Hydrocodone/Chlorpheniramine/Pseudoephedrine

DEA Class; Rx

Common Brand Names; Zutripro

Oral sedating antihistamine, opiate agonist antitussive, and decongestant combination
Used to relieve cough and congestion due to allergies, acute or chronic bronchitis, colds, and other acute respiratory infections
Not indicated in pediatric patients under 18 years of age; contraindicated in neonates, infants and children less than 6 years of age

Hypersensitivity

Coadministration with MAOIs or within 14 ays of discontinuing MAOIs; may increase risk of hypertensive crisis

Narrow angle glaucoma

Urinary retention

Severe hypertension or severe coronary artery disease

Hydrocodone, an opioid, may result in respiratory depression, drug dependence, increased ICP, decreased mental alertness, or paralytic ileus

Pseudoephedrine, a sympathomimetic, may result in CNS effects (eg, insomnia, dizziness, weakness, tremor, convulsions or cardiovascular effects (eg, arrhythmias, increased blood pressure)

Chlorpheniramine, an antihistamine, may result in decreased mental alertness or anticholinergic effects (urinary retention, ileus)

Common adverse effects include sedation, somnolence, mental clouding, lethargy, impairment of mental and physical performance, anxiety, fear, dysphoria, dizziness, psychic dependence, mood changes, nervousness, or sleeplessness; blurred, double, or other visual disturbances; confusion, headache, euphoria, facial dyskinesia, feeling faint, lightheadedness, agitation, restlessness, insomnia, irritability, and tremor

May cause dose-related respiratory depression; use with caution

Hydrocodone can cause drug dependence; prescribe with caution that is appropriate to the use of other opioids

Avoid use in patients with head injury or elevated ICP; opioids decrease respiratory depression and may increase ICP

May cause drowsiness; avoid engaging in hazardous tasks requiring complete mental alertness such as driving or operating machinery

Elicits CNS depressant effects; avoid concurrent use of alcohol or other central nervous system depressants

Use with caution with acute abdominal conditions; opioids may obscure diagnosis and anticholinergics may increase risk of paralytic ileus

Coexisting conditions: Use with caution with diabetes, thyroid disease, Addison’s disease, prostatic hypertrophy or urethral stricture, or asthma

Use with TCAs may increase effects of hydrocodone or TCAs

Pseudoephedrine component may increase risk for hypertension

Observational studies have demonstrated that concomitant use of opioid analgesics and benzodiazepines increases risk of drug-related mortality compared to use of opioids alone; because of similar pharmacologic properties, it is reasonable to expect similar risk with concomitant use of opioid cough medications and benzodiazepines, other CNS depressants, or alcohol

Pregnancy Category: C

Lactation: Hydrocodone, chlorpheniramine, and pseudoephedrine are distributed in breast milk; caution advised, chlorpheniramine may suppress lactation is used prior to nursing