What is Hycodan (Hydrocodone)?
Hycodan is a liquid hydrocodone formulation (hydrocodone bitartrate combined with homatropine) used as a prescription opioid antitussive (cough suppressant) for managing refractory cough, particularly in cancer-related and chronic cough conditions. 1, 2
Medication Composition and Mechanism
Hydrocodone is a full opioid agonist with selectivity for the mu-opioid (μ) receptor that acts centrally on brain stem respiratory centers to suppress the cough reflex 2
The liquid formulation (Hycodan) combines hydrocodone bitartrate with homatropine, a peripherally-acting anticholinergic agent 2, 3
Hydrocodone bitartrate occurs as fine, white crystals or crystalline powder and is affected by light 2
Clinical Indications and Evidence Base
Hydrocodone is one of the most effective centrally-acting cough suppressants for patients with lung cancer and refractory chronic cough, with demonstrated effectiveness in reducing cough frequency by a median of 70% (range 50-90%) 4, 5
The American College of Chest Physicians recommends centrally acting cough suppressants such as hydrocodone for patients with cough and lung cancer (Grade C recommendation) 4
Hydrocodone has been extensively studied and used for cough suppression with a good safety profile, though most robust evidence exists specifically for cancer-related cough 1
Dosing Guidelines
Initial dosing typically starts at 5 mg twice daily (10 mg/day total) for cough suppression in adults, with dose titration as needed 1, 5
The median effective dose for optimal cough control is 10 mg/day, though some patients may require up to 30-60 mg/day with careful titration 5
The liquid formulation allows for flexible dosing, which is particularly important given that effective doses vary significantly between patients 1
Most patients achieve improvement within one day of starting therapy 5
Safety Profile and Side Effects
Common side effects include dry mouth, nausea, and drowsiness, which are generally mild and tolerable 5
Caution must be exercised with graduated doses due to risk of respiratory depression and hypoventilation 4
Hydrocodone produces dose-related effects including miosis (pinpoint pupils), peripheral vasodilation, constipation, and potential for physical dependence 2
At the highest doses tested (20 mg hydrocodone/6 mg homatropine), Hycodan produces both pleasant and unpleasant subjective effects similar to morphine 3
Critical Prescribing Considerations
Hydrocodone is contraindicated in patients under 18 years of age for cough treatment, as the FDA determined the benefit-risk profile is unfavorable in pediatric populations due to lack of efficacy data and risk of serious adverse events including respiratory depression 6
Hydrocodone should be reserved for refractory cough that has not responded to non-opioid treatments, as it carries risks of addiction, abuse/misuse, and serious adverse events 7
The medication influences the hypothalamic-pituitary-gonadal axis with chronic use, potentially causing androgen deficiency manifesting as low libido, impotence, erectile dysfunction, amenorrhea, or infertility 2
Although hydrocodone is widely used for cough, it has not been specifically studied in patients with common cold, unlike its use in cancer-related cough 8
Comparison to Alternative Agents
Dextromethorphan has been shown to be more effective than codeine in controlling cough, though hydrocodone remains a preferred option for refractory cases 4
Codeine has similar efficacy but hydrocodone may offer advantages in specific clinical contexts, particularly cancer-related cough 4
Levodropropizine (not available in the United States) showed similar antitussive efficacy to dihydrocodeine with significantly lower somnolence rates (8% vs 22%) 4