hydrocodone / aspirin

• Risk factors: Personal or family history of substance or alcohol abuse | History of mental health conditions | Taking more of hydrocodone/aspirin than prescribed or taking it for a long time

Taking hydrocodone/aspirin can lead to abuse, misuse, or addiction, even if you take it at the recommended dose. This can cause serious problems, such as overdose and death. Because of this risk, the FDA has required this medication and all opioids to be under a Risk Evaluation and Mitigation Strategy (REMS) program. This means your provider or pharmacist will talk to you about proper use, serious risks, and appropriate storage and disposal of this medication in order to keep you and your loved ones safe.

• Risk factors: Age 65 years or older | History of severe chronic obstructive pulmonary disease (COPD) | History of severe weakness or muscle loss (debilitation) | Drinking alcohol | Taking medications that affect your mental state | Taking high doses of hydrocodone/aspirin

Hydrocodone/aspirin can slow your breathing down to the point where it's life-threatening. This can cause symptoms, such as shortness of breath, slow and shallow breathing, and bluish-colored lips, fingers, or toes. If this change in your breathing isn't recognized and treated right away, it can lead to death. Though this can happen at any time while you're taking hydrocodone/aspirin, the risk is the highest when you first start the medication or when your dose is raised.

Drinking alcohol and taking medications that affect your mental state, such as benzodiazepines, sedatives, some muscle relaxants, and some mental health medications, can slow your breathing even further, which can lead to unconsciousness, coma, and death. Hydrocodone/aspirin is especially dangerous for children, who can experience slowed breathing and death even from one accidental dose of hydrocodone/aspirin. Your provider will monitor you closely for slowed breathing for the first few days after you start taking hydrocodone/aspirin or after they prescribe a higher dose.

Your provider might also prescribe naloxone (Narcan or Evzio), which is a medication that can temporarily reverse the effects of hydrocodone/aspirin in case of an accidental overdose. It's important that you and your caregiver know when and how to administer naloxone. If you experience any of the symptoms mentioned above, get emergency medical help right away even if naloxone was administered.

Certain medications can interfere with how your body gets rid of hydrocodone/aspirin. This can affect the amount of hydrocodone/aspirin in your body, how well it works, and the risk of side effects.

Some medications, like erythromycin (Ery-Tab), ketoconazole, and ritonavir (Norvir), can raise the levels of hydrocodone/aspirin in your body, especially if you start one of these medications while you're already on a stable dose of hydrocodone/aspirin. Higher levels can lead to potentially deadly slowed breathing.

On the other hand, medications, such as rifampin (Rifadin), carbamazepine (Tegretol), and phenytoin (Dilantin), can lower the levels of hydrocodone/aspirin in your body. This can cause hydrocodone/aspirin to not work as well, and it might cause bothersome side effects.

In addition, if you're already on stable doses of hydrocodone/aspirin together with one of these other medications, don't stop taking them suddenly, since this can also lead to unsafe hydrocodone/aspirin levels. Let your provider or pharmacist know what other medications you’re taking before starting hydrocodone/aspirin to make sure your medications are safe for you to take.

• Risk factors: Long-term use during pregnancy

Taking hydrocodone/aspirin for a long period of time during pregnancy can cause neonatal opioid withdrawal syndrome. This is a condition where your unborn baby becomes dependent on hydrocodone/aspirin while in the womb, because the medication is passed into their system through the placenta. Once your baby is born and they're no longer exposed to hydrocodone/aspirin, they experience withdrawal symptoms, such as poor feeding or sucking, breathing problems, fever, high-pitched crying, or seizures. This can be life-threatening if it's not recognized and treated, and your baby will need special care after birth from experts in this area.

Hydrocodone/aspirin can also affect your baby's kidneys and the amount of fluid in your belly (amniotic fluid) if it's taken at 20 weeks of pregnancy or later. After 30 weeks of pregnancy, hydrocodone/aspirin can cause heart defects in your unborn baby. It's important that you talk to your provider about the risks and benefits of taking this medication for long periods of time if you're pregnant.

• Risk factors: History of stomach bleeding or ulcers | Taking corticosteroids, blood thinners, aspirin, and certain antidepressants | Smoking | Alcohol use | Severe liver disease | History of bleeding problems | Taking NSAIDs at high doses or for long periods of time | Age 65 years or older | Having poor health

Hydrocodone/aspirin can cause serious problems, such as ulcers, bleeding, and tears in the stomach, intestines, or esophagus (tube that leads from your mouth to your stomach). This can happen at any time without warning while you’re taking hydrocodone/aspirin, and it can lead to death. Get medical help right away if you vomit blood, have bloody stool, or if your stool is black and sticky like tar.

Hydrocodone/aspirin can cause your body to produce less hormones. This is more likely to happen if you've been taking hydrocodone/aspirin for more than one month. Let your provider know if you develop nausea, vomiting, loss of appetite, tiredness, weakness, dizziness, or low blood pressure, because these can be signs that your body isn't making enough hormones.

• Risk factors: Age 65 years or older | Taking other medications that lower blood pressure | History of low blood volume | Taking certain medications that alter your mental state

Hydrocodone/aspirin can cause extremely low blood pressure, including a drop in blood pressure when you stand from a sitting or lying down position. This can lead to dizziness and fainting. To avoid falling, get up slowly if you've been sitting or lying down. If dizziness or lightheadedness doesn't go away, talk to your healthcare provider.

• Risk factors: Taking hydrocodone/aspirin or other NSAIDs for a long period of time or at high doses | History of kidney problems | Dehydration | Low blood volume | History of heart failure | History of liver problems | Taking water pills or medications called ACE inhibitors (i.e., lisinopril (Zestril), enalapril (Vasotec)) or angiotensin receptor blockers (i.e., losartan (Cozaar), valsartan (Diovan)) | Age 65 years or older

Taking hydrocodone/aspirin or other NSAIDs at high doses or for long periods of time can lower the blood flow to your kidneys, which can cause kidney damage. If you have severe kidney problems, it's not recommended that you take hydrocodone/aspirin unless you really need to. Your provider might order blood tests to monitor your kidneys while you're taking this medication.

• Risk factors: History of seizures

The hydrocodone in hydrocodone/aspirin can cause people with a history of seizures to have seizures more often. It can also raise your risk of seizures in certain situations. Let your healthcare provider know if you've had seizures in the past before you start taking hydrocodone/aspirin.

The aspirin in hydrocodone/aspirin can cause a rare but serious condition called Reye's syndrome if it is taken by children or teenagers who have viral infections, with or without a fever. Reye's syndrome is known to cause brain and liver damage, which can be life-threatening. Children and teenagers should avoid using hydrocodone/aspirin if they have a viral infection.

Hydrocodone/aspirin can cause serious skin reactions that can lead to death. If you develop any type of rash, fever, swollen lymph nodes, and swelling in the face, stop taking hydrocodone/aspirin right away, and contact your provider as soon as possible.

• Risk factors: Chronic, heavy alcohol use (more than 3 drinks per day)

Hydrocodone/aspirin can make it harder for your body to form blood clots, which puts you at a higher risk of bleeding. Drinking more than 3 alcoholic drinks a day while taking hydrocodone/aspirin also raises your risk of bleeding. Hydrocodone/aspirin should not be used in people who have bleeding conditions such as hemophilia.