What are the implications for a patient experiencing vomiting while taking hydrocodone (every 8 hours)?

From the Guidelines

The patient experiencing vomiting while on hydrocodone every 8 hours should contact their healthcare provider immediately to discuss potential medication adjustments, such as adding an antiemetic like ondansetron or metoclopramide, as nausea and vomiting are common side effects of opioid medications. According to the most recent guidelines from the National Comprehensive Cancer Network 1, prophylactic treatment with antiemetic agents is highly recommended for patients with a prior history of opioid-induced nausea. If nausea develops, other causes of nausea must be assessed, and effective agents like phenothiazines or dopamine receptor antagonists may be considered.

Some key points to consider in managing opioid-induced nausea and vomiting include:

• Adding therapies that target different mechanisms of action, resulting in a synergistic effect, may be helpful 1
• Serotonin receptor antagonists like granisetron or ondansetron may be beneficial and have a lower rate of CNS effects 1
• Corticosteroids can also be quite beneficial for reducing opioid-induced nausea and vomiting, particularly in combination with metoclopramide and ondansetron 1
• If nausea persists for longer than a week, the cause of nausea needs to be reassessed, and opioid rotation must be considered 1

It is essential to stay hydrated with small sips of clear fluids to prevent dehydration while experiencing vomiting. The vomiting occurs because hydrocodone stimulates the chemoreceptor trigger zone in the brain and slows gastrointestinal motility. If vomiting is severe or persistent, this could indicate an adverse reaction requiring prompt medical attention, especially if accompanied by severe abdominal pain, dizziness, or confusion. Never adjust the hydrocodone dosage without medical supervision, as this medication requires careful management.

From the FDA Drug Label

The possible side effects of hydrocodone Bitartrate and Acetaminophen Tablets: constipation, nausea, sleepiness, vomiting, tiredness, headache, dizziness, abdominal pain. Call your healthcare provider if you have any of these symptoms and they are severe

The patient on hydrocodone q8hrs experiencing vomiting may be experiencing a side effect of the medication. Vomiting is a possible side effect of hydrocodone. The patient should be advised to call their healthcare provider if the vomiting is severe 2.

From the Research

Patient on Hydrocodone q8hrs with Vomiting

• The patient is experiencing vomiting while taking hydrocodone every 8 hours, which may be related to opioid-induced nausea and vomiting (OINV) 3.
• A study found that combining hydrocodone with a low-dose antiemetic, such as promethazine, can reduce the incidence of OINV by 64% compared to hydrocodone alone 3.
• Another study suggests that taking opioids with food may not consistently reduce nausea and vomiting, and in some cases, may even increase the frequency of these adverse events 4.
• For preventing postoperative nausea and vomiting, a network meta-analysis found that certain antiemetic drugs, such as aprepitant, ramosetron, and granisetron, can be effective in reducing vomiting, with high-certainty evidence 5.
• The study also found that combinations of drugs were generally more effective than single drugs in preventing vomiting, and that NK₁ receptor antagonists were the most effective drug class 5.

Management of OINV

• The use of antiemetic drugs, such as promethazine, can be effective in preventing OINV 3.
• Other antiemetic drugs, such as ondansetron and droperidol, may also be effective in reducing vomiting, although the certainty of evidence for these drugs is lower 5.
• The choice of antiemetic drug and dosage should be based on the individual patient's needs and medical history, as well as the specific opioid being used 5, 3.

Hydrocodone Pharmacokinetics

• A study found that hydrocodone is frequently detected in oral fluid and blood within 15-30 minutes after administration, with a mean oral fluid to blood ratio of 3.2 6.
• The period of detection for hydrocodone in oral fluid exceeded that in blood at all evaluated thresholds, with a mean detection time of 30 hours at a 1-ng/mL threshold 6.