Hydrocodone

Hydrocodone is an opioid pain medication. An opioid is sometimes called a narcotic.

Zohydro ER and Hysingla ER are extended-release forms of hydrocodone that are used for around-the-clock treatment of severe pain. Extended-release hydrocodone is not for use on an as-needed basis for pain.

Hydrocodone may also be used for purposes not listed in this medication guide.

Hydrocodone can slow or stop your breathing. Never use this medicine in larger amounts, or for longer than prescribed. Do not crush, break, or open an extended-release pill. Swallow it whole to avoid exposure to a potentially fatal dose. Hydrocodone may be habit-forming, even at regular doses. Never share this medicine with another person, especially someone with a history of drug abuse or addiction. Keep the medication in a place where others cannot get to it.

MISUSE OF NARCOTIC MEDICINE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH, especially in a child or other person using the medicine without a prescription.

You should not use this medicine if you have severe asthma or breathing problems, or a blockage in your stomach or intestines.

Tell your doctor if you are pregnant. Hydrocodone may cause life-threatening withdrawal symptoms in a newborn.

Do not drink alcohol. Dangerous side effects or death can occur when alcohol is combined with hydrocodone.

You should not use hydrocodone if you are allergic to it, or if you have:

• severe asthma or breathing problems; or
• a bowel obstruction called paralytic ileus.

To make sure hydrocodone is safe for you, tell your doctor if you have:

• any type of breathing problem or lung disease;
• a history of head injury, brain tumor, or seizures;
• a history of drug abuse, alcohol addiction, or mental illness;
• urination problems;
• liver or kidney disease;
• a heart rhythm disorder called long QT syndrome;
• a blockage in your stomach or intestines; or
• problems with your gallbladder, pancreas, or thyroid.

It is not known whether this medicine will harm an unborn baby. If you use hydrocodone while you are pregnant, your baby could become dependent on the drug. This can cause life-threatening withdrawal symptoms in the baby after it is born. Babies born dependent on habit-forming medicine may need medical treatment for several weeks. Tell your doctor if you are pregnant or plan to become pregnant.

Hydrocodone can pass into breast milk and may harm a nursing baby. You should not breast-feed while you are using hydrocodone.

Do not drink alcohol. Dangerous side effects or death can occur when alcohol is combined with hydrocodone. Check your food and medicine labels to be sure these products do not contain alcohol.

This medication may impair your thinking or reactions. Avoid driving or operating machinery until you know how hydrocodone will affect you. Dizziness or severe drowsiness can cause falls or other accidents.

Taking this medicine with other drugs that make you sleepy or slow your breathing can cause dangerous or life-threatening side effects. Ask your doctor before taking hydrocodone with a sleeping pill, muscle relaxer, other pain medicine, or medicine for anxiety, depression, or seizures.

Other drugs may interact with hydrocodone, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Follow all directions on your prescription label. Hydrocodone can slow or stop your breathing, especially when you start using this medicine or whenever your dose is changed. Never use hydrocodone in larger amounts, or for longer than prescribed. Tell your doctor if the medicine seems to stop working as well in relieving your pain.

Hydrocodone may be habit-forming, even at regular doses. Never share this medicine with another person, especially someone with a history of drug abuse or addiction. MISUSE OF NARCOTIC MEDICINE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH, especially in a child or other person using the medicine without a prescription. Selling or giving away hydrocodone is against the law.

Your dose needs may be different if you have recently used a similar opioid (narcotic) pain medicine and your body is tolerant to it. Talk with your doctor if you are not sure you are opioid-tolerant.

Do not crush, break, or open an extended-release pill. Swallow it whole to avoid exposure to a potentially fatal dose.

Do not stop using this medicine suddenly after long-term use, or you could have unpleasant withdrawal symptoms. Ask your doctor how to safely stop using hydrocodone.

Never crush or break a hydrocodone pill to inhale the powder or mix it into a liquid to inject the drug into your vein. This practice has resulted in death with the misuse of hydrocodone and similar prescription drugs.

