structural formula of acetaminophen.
Clinical Pharmacology:
Clinical pharmacology hydrocodone is a semisynthetic narcotic analgesic and antitussive with multiple actions qualitatively similar to those of codeine. most of these involve the central nervous system and smooth muscle. the precise mechanism of action of hydrocodone and other opiates is not known, although it is believed to relate to the existence of opiate receptors in the central nervous system. in addition to analgesia, narcotics may produce drowsiness, changes in mood and mental clouding. the analgesic action of acetaminophen involves peripheral influences, but the specific mechanism is as yet undetermined. antipyretic activity is mediated through hypothalamic heat regulating centers. acetaminophen inhibits prostaglandin synthetase. therapeutic doses of acetaminophen have negligible effects on the cardiovascular or respiratory systems; however, toxic doses may cause circulatory failure and rapid, shallow breathing. pharmacokinetics the behavior of the individual components is desc
Read more...ribed below. hydrocodone: following a 10 mg oral dose of hydrocodone administered to five adult male subjects, the mean peak concentration was 23.6 ± 5.2 ng/ml. maximum serum levels were achieved at 1.3 ± 0.3 hours and the half-life was determined to be 3.8 ± 0.3 hours. hydrocodone exhibits a complex pattern of metabolism including o-demethylation, n-demethylation and 6-keto reduction to the corresponding 6-α- and 6-β-hydroxymetabolites. see overdosage for toxicity information. acetaminophen: acetaminophen is rapidly absorbed from the gastrointestinal tract and is distributed throughout most body tissues. the plasma half-life is 1.25 to 3 hours, but may be increased by liver damage and following overdosage. elimination of acetaminophen is principally by liver metabolism (conjugation) and subsequent renal excretion of metabolites. approximately 85% of an oral dose appears in the urine within 24 hours of administration, most as the glucuronide conjugate, with small amounts of other conjugates and unchanged drug. see overdosage for toxicity information.
How Supplied:
How supplied hydrocodone bitartrate and acetaminophen tablets, usp, contain hydrocodone bitartrate 5 mg and acetaminophen 325 mg. they are supplied as white to off-white, scored, oblong biconvex tablets, debossed âip 109â on obverse and bisected on the reverse. they are available as follows: bottles of 15: ndc 63187-112-15 bottles of 20: ndc 63187-112-20 bottles of 30: ndc 63187-112-30 bottles of 60: ndc 63187-112-60 storage: store at 20° to 25°c (68° to 77°f); excursions permitted to 15° to 30°c (59° to 86°f) [see usp controlled room temperature]. dispense in a tight, light-resistant container with a child-resistant closure. a schedule cii narcotic.
Package Label Principal Display Panel:
Package label.principal display panel 63187-112-15