hydrocodone and homatropine

it may enhance the QTc-prolonging effect

protriptyline

it may enhance the QTc-prolonging effect

sorafenib

it may enhance the QTc-prolonging effect

ritonavir

it may enhance the QTc-prolonging effect

nortriptyline

it may enhance the QTc-prolonging effect

it may increase the levels of serum concentration

it may increase the levels of serum concentration

diacerein

it may increase the levels of serum concentration

tranylcypromine

it may increase the levels of serum concentration

anastrozole

it may increase the levels of serum concentration

curcumin

it may increase the levels of serum concentration

it may increase the levels of serum concentration

it may increase the levels of serum concentration

diacerein

it may increase the levels of serum concentration

tranylcypromine

it may increase the levels of serum concentration

lenacapavir

it may increase the levels of serum concentration

it may increase the levels of serum concentration

it may increase the levels of serum concentration

citalopram

it may increase the levels of serum concentration

efavirenz

it may increase the levels of serum concentration

it may increase the levels of serum concentration

efavirenz

it may increase the levels of serum concentration

abametapir

it may increase the levels of serum concentration

efavirenz

it may increase the levels of serum concentration

propofol

it may increase the levels of serum concentration

tucatinib

it may increase the levels of serum concentration

efavirenz

it may increase the levels of serum concentration

efavirenz

it may increase the levels of serum concentration

propofol

it may increase the levels of serum concentration

famprofazone

may have an increased analgesic effect when combined with opioid agonists

lisdexamfetamine

may have an increased analgesic effect when combined with opioid agonists

methamphetamine

may have an increased analgesic effect when combined with opioid agonists

dextroamphetamine

may have an increased analgesic effect when combined with opioid agonists

pseudoephedrine

may have an increased analgesic effect when combined with opioid agonists

primidone

it may decrease the levels of serum concentration

phenobarbital

it may decrease the levels of serum concentration

carbamazepine

it may decrease the levels of serum concentration

efavirenz

it may decrease the levels of serum concentration

isoniazid

it may decrease the levels of serum concentration

memantine/donepezil

may enhance the CNS depressant effect

donepezil transdermal

may enhance the CNS depressant effect

efavirenz

may enhance the CNS depressant effect

prednisolone

may enhance the CNS depressant effect

albendazole

it may decrease the levels of serum concentration

Dosage Forms & Strengths 

Tablet: Schedule II 

5mg/1.5mg  

oral solution: Schedule II 

(5mg/1.5mg)/5mL  

Cough

5 mg/1.5 mg orally every 4-6 hours 

Dosage Forms & Strengths 

Tablet: Schedule II 

5mg/1.5mg  

oral solution: Schedule II 

(5mg/1.5mg)/5mL  

Cough

5 mg/1.5 mg orally every 4-6 hours 

Adverse drug reactions:  

Frequency not Defined 

Angina  

arrhythmias  

cardiac arrest  

myocardial infarction  

QT-interval prolongation   

ventricular tachycardia 

Eczematoid dermatitis 

Increased IOP 

Follicular conjunctivitis 

Edema 

Vascular congestion 

Exudate 

Black Box Warning:

none

Contraindication / Caution:

Contraindications:

Hypersensitivity: The use of hydrocodone/homatropine is contraindicated in individuals who have a known hypersensitivity or allergy to hydrocodone, homatropine, or any of the other components of the medication.
Respiratory Depression: hydrocodone is an opioid that can depress respiratory function. The use of hydrocodone/homatropine is contraindicated in individuals with severe respiratory depression, acute or severe bronchial asthma, and respiratory insufficiency.
Paralytic Ileus: Paralytic ileus is a condition characterized by the inability of the intestinal muscles to contract and move the contents through the digestive system. Hydrocodone/homatropine is contraindicated in individuals with paralytic ileus.
Glaucoma: homatropine, an anticholinergic agent present in hydrocodone/homatropine, can increase intraocular pressure. The use of hydrocodone/homatropine is contraindicated in individuals with narrow-angle glaucoma.