Store at room temperature, away from heat, moisture, and light. Keep the medication in a place where others cannot get to it.

Keep track of the amount of medicine used from each new bottle. Hydrocodone is a drug of abuse and you should be aware if anyone is using your medicine improperly or without a prescription.

Do not keep leftover hydrocodone pills. Ask your pharmacist where to locate a drug take-back disposal program. If there is no take-back program, flush any unused pills down the toilet.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. A hydrocodone overdose can be fatal, especially in a child or other person using the medicine without a prescription. Overdose symptoms may include slow breathing and heart rate, severe drowsiness, muscle weakness, cold and clammy skin, pinpoint pupils, and fainting.

Since hydrocodone is used for pain, you are not likely to miss a dose. Skip any missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Capsule ER 12 Hour Abuse-Deterrent, Oral, as bitartrate:

Zohydro ER: 10 mg (60 ea); 15 mg (60 ea); 20 mg (60 ea); 30 mg (60 ea); 40 mg (60 ea); 50 mg (60 ea) [contains brilliant blue fcf (fd&c blue #1), fd&c red #40]

Capsule Extended Release 12 Hour, Oral, as bitartrate:

Zohydro ER: 10 mg [DSC], 15 mg [DSC], 20 mg [DSC], 30 mg [DSC], 40 mg [DSC], 50 mg [DSC] [contains brilliant blue fcf (fd&c blue #1), fd&c red #40]

Tablet ER 24 Hour Abuse-Deterrent, Oral, as bitartrate:

Hysingla ER: 20 mg [contains fd&c blue #2 aluminum lake]

Hysingla ER: 30 mg, 40 mg, 60 mg, 80 mg

Hysingla ER: 100 mg [contains fd&c blue #2 aluminum lake]

Hysingla ER: 120 mg

Hypersensitivity (eg, anaphylaxis) to hydrocodone or any component of the formulation; GI obstruction, including paralytic ileus (known or suspected); significant respiratory depression; acute or severe bronchial asthma in an unmonitored setting or without resuscitative equipment.

Documentation of allergenic cross-reactivity for opioids is limited. However, because of similarities in chemical structure and/or pharmacologic actions, the possibility of cross-sensitivity cannot be ruled out with certainty.

Refer to adult dosing. Initiate dosing at the lower end of the dosage range. Monitor closely.

Store at 25°C (77° F); excursions are permitted between 15°C and 30°C (59°F and 86°F).

>10%: Gastrointestinal: Constipation (3% to 14%), nausea (7% to 12%)

1% to 10%:

Cardiovascular: Hypertension (≥1% to <5%), peripheral edema (3%)

Central nervous system: Headache (6%), chills (≥1% to <5%), sedation (≥1% to <5%), anxiety (4%), insomnia (3%), dizziness (2% to 3%), drowsiness (1% to 3%), fatigue (2%), depression, falling, lethargy, migraine, pain, paresthesia

Dermatologic: Pruritus (1%), hyperhidrosis, night sweats, skin rash

Endocrine & metabolic: Dehydration, hot flash, hypokalemia, increased gamma-glutamyl transferase, increased serum cholesterol

Gastrointestinal: Vomiting (5% to 6%), dyspepsia (≥1% to <5%), gastroenteritis (≥1% to <5%), upper abdominal pain (≥1% to <5%), viral gastroenteritis (≥1% to <5%), diarrhea (4%), abdominal pain (3%), decreased appetite (2%), xerostomia (1%), abdominal distress, gastroesophageal reflux disease

Genitourinary: Urinary tract infection (5%)

Hematologic & oncologic: Bruise

Infection: Influenza (3%)

Neuromuscular & skeletal: Back pain (4%), muscle spasm (3%), tremor (3%), arthralgia, bone fracture (foot), injury to the joint, joint sprain, limb pain, musculoskeletal chest pain, musculoskeletal pain, myalgia, neck pain, osteoarthritis, strain

Otic: Tinnitus (2%)

