Hydrocodone Bitartrate and Ipratropium Inhalation Aerosol

• Generic Name: hydrocodone
• Dosage Forms: n.a.
• Other Brand Names: Hysingla ER, Zohydro ER, Vantrela ER

Extended-release hydrocodone: Relief of pain that is severe enough to require long-term, daily, around-the-clock use of an opiate analgesic and for which alternative treatment options (e.g., nonopiate analgesics or immediate-release opiates) are inadequate or not tolerated. Not indicated for as-needed (“prn”) use.

Hydrocodone/acetaminophen fixed combinations: Symptomatic relief of moderate to moderately severe pain.

Hydrocodone/ibuprofen fixed combinations: Short-term (generally <10 days) use for the relief of acute pain; not indicated for management of pain associated with such chronic conditions as osteoarthritis or rheumatoid arthritis.

Combinations of hydrocodone and NSAIAs or acetaminophen may produce additive analgesic effects because of differing mechanisms of action.

In symptomatic treatment of acute pain, reserve opiate analgesics for pain resulting from severe injuries, severe medical conditions, or surgical procedures, or when nonopiate alternatives for relieving pain and restoring function are expected to be ineffective or are contraindicated. Use smallest effective dosage for shortest possible duration since long-term opiate use often begins with treatment of acute pain. Optimize concomitant use of other appropriate therapies. (See Managing Opiate Therapy for Acute Pain under Dosage and Administration.)

Generally use opiates for management of chronic pain (i.e., pain lasting >3 months or past the time of normal tissue healing ) that is not associated with active cancer treatment, palliative care, or end-of-life care only if other appropriate nonpharmacologic and nonopiate pharmacologic strategies have been ineffective and expected benefits for both pain relief and functional improvement are anticipated to outweigh risks.

If used for chronic pain, opiate analgesics should be part of an integrated approach that also includes appropriate nonpharmacologic modalities (e.g., cognitive-behavioral therapy, relaxation techniques, biofeedback, functional restoration, exercise therapy, certain interventional procedures) and other appropriate pharmacologic therapies (e.g., nonopiate analgesics, analgesic adjuncts such as selected anticonvulsants and antidepressants for certain neuropathic pain conditions).

Available evidence insufficient to determine whether long-term opiate therapy for chronic pain results in sustained pain relief or improvements in function and quality of life or is superior to other pharmacologic or nonpharmacologic treatments. Use is associated with serious risks (e.g., opiate use disorder, overdose). (See Managing Opiate Therapy for Chronic Noncancer Pain under Dosage and Administration.)

Symptomatic relief of nonproductive cough, alone or in combination with other antitussives or expectorants.

Not indicated for management of cough in patients <18 years of age. (See Pediatric Use under Cautions.)

• Generic Name: ipratropium
• Dosage Forms: n.a.
• Other Brand Names: Atrovent HFA, Atrovent

• It is used to open the airways in lung diseases where spasm may cause breathing problems.
• This medicine is not to be used to treat intense flare-ups of shortness of breath. Use a rescue inhaler. Talk with the doctor.