Hydrocodone, Carbinoxamine, Phenylephrine

Drug Class: Hydrocodone, Carbinoxamine, Phenylephrine > Hydrocodone > Semi Synthetic Opioid > Opioids > Opioid Agonist > Analgesic.

Uses

Doctors prescribe hydrocodone, carbinoxamine and phenylephrine combination drugs, known as polydrugs, to relieve symptoms associated with the common cold, sinus infections and allergies. This polydrug eases symptoms such as cough, nasal congestion, sneezing and itchy, watery eyes. It also treats itching, skin rash and hives associated with allergies. Do not use hydrocodone, carbinoxamine and phenylephrine preparations to treat a cough with a lot of mucus. Use hydrocodone, carbinoxamine and phenylephrine preparations so you can sleep, work or go to school undisturbed by symptoms.

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Other, off label uses for this medicine

Your doctor may suggest you use hydrocodone, carbinoxamine and phenylephrine polydrugs to treat a long-term cough caused by chronic conditions such as smoking, emphysema and asthma.

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Administration/Dosage

Hydrocodone, carbinoxamine and phenylephrine preparations are available in a syrup form. Brand name preparations include Donatussin MAX, Excof, Excof-SF and Max HC.

This medication is available in two strengths, each with its own dosing instructions. One preparation contains 5 mg of hydrocodone, 4 mg of carbinoxamine and 8 mg of phenylephrine in every 5 ml of liquid; the usual adult prescription for this preparation calls for one 5 ml dose every three to four times each day. Your doctor may have prescribed the other preparation, which contains 5 mg of hydrocodone, 2 mg of carbinoxamine and 6 mg of phenylephrine in every 5 ml of liquid. The typical adult prescription for this strength calls for 5 ml to 10 ml every 4 to 6 hours, not to exceed four doses in 24 hours.

Children over the age of 12 years may take an adult dose as prescribed by his pediatrician. Talk with your child's pediatrician to discuss dosing for children between the ages of two years and eleven years. Do not administer this medication to a child younger than the age of two years. Death can occur from misuse of hydrocodone, carbinoxamine and phenylephrine in very young children.

Adults over the age of 60 may be more sensitive to the effects of hydrocodone, carbinoxamine and phenylephrine combination drugs. Physicians should prescribe lower initial doses and monitor the patient's condition closely until tolerance is established.

Use a medical dosing spoon, syringe or cup to dispense liquid medication, especially when administering medication to children. Do not use a household spoon, which may result in dosing errors, such as inadequate doses or dangerous overdoses. You may obtain a dose-measuring device from your pharmacist or drug store.

Take this medication with or without food. If hydrocodone, carbinoxamine and phenylephrine preparations upset your stomach, take with food or milk.

Hydrocodone, carbinoxamine and phenylephrine polydrugs may cause constipation. Drink six to eight full glasses of water each day to soften stools. Talk with your healthcare provider or nutritionist about increasing your intake of dietary fiber, known to benefit your digestive system.

Take missed doses as soon as you remember and adjust your dosing schedule accordingly. If you miss a dose and it is almost time to take your regularly scheduled dose, skip the missed dose and resume your normal schedule. Do not take more than one dose in an effort to make up for missed doses.

Check with your doctor if your symptoms do not get better after taking hydrocodone, carbinoxamine and phenylephrine for five to seven days, or if your symptoms get worse. Notify the prescribing physician if hydrocodone, carbinoxamine and phenylephrine stop working to relieve your symptoms; this may be a sign of growing tolerance to opioids. Do not take more medicine in an effort to relieve your symptoms unless directed to do so by your doctor.

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Action

Hydrocodone, carbinoxamine and phenylephrine work in different ways to provide relief for a variety of symptoms. Hydrocodone is a narcotic cough suppressant that works directly on the part of the brain responsible for the cough reflex, the medulla. Hydrocodone makes your brain not care about the need to cough. Carbinoxamine is an antihistamine that works by reducing histamines, naturally occurring chemicals that cause watery eyes, runny nose and itching. Phenylephrine is a decongestant. It works to open the airways in your nose by constricting the blood vessels in the lining of nasal passages. More About How Hydrocodone, Carbinoxamine, Phenylephrine Works

Precautions

Call your doctor if you have a fever or if your symptoms get worse or do not improve after taking this medicine. Notify the prescribing physician if hydrocodone, carbinoxamine and phenylephrine prescription stops working to relieve your symptoms, this could be a sign of increased tolerance to opioids.

An allergic reaction is a medical emergency. Seek medical assistance at the first symptom of an allergic reaction. Take all your medications to the hospital to help urgent care staff understand which drug caused the allergic reaction. Symptoms of an allergic reaction include hives, difficulty breathing and swelling of the face, lips or tongue.

Anaphylaxis is a serious form of allergic reaction. Without expert medical intervention, you could die within 15 minutes of exposure to the allergen. Anaphylaxis strikes about 82,000 Americans each year. People with asthma are at greater risk for anaphylaxis.