Respiratory: Bronchitis (≥1% to <5%), nasal congestion (≥1% to <5%), nasopharyngitis (≥1% to <5%), oropharyngeal pain (≥1% to <5%), sinusitis (≥1% to <5%), upper respiratory tract infection (3%), cough, dyspnea

Miscellaneous: Fever, laceration

<1%, postmarketing and/or case reports: Abdominal distention, abnormality in thinking, agitation, altered mental status, anaphylaxis, choking sensation, confusion, decreased libido, drug-induced hypersensitivity, drug withdrawal, dysphagia, edema, erythema, esophageal obstruction, flushing, hypogonadism (Brennan 2013; Debono, 2011), hypotension, hypoxia, increased thirst, intestinal obstruction, irritability, malaise, mood changes, muscle twitching, opioid dependence, orthostatic hypotension, palpitations, pancreatitis, presyncope, prolonged Q-T interval on ECG, respiratory depression, retching, syncope, urinary retention, weakness

Concerns related to adverse effects:

• Cardiovascular effects: QTc prolongation has been observed with hydrocodone ER following doses of 160 mg/day. Use with caution in patients with heart failure, bradyarrhythmias, electrolyte abnormalities or using other drugs known to prolong the QTc interval. Avoid use in patients with congenital long QT syndrome. If patients develop QTc prolongation, consider dose reduction of 33% to 50% or change to an alternate analgesic.

• CNS depression: May cause CNS depression, which may impair physical or mental abilities; patients must be cautioned about performing tasks which require mental alertness (eg, operating machinery, driving).

• Constipation: May cause constipation which may be problematic in patients with unstable angina and patients post-myocardial infarction. Consider preventive measures (eg, stool softener, increased fiber) to reduce the potential for constipation.

• Hypotension: May cause severe hypotension (including orthostatic hypotension and syncope); use with caution in patients with hypovolemia, cardiovascular disease (including acute myocardial infarction [MI]), or drugs that may exaggerate hypotensive effects (including phenothiazines or general anesthetics). Monitor for symptoms of hypotension following initiation or dose titration. Avoid use in patients with circulatory shock.

• Phenanthrene hypersensitivity: Use with caution in patients with hypersensitivity reactions to other phenanthrene-derivative opioid agonists (codeine, hydromorphone, levorphanol, oxycodone, oxymorphone).

• Respiratory depression: [US Boxed Warning]: Serious, life-threatening, or fatal respiratory depression may occur. Monitor closely for respiratory depression, especially during initiation or dose escalation. Swallow ER capsules or tablets whole; crushing, chewing, or dissolving can cause rapid release and a potentially fatal dose. Carbon dioxide retention from opioid-induced respiratory depression can exacerbate the sedating effects of opioids.

Disease related concerns:

• Abdominal conditions: May obscure diagnosis or clinical course of patients with acute abdominal conditions.

• Adrenocortical insufficiency: Use with caution in patients with adrenal insufficiency, including Addison disease. Long-term opioid use may cause secondary hypogonadism, which may lead to sexual dysfunction, infertility, mood disorders, and osteoporosis (Brennan 2013).

• Biliary tract impairment: Use with caution in patients with biliary tract dysfunction or acute pancreatitis; may cause constriction of sphincter of Oddi.

• CNS depression/coma: Avoid use in patients with impaired consciousness or coma as these patients are susceptible to intracranial effects of CO2 retention.

• Delirium tremens: Use with caution in patients with delirium tremens.

• Head trauma: Use with extreme caution in patients with head injury, intracranial lesions, or elevated intracranial pressure (ICP); exaggerated elevation of ICP may occur.

• Hepatic impairment: Use with caution in patients with hepatic impairment; dose adjustment may be needed. Vantrela ER is not recommended in patients with severe hepatic impairment.

• Mental health conditions: Use opioids with caution for chronic pain in patients with mental health conditions (eg, depression, anxiety disorders, post-traumatic stress disorder) due to increased risk for opioid use disorder and overdose; more frequent monitoring is recommended (Dowell [CDC 2016]).

