![]() Do not await acetaminophen assay results before initiating treatment. Serum acetaminophen levels should be obtained, since levels four or more hours following ingestion help predict acetaminophen toxicity. If the dose of acetaminophen may have exceeded 140 mg/kg, acetylcysteine should be administered as early as possible. ![]() A narcotic antagonist should not be administered in the absence of clinically significant respiratory or cardiovascular depression. Since the duration of action of hydrocodone may exceed that of naloxone, the patient should be kept under continuous surveillance and repeated doses of the antagonist should be administered as needed to maintain adequate respiration. Naloxone hydrochloride 0.4 mg to 2 mg is given parenterally. Naloxone, a narcotic antagonist, can reverse respiratory depression and coma associated with opioid overdose. If hypoprothrombinemia occurs due to acetaminophen overdose, vitamin K should be administered intravenously. In severe cases of intoxication, peritoneal dialysis, or preferably hemodialysis may be considered. Meticulous attention should be given to maintaining adequate pulmonary ventilation. A cuffed endo-tracheal tube should be inserted before gastric lavage of the unconscious patient and, when necessary, to provide assisted respiration. Vasopressors and other supportive measures should be employed as indicated. Hypotension is usually hypovolemic and should respond to fluids. If repeated doses are used, the cathartic might be included with alternate doses as required. The first dose should be accompanied by an appropriate cathartic. Oral activated charcoal (1 g/kg) should follow gastric emptying. Vomiting should be induced mechanically, or with syrup of ipecac, if the patient is alert (adequate pharyngeal and laryngeal reflexes). Immediate treatment includes support of cardiorespiratory function and measures to reduce drug absorption. Treatment – A single or multiple overdose with hydrocodone and acetaminophen is a potentially lethal polydrug overdose, and consultation with a regional poison control center is recommended. The rate of development of tolerance varies among patients. Tolerance, in which increasingly large doses are required in order to produce the same degree of analgesia, is manifested initially by a shortened duration of analgesic effect, and subsequently by decreases in the intensity of analgesia. Physical dependence, the condition in which continued administration of the drug is required to prevent the appearance of a withdrawal syndrome, assumes clinically significant proportions only after several weeks of continued narcotic use, although some mild degree of physical dependence may develop after a few days of narcotic therapy. However, psychic dependence is unlikely to develop when hydrocodone bitartrate and acetaminophen tablets are used for a short time for the treatment of pain. Hydrocodone may cause confusion and over-sedation in the elderly elderly patients generally should be started on low doses of hydrocodone bitartrate and acetaminophen tablets and observed closely.Ībuse and Dependence – Psychic dependence, physical dependence, and tolerance may develop upon repeated administration of narcotics therefore, this product should be prescribed and administered with caution. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function. Thus the risk of toxic reactions may be greater in patients with impaired renal function due to the accumulation of the parent compound and/or metabolites in the plasma. Hydrocodone and the major metabolites of acetaminophen are known to be substantially excreted by the kidney. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. Geriatric Use – Clinical studies of hydrocodone bitartrate and acetaminophen tablets did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects.
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