Dosing and uses of Hycofenix (hydrocodone/pseudoephedrine/guaifenesin)
Adult dosage forms and strengths
hydrocodone/pseudoephedrine/gauifenesin
oral solution: Schedule III
- (2.5mg/30mg/200mg)/5mL
Cough with Congestion
Temporary relief of nasal congestion and cough associated with respiratory tract infections and related conditions when these conditions are complicated by tenacious mucus or mucus plugs and congestion
10 mL PO q4-6hr; not to exceed 4 doses (40 mL) per 24 hr
Pediatric dosage forms and strengths
<18 years: Safety and efficacy not established
Use of hydrocodone in children aged <6 years is associated with fatal respiratory depression
Hycofenix (hydrocodone/pseudoephedrine/guaifenesin) adverse (side) effects
Frequency not defined
Hydrocodone
- Respiratory depression
- Drug dependence
- Increased intracranial pressure
- Decreased mental alertness with impaired mental and/or physical abilities
- Paralytic ileus
Pseudoephedrine
- CNS effects (eg, insomnia, dizziness, weakness, tremor, or convulsions)
- Cardiovascular system effects (eg, arrhythmias, or increased blood pressure), cardiovascular collapse with accompanying hypotension
Warnings
Contraindications
Documented hypersensitivity
Patients receiving MAOI therapy or within 14 days of stopping such therapy
Narrow angle glaucoma
Urinary retention
Severe hypertension
Severe coronary artery disease
Cautions
Hydrocodone produces dose-related respiratory depression by directly acting on brain stem respiratory centers
Hydrocodone can produce drug dependence and tolerance may develop upon repeated administration; prescribe with same degree of caution as use of other opioid drugs
Respiratory depression effects of opioids and their capacity to elevate cerebrospinal fluid pressure may be markedly exaggerated in the presence of head injury, other intracranial lesions, or a pre-existing increase in intracranial pressure
Hydrocodone may produce marked drowsiness and impair mental and physical abilities required for hazardous activities (eg, driving); concurrent use with alcohol or other CNS depressants should be avoided
Caution in patients with acute abdominal conditions; hydrocodone may obscure the diagnosis or clinical course of acute abdominal illness
Concurrent use of anticholinergics with hydrocodone may cause paralytic ileus
Use of MAOIs or TCAs with hydrocodone may increase the effect of either the antidepressant or hydrocodone; do not use with MAOIs or within 14 days of stopping an MAOI
Pseudoephedrine can produce cardiovascular and CNS effects in some patients (eg, insomnia, dizziness, weakness, tremor, or arrhythmias); CNS stimulation with convulsions or cardiovascular collapse with accompanying hypotension has also been reported
Do not for persistent or chronic cough (eg, associated with smoking, asthma, chronic bronchitis, or emphysema), or where cough is accompanied by excessive phlegm
Measure dose with accurate milliliter measuring device to avoid overdose
Caution with diabetes, thyroid disease, Addison disease, prostatic hypertrophy, urethral stricture, and asthma
Caution with severe renal or hepatic impairment
Pregnancy and lactation
Pregnancy
Pregnancy category: C
Babies born to mothers who have been taking opioids regularly prior to delivery will be physically dependent; the withdrawal signs include irritability and excessive crying, tremors, hyperactive reflexes, increased respiratory rate, increased stools, sneezing, yawning, vomiting, and fever; the intensity of the syndrome does not always correlate with the duration of maternal opioid use or dose
As with all opioids, administration to the mother shortly before delivery may result in some degree of respiratory depression in the newborn, especially if higher doses are used
Lactation
Caution; hydrocodone and pseudoephedrine are known to be excreted in human milk; no studies have been performed to determine if guaifenesin is excreted into breastmilk
The potential for serious adverse reactions in nursing infants from hydrocodone exist, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Hycofenix (hydrocodone/pseudoephedrine/guaifenesin)
Mechanism of action
Hydrocodone: Antitussive; narcotic agonist analgesic
Pseudoephedrine: Decongestant; alpha adrenergic agonist
Guaifenesin: Reduces viscosity of secretions by increasing amount of respiratory tract fluid
Pharmacokinetics
Hydrocodone
- Half-life: 3.3-4.4 hr
- Duration: 4-8 hr
- Peak plasma time: 1.3 hr
- Concentration: 23.6 ng/mL
- Metabolism: liver (O-demethylation, N-demethylation, 6-keto reduction); hepatic P450 enzyme CYP2D6
- Excretion: urine (mainly)
Pseudoephedrine
- Half-Life: 3 hr (children); 9-16 hr (adults)
- Onset: 30 min (decongestant)
- Duration: 3-8 hr
- Peak plasma time: 1.97 hr
- Concentration: 422 ng/mL
- Metabolism: Liver, by N-demethylation
- Metabolites: inactive
- Clearance: 7.3-7.6 mL/min/kg
- Excretion: Urine (43-96%)
Guaifenesin
- Half-Life: 1 hr
- Onset: 30 min
- Duration: 4-6 hr
- Metabolism: liver
- Metabolite: b-(2-methoxyphenoxy) lactic acid
- Excretion: Urine
Administration
Instructions
Measure dose with accurate milliliter measuring device to prevent overdose (ie, household teaspoon is not an accurate measuring device)
Administer with food if GI upset occurs