• Obesity: Use with caution in patients who are morbidly obese.

• Prostatic hyperplasia/urinary stricture: Use with caution in patients with prostatic hyperplasia and/or urinary stricture.

• Psychosis: Use with caution in patients with toxic psychosis.

• Renal impairment: Use with caution in patients with moderate to severe renal impairment; dose adjustment may be needed.

• Respiratory disease: Use with caution and monitor for respiratory depression in patients with significant chronic obstructive pulmonary disease or cor pulmonale, and those having a substantially decreased respiratory reserve, hypoxia, hypercarbia, or preexisting respiratory depression, particularly when initiating therapy and titrating therapy; critical respiratory depression may occur, even at therapeutic dosages. Consider the use of alternative nonopioid analgesics in these patients.

• Seizures: Use with caution in patients with a history of seizure disorders; may cause or exacerbate preexisting seizures.

• Sleep-disordered breathing: Use opioids with caution for chronic pain and titrate dosage cautiously in patients with risk factors for sleep-disordered breathing, including HF and obesity. Avoid opioids in patients with moderate to severe sleep-disordered breathing (Dowell [CDC 2016]).

• Thyroid dysfunction: Use with caution in patients with thyroid dysfunction.

Concurrent drug therapy issues:

• Benzodiazepines or other CNS depressants: [US Boxed Warning]: Concomitant use of opioids with benzodiazepines or other CNS depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of hydrocodone ER and benzodiazepines or other CNS depressants for use in patients for whom alternative treatment options are inadequate. Limit dosage and durations to the minimum required and follow patients for signs and symptoms of respiratory depression and sedation.

• CYP 3A4 interactions: [US Boxed Warning]: Use with all CYP3A4 inhibitors may result in an increase in hydrocodone plasma concentrations, which could increase or prolong adverse drug effects and may cause potentially fatal respiratory depression. In addition, discontinuation of a concomitant CYP 3A4 inducer may result in increased hydrocodone concentrations. Monitor patients receiving hydrocodone ER and any CYP3A4 inhibitor or inducer.

• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.

• Ethanol use: Zohydro ER: [US Boxed Warning]: Do not administer hydrocodone ER with alcoholic beverages or ethanol-containing products because of the risk of increased plasma levels and potentially fatal overdose of hydrocodone. Alcohol may disrupt extended-release characteristic of product.

Special populations:

• Cachectic or debilitated patients: Use with caution in cachectic or debilitated patients; there is a greater potential for critical respiratory depression, even at therapeutic dosages. Consider the use of alternative nonopioid analgesics in these patients.

• Elderly: Use with caution in the elderly; may be more sensitive to adverse effects. Use opioids for chronic pain with caution in this age group; monitor closely due to an increased potential for risks, including certain risks such as falls/fracture, cognitive impairment, and constipation. Clearance may also be reduced in older adults (with or without renal impairment) resulting in a narrow therapeutic window and increasing the risk for respiratory depression or overdose (Dowell [CDC 2016]). Decrease initial dose. Consider the use of alternative nonopioid analgesics in these patients.

• Neonates: Neonatal withdrawal syndrome: [US Boxed Warning]: Prolonged use of opioids during pregnancy can cause neonatal withdrawal syndrome, which may be life-threatening if not recognized and treated according to protocols developed by neonatology experts. If opioid use is required for a prolonged period in a pregnant woman, advise the patient of the risk of neonatal opioid withdrawal syndrome and ensure that appropriate treatment will be available. Signs and symptoms include irritability, hyperactivity and abnormal sleep pattern, high-pitched cry, tremor, vomiting, diarrhea, and failure to gain weight. Onset, duration, and severity depend on the drug used, duration of use, maternal dose, and rate of drug elimination by the newborn.