Your doctor may change the dosage, order medical laboratory tests or suggest a medication other than hydrocodone, carbinoxamine and phenylephrine drugs if you have a history of or are currently experiencing certain medical conditions. Hydrocodone, carbinoxamine and phenylephrine may worsen your condition or interfere with treatment. Your illness may change the way hydrocodone, carbinoxamine and phenylephrine works in your body.

Tell your physician about any significant illnesses or conditions, including: Addison's disease

  • Biliary Disease.
  • Bladder or Bowel Disease.
  • Breathing Problems Such As Asthma, Emphysema or Chronic Bronchitis.
  • Chronic Cough.
  • Constipation or Diarrhea.
  • Diabetes Mellitus.
  • Fever.
  • Glaucoma.
  • Heart Disease Including Angina, Blockage in Heart Vessels, Enlarged Heart, Heart Attack, Heart Failure, Irregular Heartbeat.
  • High Blood Pressure.
  • History of Stroke or Aneurysm.
  • Intestine Problems.
  • Kidney Disease.
  • Liver Disease.
  • Low Blood Pressure.
  • Pain or Difficulty Passing Urine.
  • Peripheral Vascular Disease.
  • Prostate Trouble.
  • Recent Head Injury.
  • Seizures.
  • Thyroid Disease.
  • Ulcers or Other Stomach Problem.

Taking hydrocodone, carbinoxamine and phenylephrine may make you dizzy, drowsy or have blurred vision. Alcohol and some medications may enhance this effect. Avoid performing potentially unsafe tasks until you know how hydrocodone, carbinoxamine and phenylephrine affects you.

Hydrocodone, carbinoxamine and phenylephrine polydrugs can impair your thinking or reactions. Take care when engaging in any potentially risky behavior or performing any activity that requires quick reflexes. Avoid drinking alcohol - it can enhance dizziness, drowsiness and impaired thinking.

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Warnings

Do not take hydrocodone, carbinoxamine and phenylephrine polydrugs if you have taken MAO inhibitors in the past 14 days. Serious, life-threatening drug interactions can occur if you take hydrocodone, carbinoxamine and phenylephrine while an MAO inhibitor is still in your system. Generic names for MAOIs include isocarboxazid, phenelzine, tranylcypromine and selegiline. Brand name preparations include Marplan, Nardil, Parnate and Eldepryl. Consult with a doctor or pharmacist if you are uncertain if one of the drugs you are taking is an MAO inhibitor.

Taking hydrocodone, carbinoxamine and phenylephrine preparations late in a pregnancy may cause harm to a fetus. Hydrocodone, carbinoxamine and phenylephrine can pass into breast milk and may harm a nursing child. Tell the prescribing caregiver if you are pregnant or plan to become pregnant while taking hydrocodone, carbinoxamine and phenylephrine. Notify your physician immediately if you become pregnant while taking this medication. Do not breastfeed a baby while using hydrocodone, carbinoxamine and phenylephrine products.

Do not stop taking hydrocodone, carbinoxamine and phenylephrine abruptly; doing so may cause uncomfortable symptoms of withdrawal, especially if you have taken high doses or used this compound for a long time. To avoid withdrawal symptoms, wean yourself from hydrocodone, carbinoxamine and phenylephrine by taking successively smaller doses less frequently. Talk with your doctor or rehabilitation specialist if your withdrawal symptoms prevent you from discontinuing this drug.

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Drug Interactions

Some drugs may interact with hydrocodone, carbinoxamine and phenylephrine in dangerous or unwanted ways. Give the prescribing physician and pharmacist filling the order a list of all your medications, including prescription and non-prescription drugs, herbal remedies and vitamin supplements. Do not start, stop or change the way you take any medicine, remedy or supplement without first consulting with a physician.

Beta-blockers, COMT inhibitors, furazolidone, indomethacin, MAO inhibitors, sodium oxybate or tricyclic antidepressants may increase the risk for side effects associated with hydrocodone, carbinoxamine and phenylephrine polydrugs. Taking barbiturates, cimetidine, digoxin, droxidopa or sodium oxybate alongside hydrocodone, carbinoxamine and phenylephrine may increase the risk of severe drowsiness, breathing problems, seizures, irregular heartbeat or heart attack. Naltrexone may reduce the effectiveness of hydrocodone, carbinoxamine and phenylephrine. Hydrocodone, carbinoxamine and phenylephrine may increase the risk for side effects associated with bromocriptine or hydantoins, especially phenytoin. Hydrocodone, carbinoxamine and phenylephrine may decrease the effectiveness of other drugs, such as reserpine, guanadrel, guanethidine, methyldopa and mecamylamine.

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Side effects

Patients have reported side effects associated with hydrocodone, carbinoxamine and phenylephrine polydrugs. Most of the commonly reported side effects are not serious. Continue taking your medication if you experience these non-serious side effects but notify your physician if these side effects become intolerable or if they do not disappear on their own.

