![]() ![]() Careful monitoring is required, particularly when CYP450 3A4 inhibitors or inducers are used concomitantly concurrent use of a CYP3A4 inhibitor or discontinuation of a concurrently used CYP3A4 inducer may increase plasma hydrocodone concentrations and potentiate the risk of fatal respiratory depression. Carbon dioxide retention from respiratory depression may also worsen opioid sedating effects. Respiratory depression, if left untreated, may cause respiratory arrest and death. Consider decreasing the opioid dosage in persons with CSA. Opioids increase the risk of central sleep apnea (CSA) and sleep-related hypoxemia in a dose-dependent fashion. Monitor such persons closely, particularly when initiating and titrating the opioid consider the use of non-opioid analgesics. Persons with advanced age, cachexia, or debilitation are also at an increased risk for opioid-induced respiratory depression. Persons with chronic obstructive pulmonary disease (COPD), cor pulmonale, respiratory insufficiency, hypoxemia, hypercapnia, or preexisting respiratory depression are at increased risk of decreased respiratory drive even at recommended doses. ![]() Monitor closely for signs or symptoms of respiratory depression and sedation. Reserve concomitant prescribing of these drugs for use in persons for whom alternative treatment options are inadequate if concurrent use is necessary, use the lowest effective dosages and minimum treatment durations needed. Avoid coadministration with other CNS depressants when possible, as this significantly increases the risk for profound sedation, respiratory depression, coma, and death. Asthma, chronic obstructive pulmonary disease (COPD), coadministration with other CNS depressants, cor pulmonale, hypoxemia, respiratory depression, respiratory insufficiency, sleep apneaĪcetaminophen hydrocodone is contraindicated in persons with significant respiratory depression and those with acute or severe asthma in an unmonitored setting or in the absence of resuscitative equipment. ![]()
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