Dosage form specific issues:

• Dysphagia/choking: Hysingla ER: Esophageal obstruction, dysphagia, and choking have occurred. Patients with underlying gastrointestinal (GI) disorders (eg, esophageal or colon cancer) with a small GI lumen are at greater risk. Consider the use of alternative analgesics in these patients. Do not presoak, lick, or wet tablets prior to ingestion; take 1 tablet at a time with enough water to ensure complete swallowing immediately after placing in mouth.

Other warnings/precautions:

• Abuse/misuse/diversion: [US Boxed Warning]: Use exposes patients and other users to the risks of addiction, abuse, and misuse, potentially leading to overdose and death. Assess each patient’s risk prior to prescribing; monitor all patients regularly for development of these behaviors or conditions. Use with caution in patients with a history of drug abuse or acute alcoholism; potential for drug dependency exists. Other factors associated with increased risk include younger age, concomitant depression (major), and psychotropic medication use. Consider offering naloxone prescriptions in patients with factors associated with an increased risk for overdose, such as history of overdose or substance use disorder, higher opioid dosages (≥50 morphine milligram equivalents/day orally), and concomitant benzodiazepine use (Dowell [CDC 2016]).

• Accidental ingestion: [US Boxed Warning]: Accidental ingestion of even one dose, especially in children, can result in a fatal overdose of hydrocodone.

• Appropriate use: Chronic pain (outside of end-of-life or palliative care, active cancer treatment, sickle cell disease, or medication-assisted treatment for opioid use disorder) in outpatient setting in adults: Opioids should not be used as first-line therapy for chronic pain management (pain >3-month duration or beyond time of normal tissue healing) due to limited short-term benefits, undetermined long-term benefits, and association with serious risks (eg, overdose, MI, auto accidents, risk of developing opioid use disorder). Preferred management includes nonpharmacologic therapy and nonopioid therapy (eg. NSAIDs, acetaminophen, certain anticonvulsants and antidepressants). If opioid therapy is initiated, it should be combined with nonpharmacologic and nonopioid therapy, as appropriate. Prior to initiation, known risks of opioid therapy should be discussed and realistic treatment goals for pain/function should be established, including consideration for discontinuation if benefits do not outweigh risks. Therapy should be continued only if clinically meaningful improvement in pain/function outweighs risks. Therapy should be initiated at the lowest effective dosage using immediate-release opioids (instead of extended-release/long-acting opioids). Risk associated with use increases with higher opioid dosages. Risks and benefits should be re-evaluated when increasing dosage to ≥50 morphine milligram equivalents (MME)/day orally; dosages ≥90 MME/day orally should be avoided unless carefully justified (Dowell [CDC 2016]).

• Optimal regimen: An opioid-containing analgesic regimen should be tailored to each patient's needs and based upon the type of pain being treated (acute versus chronic), the route of administration, degree of tolerance for opioids (naive versus chronic user), age, weight, and medical condition. The optimal analgesic dose varies widely among patients; doses should be titrated to pain relief/prevention.

• Surgery: Opioids decrease bowel motility; monitor for decreased bowel motility in postop patients receiving opioids. Use with caution in the perioperative setting; individualize treatment when transitioning from parenteral to oral analgesics.

• Withdrawal: Concurrent use of mixed agonist/antagonist analgesics (eg, pentazocine, nalbuphine, butorphanol) or partial agonist (eg, buprenorphine) analgesics may precipitate withdrawal symptoms and/or reduced analgesic efficacy in patients following prolonged therapy with mu opioid agonists. Taper dose gradually when discontinuing.

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience vomiting, or nausea. Have patient report immediately to prescriber slow breathing, shallow breathing, difficulty breathing, signs of low potassium (muscle pain or weakness, muscle cramps, or an abnormal heartbeat), severe fatigue, severe dizziness, passing out, angina, swelling of arms or legs, burning or numbness feeling, tachycardia, confusion, severe constipation, severe abdominal pain, severe loss of strength and energy, mood changes, memory impairment, severe headache, seizures, sexual dysfunction (men), amenorrhea, loss of libido, infertility, difficulty swallowing, painful urination, choking, signs of adrenal gland problems (severe nausea, vomiting, severe dizziness, passing out, muscle weakness, severe fatigue, mood changes, lack of appetite, or weight loss), or signs of serotonin syndrome (dizziness, severe headache, agitation, hallucinations, tachycardia, abnormal heartbeat, flushing, tremors, sweating a lot, change in balance, severe nausea, or severe diarrhea) (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.

