Serious overdosage 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. The ingestion of very large amounts of Hydromet (Homatropine_Hydrocodone bitartrate) may, in addition, result in acute homatropine intoxication.
TreatmentPrimary 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 for respiratory depression which may result from overdosage or unusual sensitivity to narcotics including hydrocodone. Therefore, an appropriate dose of naloxone hydrochloride should be administered, preferably by the intravenous route, simultaneously with efforts at respiratory resuscitation. For further information, see full prescribing information for naloxone hydrochloride. An antagonist should not be administered in the absence of clinically significant respiratory depression. Oxygen, intravenous fluids, vasopressors and other supportive measures should be employed as indicated. Gastric emptying may be useful in removing unabsorbed drug.
Hydromet (Homatropine_Hydrocodone bitartrate) should not be administered to patients who are hypersensitive to hydrocodone or homatropine methylbromide.
Sedation, drowsiness, mental clouding, lethargy, impairment of mental and physical performance, anxiety, fear, dysphoria, dizziness, psychic dependence, mood changes.
Gastrointestinal SystemNausea and vomiting may occur; they are more frequent in ambulatory than in recumbent patients.
Prolonged administration of Hydromet (Homatropine_Hydrocodone bitartrate) may produce constipation.
Genitourinary SystemUreteral spasm, spasm of vesicle sphincters and urinary retention have been reported with opiates.
Respiratory DepressionHydromet (Homatropine_Hydrocodone bitartrate) may produce dose-related respiratory depression by acting directly on brain stem respiratory centers (see OVERDOSE).
DermatologicalSkin rash, pruritus.
Hydromet (Homatropine_Hydrocodone bitartrate) is indicated for the symptomatic relief of cough.
Hydrocodone can produce drug dependence of the morphine type and, therefore, has the potential for being abused. Psychic dependence, physical dependence and tolerance may develop upon repeated administration of Hydromet (Homatropine_Hydrocodone bitartrate) and it should be prescribed and administered with the same degree of caution appropriate to the use of other narcotic drugs (see Drug Abuse And Dependence).
Respiratory DepressionHydromet (Homatropine_Hydrocodone bitartrate) produces dose-related respiratory depression by directly acting on brain stem respiratory centers. If respiratory depression occurs, it may be antagonized by the use of naloxone hydrochloride and other supportive measures when indicated.
Head Injury And Increased Intracranial PressureThe respiratory depression properties 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 pre-existing increase in intracranial pressure. Furthermore, narcotics produce adverse reactions which may obscure the clinical course of patients with head injuries.
Acute Abdominal ConditionsThe administration of Hydromet (Homatropine_Hydrocodone bitartrate) or other narcotics may obscure the diagnosis or clinical course of patients with acute abdominal conditions.
Pediatric UseIn young children, as well as adults, the respiratory center is sensitive to the depressant action of narcotic cough suppressants in a dose-dependent manner. Benefit to risk ratio should be carefully considered especially in children with respiratory embarrassment (e.g. croup).
PRECAUTIONS GeneralBefore prescribing medication to suppress or modify cough, it is important to ascertain that the underlying cause of cough is identified, that modification of cough does not increase the risk of clinical or physiological complications, and that appropriate therapy for the primary disease is provided.
Special Risk PatientsHydromet (Homatropine_Hydrocodone bitartrate) should be given with caution to certain patients such as the elderly or debilitated, and those with severe impairment of hepatic or renal functions, hypothyroidism, Addison's disease, prostatic hypertrophy or urethral stricture, asthma, and narrow-angle glaucoma.
Carcinogenesis, Mutagenesis, Impairment Of FertilityStudies of Hydromet (Homatropine_Hydrocodone bitartrate) in animals to evaluate the carcinogenic and mutagenic potential and the effect on fertility have not been conducted.
Pregnancy Teratogenic EffectsAnimal reproduction studies have not been conducted with Hydromet (Homatropine_Hydrocodone bitartrate). It is also not known whether Hydromet (Homatropine_Hydrocodone bitartrate) can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Hydromet (Homatropine_Hydrocodone bitartrate) should be given to a pregnant woman only if clearly needed.
Nonteratogenic EffectsBabies 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.
Labor And DeliveryAs with all narcotics, administration of Hydromet (Homatropine_Hydrocodone bitartrate) to the mother shortly before delivery may result in some degree of respiratory depression in the newborn, especially if higher doses are used.
Nursing MothersIt is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants from Hydromet (Homatropine_Hydrocodone bitartrate), 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.
Pediatric UseSafety and effectiveness of Hydromet (Homatropine_Hydrocodone bitartrate) in children under six have not been established.
One (1) tablet every 4 to 6 hours as needed; do not exceed six (6) tablets in 24 hours.
Children 6 To 12 Years Of AgeOne-half (1/2) tablet every 4 to 6 hours as needed; do not exceed three (3) tablets in 24 hours.
