Can dextromethorphan be given with hydrocodone (Hydrocodone)?

From the Guidelines

Dextromethorphan should not be given with hydrocodone due to potentially dangerous drug interactions. These medications can interact to cause increased central nervous system depression, which may lead to excessive sedation, respiratory depression, and in severe cases, coma or death. Both medications affect the central nervous system, with hydrocodone being an opioid pain reliever and dextromethorphan a cough suppressant that works on the brain's cough center. According to the study by Molassiotis et al. 1, opioids such as hydrocodone are recommended for the management of cough in patients with lung cancer, but there is no mention of combining them with dextromethorphan. In fact, the study suggests that morphine should be used if the cough is not suppressed by other opioid derivatives or other means, including other centrally acting antitussives such as dextromethorphan, implying that they should not be used together. Additionally, some individuals may experience serotonin syndrome when these medications are combined, particularly if they are taking other serotonergic medications. Symptoms of serotonin syndrome include confusion, rapid heart rate, high blood pressure, dilated pupils, muscle rigidity, and hyperthermia. If you are taking hydrocodone for pain and need cough relief, consult your healthcare provider for safer alternatives. They may recommend a different cough suppressant or adjust your medication regimen to avoid this potentially harmful interaction.

Some key points to consider when managing cough in patients with lung cancer include:

• The use of centrally acting cough suppressants such as dihydrocodeine and hydrocodone is recommended 1
• The choice of treatment may be dictated primarily by availability rather than pharmacologic parameters 1
• Local anesthetics, such as nebulized lidocaine, have been suggested to be helpful in case studies and are commonly used in palliative care for intractable cough that has not responded to any other approaches 1
• Doses used in the medications mentioned vary from country to country, and it is essential to follow the recommended dosage to avoid adverse effects 1

In terms of dosage, the study by Molassiotis et al. 1 provides indicative doses for antitussives, demulcents, and topical anesthetics, including:

• Dextromethorphan: 10-15 mg tid or qid (10-30 mg in some publications, maximum dose of 120 mg/d)
• Hydrocodone: 5 mg bid
• Morphine (Oramorph): 5 mg (single-dose trial of Oramorph; if effective 5-10 mg slow-release morphine bid)

It is crucial to consult a healthcare provider before taking any medication, especially when combining different medications, to ensure safe and effective treatment.

From the Research

Dextromethorphan and Hydrocodone Interaction

• There is no direct evidence in the provided studies that discusses the interaction between dextromethorphan and hydrocodone 2, 3, 4, 5, 6.
• However, it is known that dextromethorphan is a non-opioid antitussive, while hydrocodone is an opioid 5.
• The study by 6 compares the antitussive activity of dextromethorphan and codeine, another opioid, in patients with chronic cough, but does not discuss interactions between dextromethorphan and hydrocodone.
• The study by 3 mentions that co-administration of monoamine oxidase inhibiting (MAOI) drugs and dextromethorphan can lead to safety concerns, but does not discuss interactions with opioids like hydrocodone.
• The study by 2 provides guidelines for the management of dextromethorphan ingestion, including the potential for interactions with other substances, but does not specifically discuss hydrocodone.

Safety Considerations

• When considering the use of dextromethorphan with other medications, it is essential to assess the potential for interactions and adjust management recommendations accordingly 2.
• The safety profile of dextromethorphan is generally reassuring, particularly relating to overdose in adults and children 3.
• However, caution is needed when co-administering dextromethorphan with other substances that may interact with it, such as MAOIs or selective serotonin reuptake inhibitors 2, 3.