allergy, cold and cough remedies
Controlled Substance Schedule: III
Relief of cough/nasal congestion associated with the common cold.
- Consists of an antitussive (hydrocodone) and a nasal decongestant (pseudoephedrine).
- Hydrocodone– Binds to opiate receptors in the CNS; suppress the cough reflex via a direct central action.
- Pseudoephedrine– Stimulates alpha- and beta-adrenergic receptors; produces vasoconstriction in the respiratory tract mucosa (alpha-adrenergic stimulation) and possibly bronchodilation (beta2 -adrenergic stimulation).
Decreased cough and nasal congestion associated with the common cold.
Absorption: Well absorbed following oral administration.
Distribution: Enters breast milk.
Metabolism and Excretion: Mostly metabolized by the liver; eliminated in the urine (50–60% as metabolites, 15% as unchanged drug).
Half-life: 2.2 hr.
Absorption: Well absorbed after oral administration.
Distribution: Appears to enter the CSF; probably crosses the placenta and enters breast milk.
Metabolism and Excretion: Partially metabolized by the liver. 55–75% excreted unchanged by the kidneys (depends on urine pH).
Half-life: Adults: 9–16 hr (depends on urine pH).
TIME/ACTION PROFILE (cough suppression/nasal decongestion)
- Hypersensitivity to hydrocodone or pseudoephedrine
- Concurrent or history of recent (within 14 days) MAOI therapy
- Narrow angle glaucoma, urinary retention, severe hypertension or severe coronary artery disease
- Lactation:Avoid use during lactation.
Use Cautiously in:
- Head injury, increased intracranial pressure, intracranial injuries
- Acute abdominal conditions
- Diabetes, cardiovascular disease, thyroid disease, Addison's disease, prostatic hypertrophy, urethral stricture or asthma
- Severe hepatic/renal impairment
- History of substance abuse
- OB: Use in pregnancy only if the benefit justifies potential risk to fetus;
- Pedi: Safe and effective use in children <18 yr not established.
Adverse Reactions/Side Effects
CNS: confusion, dizziness, sedation, euphoria, hallucinations, headache, unusual dreams
EENT: blurred vision, diplopia, miosis
Resp: respiratory depression
CV: hypotension, bradycardia
GI: constipation, dyspepsia, nausea, vomiting
GU: urinary retention
Misc: physical dependence, psychological dependence, tolerance
CNS: SEIZURES, anxiety, nervousness, dizziness, drowsiness, excitability, fear, hallucinations, headache, insomnia, restlessness, weakness
Resp: respiratory difficulty
CV: CARDIOVASCULAR COLLAPSE, palpitations, hypertension, tachycardia
GI: anorexia, dry mouth
CNS: anxiety, dizziness, drowsiness, dysphoria, fear, lethargy, mental clouding, mental/physical performance impairment, mood changes, nervousness, sedation, sleeplessness
Resp: RESPIRATORY DEPRESSION
CV: arrhythmia, hypertension, hypotension, palpitation, shock-like state, syncope
GI: constipation, nausea, vomiting (↑ in ambulatory patients
GU: spasm of vesicle sphincters, ureteral spasm, urinary retention
Derm: pruritus, rash
Misc: physical dependence, psychological dependence
* CAPITALS indicate life-threatening.
Underline indicate most frequent.
- Concurrent use with MAOIs or tricyclic antidepressantsmay ↑ effect of hydrocodone or antidepressants; may also ↑ BP; avoid concurrent use.
- ↑ CNS depression with antihistamines, antipsychotics, anti-anxiety agents, and some antidepressants; avoid concurrent use.
- Concurrent use with anticholinergics may ↑ risk of paralytic ileus and other anticholinergic adverse reactions.
PO: (Adults) 5 mL every 4–6 hr as needed (not to exceed 4 doses [20 mL]) in 24 hr.
Oral solution (grape): hydrocodone 5 mg and pseudoephedrine 60 mg/5 mL
- Assess BP, pulse, and respirations before and periodically during administration. If respiratory rate is <10/min, assess level of sedation. Physical stimulation may be sufficient to prevent significant hypoventilation.
- Assess cough and lung sounds periodically during therapy.
- Assess bowel function routinely. Prevention of constipation should be instituted with increased intake of fluids and bulk, and laxatives to minimize constipating effects. Stimulant laxatives should be administered routinely if opioid use exceeds 2–3 days, unless contraindicated.
- Prolonged use may lead to physical and psychological dependence and tolerance.
- Administer using a accurate mL measuring device.
- May be administered with food or milk to minimize GI irritation.
- Instruct patient to take medication as directed and not to take more than the recommended amount. Use an accurate mL measuring device to measure dose; household teaspoon is not accurate and may result in overdose.
- May cause drowsiness or dizziness. Caution patient to avoid driving or other activities requiring alertness until response to the medication is known.
- Caution patient to avoid concurrent use of alcohol or other CNS depressants with this medication.
- Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking other Rx, OTC, or herbal products.
- Advise patient to increase fluids, maintain rest and treat other symptoms as needed.
Decreased cough and congestion associated with the common cold.
Emergency Central is a collection of disease, drug, and test information including 5-Minute Emergency Medicine Consult, Davis’s Drug, McGraw-Hill Medical’s Diagnosaurus®, Pocket Guide to Diagnostic Tests, and MEDLINE Journals created for emergency medicine professionals. Learn more.