Caution:

Respiratory Disorders: hydrocodone/homatropine should be used with caution in individuals with respiratory disorders, such as chronic obstructive pulmonary disease (COPD) or asthma. Opioids can further impair respiratory function and may require dose adjustment or monitoring in such cases.
Liver or Kidney Impairment: hydrocodone/homatropine should be used with caution in individuals with liver or kidney impairment. The medication may have an extended half-life or increased systemic exposure in these individuals, requiring dose adjustment or monitoring for adverse effects.
Drug Interactions: hydrocodone/homatropine may interact with other medications, such as benzodiazepines, sedatives, or other opioids, leading to additive effects or increased risk of side effects. Caution should be exercised and appropriate dose adjustments or monitoring should be implemented when co-administering these medications.
Substance Use Disorder: hydrocodone is an opioid with the potential for abuse and dependence.

Pregnancy warnings:    

Pregnancy category: N/A

Breastfeeding warnings: 

The release of the drug into the human breastmilk is unknown

Pregnancy Categories:     

Category A: Satisfactory and well-controlled studies show no risk to the fetus in the first or later trimester.     

Category B: No evidence shown of risk to the fetus found in animal reproduction studies, and there are not enough studies on pregnant women     

Category C: Adverse effects on the fetus found with evidence in animal reproduction studies and no adequate evidence for a result in humans must take care of potential risks in pregnant women     

Category D: There is adequate data available with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits     

Category X: Drugs listed in this category outweigh risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.     

Category N: There is no data available for the drug under this category 

Hydrocodone acts as a narcotic agonist with analgesic and antitussive effects, helping to relieve pain and suppress cough. Homatropine is an anticholinergic included in a subtherapeutic dose to discourage intentional overdose.

Pharmacodynamics

Hydrocodone works by binding to opioid receptors in the brain and spinal cord, producing pain relief and cough suppression. Homatropine, an anticholinergic, has minimal therapeutic effect at its low dose but is added to deter misuse by causing unpleasant side effects if taken in excess. Together, the combination helps manage cough and moderate pain while reducing the risk of intentional overdose.

Pharmacokinetics

Hydrocodone:

Absorption: Peak levels reached in about 1.3 hours.

Distribution/Duration: Effects last 4–8 hours.

Metabolism: Metabolized mainly in the liver by CYP2D6 through O-demethylation, N-demethylation, and 6-keto reduction.

Excretion: Eliminated mostly in the urine.

Half-life: Approximately 3.3–4.4 hours.

Homatropine:

Duration of action: Around 6 hours.

Excretion: Primarily cleared through the urine.

Give this medication by mouth only, using a precise milliliter measuring device to ensure the correct dose. Do not use a household teaspoon, as it may lead to dosing errors or overdose. If no measuring device is included, ask a pharmacist for an appropriate one and instructions on proper use. After each dose, rinse the measuring device with water.

Patient Information Leaflet

Generic Name: hydrocodone/homatropine 

Pronunciation: hy-ko-dan, HYE-droe-KOE-done/hoe-MAT-roe-peen

Why do we use hydrocodone/homatropine?

hydrocodone/homatropine is a combination medication used for the symptomatic relief of cough. Here are the main reasons why hydrocodone/homatropine is used:

Cough Suppression: hydrocodone, an opioid analgesic, acts as a cough suppressant by acting on the cough center in the brain, reducing the urge to cough. It can help relieve dry, non-productive cough associated with various respiratory conditions.
Symptomatic Relief: hydrocodone/homatropine is primarily used to provide temporary relief from coughing that can be distressing or disruptive to sleep and daily activities. By suppressing coughing, it can help individuals feel more comfortable and alleviate associated symptoms, such as throat irritation or soreness.
Anticholinergic Effects: homatropine, an anticholinergic agent present in hydrocodone/homatropine, is included in the combination to discourage misuse of the medication. It has minimal anticholinergic effects at therapeutic doses but can cause adverse effects if taken in excessive amounts.

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