Pediatrics: 16 Yrs: Usual: 1 tab q4-6h PRN. Max: 5 tabs/day. Use lowest effective dose or longest dosing interval consistent with individual treatment goals.
Not for treatment of corticosteroid insufficiency or substitute for corticosteroids. May diminish utility of fever and inflammation as diagnostic signs in detecting complications of presumed noninfectious, painful conditions. Caution in elderly. Ibuprofen: May increase risk of serious cardiovascular (CV) thrombotic events, myocardial infarction (MI), and stroke. May cause or worsen HTN. May cause renal toxicity; not recommended with advanced renal disease. Caution with renal disease, coagulation disorders, asthma, fluid retention, heart failure, HTN, history of ulcer disease or GI bleeding. Anaphylactoid reactions may occur. Avoid with ASA-triad and ASAsensitive asthma, and late pregnancy. May cause serious skin adverse events (eg, exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis). May increase risk of GI ulceration, bleeding, perforation. Anemia, fluid retention, edema, severe hepatic reactions reported. D/C if liver disease develops or if systemic manifestations occur. May inhibit platelet aggregation and prolong bleeding time. Possible risk of aseptic meningitis, especially in systemic lupus erythematosus patients. Hydrocodone: May increase risk of misuse, abuse, or diversion. May produce dose-related respiratory depression. Respiratory depressant effects and CSF pressure elevation may be markedly exaggerated in the presence of head injury, intracranial lesions, or preexisting increased intracranial pressure. May obscure diagnosis/clinical course of acute abdominal conditions or the clinical course of head injuries. Caution in debilitated, severe impairment of hepatic/renal function, hypothyroidism, Addison's disease, prostatic hypertrophy, and urethral stricture. Suppresses cough reflex; use caution postoperatively and in pulmonary disease.
Additive CNS depression with other opioid analgesics, antihistamines, antipsychotics, antianxiety agents, and other CNS depressants (eg, alcohol); reduce dose of one or both agents. Ibuprofen: Increase risk of GI bleeding with oral corticosteroids or anticoagulants. May diminish antihypertensive effect of ACE inhibitors. May increase adverse effects with ASA; concomitant administration is not recommended. Synergistic effects on GI bleeding with warfarin. May decrease natriuretic effects of furosemide and loop or thiazide diuretics; monitor for renal failure. May increase lithium levels; monitor for lithium toxicity. May enhance methotrexate toxicity; caution when coadministered. Hydrocodone: Use with MAOIs or TCAs may increase the effect of either the antidepressant or hydrocodone. Not recommended for patients taking MAOIs or within 14 days of stopping such treatment. May produce paralytic ileus with anticholinergics. Caution with concurrent agonist/antagonist analgesics (eg, pentazocine, nalbuphine, naltrexone, and butorphanol) use; may reduce analgesic effect of hydrocodone and/or precipitate withdrawal symptoms. May enhance neuromuscular-blocking action of skeletal muscle relaxants and increase respiratory depression.
Category C, not for use in nursing.
(Hydrocodone): Semisynthetic opioid analgesic; not established. Suspected to relate to existence of opiate receptors in CNS. (Ibuprofen): Nonsteroidal anti-inflammatory agent; not established. Suspected to inhibit cyclooxygenase activity and prostaglandin synthesis. Possesses analgesic and antipyretic activity.
Absorption: Hydrocodone: C=27ng/mL; T=1.7 hrs. Ibuprofen: C=30mcg/mL; T
=1.8 hrs. Distribution: Hydrocodone: Plasma protein binding (19-45%). Ibuprofen: Plasma protein binding (99%). Metabolism: Hydrocodone: CYP2D6, via O-demethylation to hydromorphone (active metabolite); CYP3A4 via N-demethylation; 6-keto reduction. Ibuprofen: Interconversion from R-isomer to S-isomer; (+)-2-4'-(2-hydroxy-2-methyl-propyl) phenyl propionic acid and (+)-2-4'-
Assess for hypersensitivity to other opioids, previous reaction to ASA or NSAIDs (eg, asthma, urticaria), type of pain (eg, CABG surgery), renal/hepatic function, pregnancy/nursing status, possible drug interactions, or any other conditions where treatment is contraindicated or cautioned. Obtain baseline BP.
Inform that drug cannot be substituted for corticosteroids or treat corticosteroid insufficiency. Caution that drug may impair mental and/or physical abilities required to perform potentially hazardous tasks (eg, operating machinery/driving). Warn that drug may be habit-forming; instruct to take only for as long as prescribed, and not more frequently than prescribed. Instruct to avoid alcohol and other CNS depressants while on therapy. Instruct to contact physician if CV events (eg, chest pain, SOB, slurring of speech), GI effects (eg, ulcers, bleeding), edema, or weight gain occur. Instruct to immediately stop therapy and contact physician if signs/symptoms of skin reactions or hepatotoxicity (eg, nausea, fatigue, jaundice) develop. Instruct to seek immediate medical attention if any anaphylactoid reactions (eg, difficulty breathing, facial swelling) develop.
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