Since hydrocodone is used for pain, you are not likely to miss a dose. Skip any missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. A hydrocodone overdose can be fatal, especially in a child or other person using the medicine without a prescription. Overdose symptoms may include slow breathing and heart rate, severe drowsiness, muscle weakness, cold and clammy skin, pinpoint pupils, and fainting.

-Extended-release capsules: Initial dose should be lowered; monitor closely for respiratory depression and sedation
-Extended-release tablets: Lower the initial dose to one-half the normal starting dose; monitor closely for respiratory depression and sedation

US REMS: The US FDA requires a Risk Evaluation and Mitigation Strategy (REMS) for EXTENDED-RELEASE (ER) AND LONG-ACTING (LA) OPIOID ANALGESICS including HYSINGLA ER and ZOHYDRO ER. This Shared System includes a medication guide and elements to assure safe use. For additional information: www.fda.gov/REMS

US BOXED WARNINGS: ADDICTION, ABUSE, AND MISUSE; LIFE-THREATENING RESPIRATORY DEPRESSION; ACCIDENTAL INGESTION; NEONATAL OPIOID WITHDRAWAL SYNDROME; INTERACTION WITH ALCOHOL; and CYP450 3A4 INTERACTION
-Addiction, Abuse, and Misuse
Hydrocodone ER exposes patients and other users to the risks of opioid addiction, abuse, and misuse, which can lead to overdose and death. Assess each patient's risk prior to prescribing this drug and monitor all patients regularly for the development of these behaviors or conditions.
-Life-threatening Respiratory Depression
Serious, life-threatening, or fatal respiratory depression may occur with use. Monitor for respiratory depression, especially during initiation of therapy or following a dose increase. Instruct patients to swallow capsules and tablets whole; crushing, chewing, or dissolving can cause rapid release and absorption of a potentially fatal dose of hydrocodone.
-Accidental Ingestion
Accidental ingestion of even one dose, especially by children, can result in a fatal overdose of hydrocodone.
-Neonatal Opioid Withdrawal Syndrome
Prolonged use during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated, and requires management according to protocols developed by neonatology experts. If opioid use is required for a prolonged period in a pregnant woman, advise the patient of the risk of neonatal opioid withdrawal syndrome and ensure that appropriate treatment will be available.
-Interaction with Alcohol
Instruct patients not to consume alcoholic beverages or use prescription or non-prescription products that contain alcohol while taking hydrocodone ER. The co-ingestion of alcohol with hydrocodone ER may result in increased plasma levels and a potentially fatal overdose of hydrocodone.
-CYP450 3A4 Interaction
The concomitant use of hydrocodone ER with all CYP450 3A4 inhibitors may result in an increase in hydrocodone plasma concentrations, which could increase or prolong adverse drug effects and may cause potentially fatal respiratory depression. In addition, discontinuation of a concomitantly used CYP450 3A4 inducer may result in an increase in hydrocodone plasma concentration. Monitor patients receiving hydrocodone ER and any CYP450 3A4 inhibitor or inducer.

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

US Controlled Substance: Schedule II

• Relieves moderate-to-severe acute and chronic pain not controlled by other pain relief medicines.
• Hydrocodone (by itself) is only available in abuse-deterrent, branded, extended-release forms, under the brand names: Hysingla ER, Vantrela ER, and Zohydro ER.
• Less potential for constipation, nausea, and vomiting than morphine. However, hydrocodone may be more constipating than oxycodone.
• Hydrocodone is available in combination with other medications, for example, hydrocodone and acetaminophen, and hydrocodone and ibuprofen. Generic formulations of these combination medications are available.