Select a medication above to begin.
hydrocodone/ ibuprofen
generic
Black Box Warnings .
Appropriate Use
should only be prescribed by healthcare professionals knowledgeable about opioid use and how to mitigate associated risks; reserve opioid analgesics for patients with inadequate tx alternatives; proper dosing and titration essential to decr. respiratory depression risk
Addiction, Abuse, and Misuse
Schedule II controlled substance combination containing an opioid agonist with risk of addiction, abuse, and misuse, which can lead to overdose and death; assess opioid abuse or addiction risk prior to prescribing; regularly reassess all patients for misuse, abuse, and addiction
Respiratory Depression
serious, life-threatening, or fatal cases may occur even with recommended use, especially during tx start or after dose incr; to decr. risk, initiate and titrate dose appropriately
Accidental Ingestion
accidental ingestion of even one dose, especially by children, can result in fatal hydrocodone overdose
Risks from Concomitant Use with Benzodiazepines, CNS Depressants
concomitant opioid use with benzodiazepines or other CNS depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death; reserve concomitant use for patients with inadequate alternative tx options
Neonatal Opioid Withdrawal Syndrome
advise pregnant patients with extended opioid use of risk of potentially life-threatening neonatal opioid withdrawal syndrome; ensure tx by neonatology experts available at delivery
Opioid Analgesic REMS
providers are strongly encouraged to complete risk evaluation and mitigation strategy (REMS)-compliant education program, counsel patients and/or caregivers with each Rx on serious risks, safe use, and importance of reading medication guide
CYP450 3A4 Interaction
concomitant use with CYP450 3A4 inhibitors or D/C of concomitant CYP450 3A4 inducers may incr. opioid concentration which may incr. or prolong adverse effects including potentially fatal respiratory depression; monitor patients receiving any concomitant CYP450 3A4 inhibitor or inducer
Cardiovascular Risk
NSAIDs incr. risk of serious and potentially fatal cardiovascular thrombotic events, including MI and stroke; risk may occur early in tx and may incr. with duration of use; contraindicated in CABG periop setting
GI Risk
NSAIDs incr. risk of serious and potentially fatal GI adverse events including bleeding, ulcer, and stomach or intestine perforation; GI events may occur at any time during use and without warning symptoms; elderly patients and patients with history of PUD or GI bleeding at greater risk for serious GI events
Adult Dosing .
Dosage forms: TAB: 2.5 mg/200 mg, 5 mg/200 mg, 7.5 mg/200 mg, 10 mg/200 mg
Special Note
- [prescribing info]
- Info: consider prescribing opioid overdose reversal agent (e.g., naloxone, nalmefene), especially if risk of opioid overdose or accidental ingestion
pain, acute
- [1 tab PO q4-6h prn]
- Max: 5 tabs/day; Info: use lowest effective dose, shortest effective tx duration; give with food if GI upset occurs; taper dose gradually to avoid withdrawal symptoms if D/C tx in physically opioid-dependent patients; search 'opioid taper' for epocrates Opioid Tapering decision tool
renal dosing
- [see below]
- CrCl >60: no adjustment; CrCl 30-60: not defined, caution advised; CrCl <30: avoid use
- HD/PD: avoid use
hepatic dosing
- [adjust dose amount]
- mild-moderate impairment: not defined; severe impairment: decr. usual start dose, amount not defined
Peds Dosing .
- Dosage forms: TAB: 2.5 mg/200 mg, 5 mg/200 mg, 7.5 mg/200 mg, 10 mg/200 mg
Special Note
- [prescribing info]
- Info: consider prescribing opioid overdose reversal agent (e.g., naloxone, nalmefene), especially if risk of opioid overdose or accidental ingestion
pain, acute
- [16 yo and older]
- Dose: 1 tab PO q4-6h prn; Max: 5 tabs/day; Info: use lowest effective dose, shortest effective tx duration; give with food if GI upset occurs; taper dose gradually to avoid withdrawal symptoms if D/C tx in physically opioid-dependent patients; search 'opioid taper' for epocrates Opioid Tapering decision tool
renal dosing
- [see below]
- CrCl >60: no adjustment; CrCl 30-60: not defined, caution advised; CrCl <30: avoid use
- HD/PD: avoid use
hepatic dosing
- [adjust dose amount]
- mild-moderate impairment: not defined; severe impairment: decr. usual start dose, amount not defined