Common side effects include:

  • Constipation or Diarrhea.
  • Dry Eyes.
  • Dry Mouth.
  • Fatigue or Drowsiness.
  • Feelings of Anxiety or Nervousness.
  • Flushing.
  • Insomnia.
  • Loss of Appetite.
  • Mild Headache.
  • Nausea.
  • Sweating.
  • Tremor.

Some side effects are serious, even life threatening. Stop taking hydrocodone, carbinoxamine and phenylephrine and contact your doctor or go to the emergency room immediately if you suffer any serious side effects. Take all your medications to the doctor's office or hospital with you to help urgent care staff understand the cause of your side effects.

Serious side effects:

  • Agitation, Nervousness, Excitability.
  • Blurry Vision or Changes in Eyesight.
  • Chest Pain.
  • Confusion.
  • Fainting or Persistent Dizziness.
  • Fast, Slow or Irregular Heartbeat.
  • Hallucinations.
  • High Blood Pressure.
  • Insomnia.
  • Pain or Difficulty Passing Urine.
  • Seizures.
  • Severe, Persistent, or Worsening Headache.
  • Skin Rash, Hives or Itching.
  • Trouble Breathing.
  • Vomiting.
  • Wheezing or Shortness of Breath.

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Overdose

Drug overdose is a serious, potentially fatal medical emergency. In 2008, more than 14,800 people died from drug overdose, three times as many than had died from OD in 1990. If you suspect you or someone you know has taken too much hydrocodone, carbinoxamine and phenylephrine or any other drug, immediately contact poison control center at 1-800-222-1222 or go to the emergency room.

Take all your medications to the doctor's office or hospital with you to help urgent care staff decipher how much medicine you took. While you are at the emergency department, you can expect life saving treatment such as stomach pumping, medicines to lower the amount of the overdosed drug, intravenous fluids, life support and other measures. Overdose symptoms include:

  • Cold, Clammy Skin.
  • Confusion.
  • Dilated Pupils.
  • Flushing, Redness of the Skin.
  • Hallucinations.
  • Labored Breathing.
  • Loss of Coordination.
  • Overexcitement.
  • Seizure.
  • Severe Dizziness, Drowsiness, Lightheadedness or Headache
  • Severe Vomiting.
  • Unusually Fast, Slow or Irregular Heartbeat.

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Abuse

To abuse a drug means to use it to treat symptoms without a prescription or to get high. Medical experts refer to this practice as using a drug non-medically. The Centers for Disease Control and Prevention, or CDC, states that 12 million Americans admit to using a prescription drug for non-medical purposes in 2008. More than half of these people got the drug free from friends or family members in a process the DEA calls diversion. Hydrocodone is the most widely prescribed painkiller in the United States and it is one of the most widely diverted. While Americans represent less than 5 percent of the world's population, it consumes 80 percent of the world's supply of pain medications.

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Withdrawal

Withdrawal is a normal, predictable physiological response to dropping levels of a chemical on which the body has become dependent. You experience symptoms of withdrawal as your body tries to stabilize its blood chemistry after you stop taking opioids such as hydrocodone. Withdrawal is a physically uncomfortable process and the flu-like symptoms of withdrawal can be overpowering enough to prevent successful rehabilitation. Withdrawal symptoms include:

  • Anxiety.
  • Diarrhea.
  • Fever, Runny Nose or Sneezing.
  • Goose Bumps and Abnormal Skin Sensations.
  • Hallucinations.
  • Insomnia.
  • Nausea or Vomiting.
  • Pain.
  • Rapid Heartbeat.
  • Rigid Muscles.
  • Shivering, Tremors.
  • Sweating.

Detox

The first phase of drug rehabilitation focuses on the physical process of withdrawal and the second phase deals with the psychological and social aspects of dependence to opioids such as hydrocodone. In the initial part of rehabilitation, doctors and nurses administer medications to ease withdrawal symptoms and drugs to cleanse and detoxify your body. While these drugs are strong, they do not completely mask the uncomfortable symptoms of withdrawal. These unpleasant symptoms last five days or longer. After withdrawal and detoxification, you may participate in counseling and other social services to address any family, work or legal issues that contributed to or were a result of your dependence on drugs.

Rapid detox is the newest, most humane approach to drug rehabilitation. During rapid detox, highly trained physicians administer anesthesia and sedatives alongside the standard anti-withdrawal and detoxification drugs. You sleep through the first phase of rehabilitation. When you awaken, you will have no memory of the unpleasant withdrawal symptoms and you can then focus on the psychological and social aspects of your dependence on drugs. Rapid detox cuts the withdrawal process from days to hours, speeding your rehabilitation from opioids such as hydrocodone.

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Storage

Put hydrocodone, carbinoxamine and phenylephrine in a safe location where others cannot access it. Keep hydrocodone, carbinoxamine and phenylephrine at room temperature, between 59 and 86 degrees Fahrenheit, away from light. Do not transfer this medication to any other container.

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