Hydrocodone overdose
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overdosage topics
Manifestations
Serious overdosage with hydrocodone is characterized by respiratory depression (a decrease in
respiratory rate and/or tidal volume, Cheyne-Stokes respiration, cyanosis), extreme somnolence
progressing to stupor or coma, skeletal muscle flaccidity, cold and clammy skin, and sometimes
bradycardia and hypotension. Although miosis is characteristic of narcotic overdose, mydriasis
may occur in terminal narcosis or severe hypoxia. In severe overdosage apnea, circulatory
collapse, cardiac arrest and death may occur. The manifestations of chlorpheniramine overdosage
may vary from central nervous system depression to stimulation.
Treatment
Primary attention should be given to the reestablishment of adequate respiratory exchange
through provision of a patent airway and the institution of assisted or controlled ventilation. The
narcotic antagonist naloxone hydrochloride is a specific antidote for respiratory depression which
may result from overdosage or unusual sensitivity to narcotics including hydrocodone. Therefore,
an appropriate dose of naloxone hydrochloride should be administered, preferably by the
intravenous route, simultaneously with efforts at respiratory resuscitation. Since the duration of
action of hydrocodone in this formulation may exceed that of the antagonist, the patient should be
kept under continued surveillance and repeated doses of the antagonist should be administered as
needed to maintain adequate respiration. For further information, see full prescribing information
for naloxone hydrochloride. An antagonist should not be administered in the absence of clinically
significant respiratory depression. Oxygen, intravenous fluids, vasopressors and other supportive
measures should be employed as indicated. Gastric emptying may be useful in removing
unabsorbed drug.
Adapted from the FDA Package Insert.