A patient with HIV, Hepatitis B, Hepatitis C, and a history of opioid abuse presents for dental treatment. Which of the following drugs CANNOT be given to this patient?

Correct answer: D. Hydrocodone

• A. INCORRECT. While ibuprofen is concerning in patients with renal disease or active GI pathology, it is not the MOST contraindicated drug in this specific patient with opioid abuse history and liver disease. Ibuprofen should be used cautiously due to hepatic metabolism concerns in Hep B/C, but it is not absolutely contraindicated in all cases.
• B. INCORRECT. Acetaminophen at standard doses can be used cautiously in patients with liver disease, though maximum daily dose should be reduced (to ≤2 g/day in hepatic impairment). It is not contraindicated.
• C. INCORRECT. Amoxicillin is an appropriate antibiotic for dental infections and is not contraindicated in HIV, Hepatitis B/C, or opioid abuse history.
• D. CORRECT. Hydrocodone (an opioid analgesic) is CONTRAINDICATED in a patient with a documented history of opioid abuse. Prescribing opioids to a patient with opioid use disorder (OUD) violates prescribing guidelines, risks relapse and overdose, and is ethically and legally problematic. Non-opioid analgesics should be used instead. Additionally, hydrocodone undergoes hepatic metabolism (CYP2D6) and may be altered by significant liver disease from Hep B/C.