From the Guidelines
Hydrocodone can significantly affect both the heart and lungs, particularly by causing respiratory depression, which can lead to severe ventilatory impairment and potentially life-threatening outcomes. The primary concern with hydrocodone's impact on the heart and lungs is its potential to cause depression of the respiratory centre in the brainstem, leading to reduced alveolar ventilation, which can result in severe opioid-induced ventilatory impairment 1. This condition, if unrecognized and untreated, may lead to brain injury or death. Furthermore, hydrocodone can cause reduced oropharyngeal muscle tone, resulting in upper airway obstruction, and depression of the hypothalamus, leading to increased arousal thresholds and reduced wakefulness (sedation) 1.
Regarding the heart, while the direct effects of hydrocodone on cardiac function are less commonly highlighted, the overall impact of opioid use, including hydrocodone, on the cardiovascular system should not be overlooked. Opioids can indirectly affect heart health by potentially leading to hypoxia due to respiratory depression, which can have severe consequences on the cardiovascular system.
It's crucial to consider the dosage and duration of hydrocodone treatment, as higher doses and longer treatment durations are associated with increased risks of opioid misuse, overdose, and death 1. The risk of overdose and death increases with doses above 50 MME/day, and careful consideration should be given before increasing the dosage to this level or beyond.
Given the potential for severe respiratory depression and other adverse effects, it is essential to use hydrocodone with caution, closely monitor patients for signs of respiratory depression, and consider alternative pain management strategies when possible. Patients with pre-existing respiratory or cardiac conditions should be particularly cautious, and healthcare providers should discuss these risks and consider the benefits and risks of hydrocodone therapy on an individual basis. Additionally, the use of naloxone, an opioid receptor antagonist, can rapidly reverse CNS and respiratory depression in cases of opioid overdose, highlighting the importance of having such reversal agents available when prescribing opioids like hydrocodone 1.
From the FDA Drug Label
Hydrocodone produces respiratory depression by direct action on brain stem respiratory centers. The respiratory depression involves a reduction in the responsiveness of the brain stem respiratory centers to both increases in carbon dioxide tension and electrical stimulation Hydrocodone produces peripheral vasodilation which may result in orthostatic hypotension or syncope. Patients with Chronic Pulmonary Disease: Hydrocodone Bitartrate and Acetaminophen Tablet-treated patients with significant chronic obstructive pulmonary disease or cor pulmonale, and those with a substantially decreased respiratory reserve, hypoxia, hypercapnia, or pre-existing respiratory depression are at increased risk of decreased respiratory drive including apnea, even at recommended dosages of Hydrocodone Bitartrate and Acetaminophen Tablets
Hydrocodone affects the heart and lungs by:
- Producing respiratory depression
- Causing peripheral vasodilation, which may result in orthostatic hypotension or syncope
- Increasing the risk of decreased respiratory drive, including apnea, in patients with chronic pulmonary disease
- Potentially causing pulmonary edema, bradycardia, and hypotension in the case of an overdose 2, 2, 2
From the Research
Effects of Hydrocodone on the Heart and Lungs
- Hydrocodone, an opioid, can affect the heart and lungs in various ways, including:
- Respiratory depression: Hydrocodone can cause respiratory depression by decreasing sensitivity of peripheral chemoreceptors to carbon dioxide and decreasing activity in the central respiratory centers 3, 4.
- Pulmonary complications: Opioids, including hydrocodone, can cause pulmonary complications such as non-cardiogenic pulmonary edema, granulomatous change, and increased risk of infectious complications 3, 5.
- Cardiovascular effects: Hydrocodone can also affect the heart, particularly in patients with pre-existing heart conditions, such as heart failure and chronic obstructive pulmonary disease (COPD) 6.
- Risk factors for opioid-induced respiratory depression include:
- Elderly age
- Female sex
- Presence of obstructive sleep apnea
- Chronic obstructive pulmonary disease
- Cardiac disease
- Diabetes mellitus
- Hypertension
- Neurologic disease
- Renal disease
- Obesity
- Two or more comorbidities
- Opioid dependence
- Use of patient-controlled analgesia
- Concomitant administration of sedatives 7
- It is essential to carefully titrate the dose of hydrocodone in patients with underlying risk factors and to enhance monitoring of sedation level, respiratory rate, pulse oximetry, and capnography, particularly in the first 24 hours after surgery 7.