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Hydrocodone Dosage

Medically reviewed by Drugs.com. Last updated on Aug 16, 2023.

Applies to the following strengths: 10 mg; 15 mg; 20 mg; 30 mg; 40 mg; 50 mg; 60 mg; 80 mg; 100 mg; 120 mg

Usual Adult Dose for Chronic Pain

The following dosing recommendations can only be considered suggested approaches to what is actually a series of clinical decisions over time; each patient should be managed individually.

As First Opioid Analgesic and For Patients who are NOT Opioid Tolerant:
Extended-Release Capsules (Zohydro(R) ER): Initial dose: 10 mg orally every 12 hours
Extended-Release Tablets (Hysingla(R) ER): Initial dose: 20 mg orally every 24 hours

Comments:


TITRATION AND MAINTENANCE:
Individually titrate to a dose that provides adequate analgesia and minimizes adverse reactions.
Breakthrough Pain: If the level of pain increases after dose stabilization, attempt to identify the source before increasing dose; rescue medication with appropriate immediate-release analgesia may be helpful

DOSE CONVERSIONS: Dose conversions should be done carefully and with close monitoring due to large patient variability in regards to opioid analgesic response. Discontinue all other around the clock opioid drugs when initiating therapy with extended-release hydrocodone.

Hydrocodone Extended-Release (ER) CAPSULES:
CONVERSION FROM OTHER ORAL OPIOIDS:
CONVERSION FROM TRANSDERMAL FENTANYL: Remove the transdermal fentanyl patch and 18 hours later initiate hydrocodone extended-release capsules at 10 mg every 12 hours for each 25 mcg/hr fentanyl transdermal patch; monitor closely as there is limited documented experience with this conversion.

Hydrocodone Extended-Release (ER) TABLETS:
CONVERSION FROM TRANSDERMAL FENTANYL: Remove the transdermal fentanyl patch and 18 hours later initiate hydrocodone extended-release tablets at 20 mg every 24 hours for each 25 mcg/hr fentanyl transdermal patch; monitor closely as there is limited documented experience with this conversion.
CONVERSION FROM TRANSDERMAL BUPRENORPHINE: Patients receiving transdermal buprenorphine 20 mcg/hr or less should initiate extended-release hydrocodone tablets at 20 mg every 24 hours; monitor closely as there is limited documented experience with this conversion.

Comments:

Use: For the management of pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate.

Renal Dose Adjustments

Liver Dose Adjustments

Extended-release capsules:


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

Dose Adjustments

Abrupt discontinuation should be avoided in the physically dependent patient:


Concomitant Use with CNS depressants: Lower the recommended starting dose by 20% to 30% and consider a lower dose of the concomitant CNS depressant.

CYP450 3A4 Inducers and Inhibitors: Dose adjustments may be necessary; closely monitor patients currently taking, or discontinuing CYP450 3A4 inducers and inhibitors

Increased Risk of Respiratory Depression: Consider lower initial doses, slower titrations, or alternative analgesics.

QTc Interval Prolongation: Reduce dose by 33% to 50%; consider alternative analgesics

Precautions

The US FDA requires a Risk Evaluation and Mitigation Strategy (REMS) for all opioids intended for outpatient use. The new FDA Opioid Analgesic REMS is a designed to assist in communicating the serious risks of opioid pain medications to patients and health care professionals. It includes a medication guide and elements to assure safe use. For additional information: www.accessdata.fda.gov/scripts/cder/rems/index.cfm

US BOXED WARNINGS: ADDICTION, ABUSE, AND MISUSE; RISK EVALUATION AND MITIGATION STRATEGY (REMS); LIFE-THREATENING RESPIRATORY DEPRESSION; ACCIDENTAL INGESTION; NEONATAL OPIOID WITHDRAWAL SYNDROME; CYTOCHROME P450 3A4 INTERACTION; and RISKS FROM CONCOMITANT USE WITH BENZODIAZEPINES OR OTHER CNS DEPRESSANTS


CONTRAINDICATIONS:

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

Consult WARNINGS section for additional precautions.

US Controlled Substance: Schedule II

Dialysis

Data not available

Other Comments

Administration advice:
Extended-release capsules:


Extended-release tablets:

General:

Monitoring:

Patient advice:

Frequently asked questions

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.