Select a medication above to begin.
hydrocodone/ acetaminophen
generic
Black Box Warnings .
Appropriate Use
should only be prescribed by healthcare professionals knowledgeable about opioid use and how to mitigate assoc. risks; reserve opioid analgesics for pts w/ inadequate tx alternatives; proper dosing and titration essential to decr. resp. depression risk
Medication Error Risk
ensure accuracy when prescribing, dispensing, and administering hydrocodone/acetaminophen oral solution; dosing errors due to confusion between mg and mL or different concentrations can result in accidental overdose and death
Addiction, Abuse, and Misuse
Schedule II controlled substance combination containing an opioid agonist w/ risk of addiction, abuse, and misuse, which can lead to overdose and death; assess opioid abuse or addiction risk prior to prescribing; regularly reassess all pts for misuse, abuse, and addiction
Respiratory Depression
serious, life-threatening, or fatal cases may occur even w/ recommended use, esp. during tx start or after dose incr; to decr. risk, initiate and titrate dose appropriately
Accidental Ingestion
accidental ingestion of even one dose, esp. by children, can result in fatal hydrocodone overdose
Risks from Concomitant Use w/ Benzodiazepines, CNS Depressants
concomitant opioid use w/ benzodiazepines or other CNS depressants, incl. alcohol, may result in profound sedation, resp. depression, coma, and death; reserve concomitant use for pts w/ inadequate alternative tx options
Neonatal Opioid Withdrawal Syndrome
extended use in pregnant pts can lead to potentially life-threatening neonatal opioid withdrawal syndrome; advise pregnant pts of risks and ensure tx by neonatology experts avail. at delivery if extended opioid use required
Opioid Analgesic REMS
providers are strongly encouraged to complete risk evaluation and mitigation strategy (REMS)-compliant education program, counsel pts and/or caregivers w/ each Rx on serious risks, safe use, and importance of reading medication guide
CYP450 3A4 Interaction
concomitant use w/ CYP450 3A4 inhibitors or D/C of concomitant CYP450 3A4 inducers may incr. opioid conc. which may incr. or prolong adverse effects incl. potentially fatal resp. depression; monitor pts receiving any concomitant CYP450 3A4 inhibitor or inducer
Hepatotoxicity
acetaminophen assoc. w/ acute liver failure incl. cases of liver transplant and death; most liver injury assoc. w/ acetaminophen doses >4000 mg per day and >1 acetaminophen-containing product
Adult Dosing .
Dosage forms: TAB: 2.5 mg/325 mg, 5 mg/300 mg, 5 mg/325 mg, 7.5 mg/300 mg, 7.5 mg/325 mg, 10 mg/300 mg, 10 mg/325 mg; SOL: 7.5 mg/325 mg per 15 mL, 10 mg/325 mg per 15 mL
Special Note
- [prescribing info]
- Info: consider prescribing naloxone if risk of opioid overdose or accidental ingestion
pain, moderate-mod. severe
- [2.5-10 mg hydrocodone PO q4-6h prn]
- Max: 4 g/day acetaminophen from all sources; Info: use lowest effective dose, shortest effective tx duration; taper dose by 25-50% q2-4 days to D/C if long-term use
renal dosing
- [see below]
- renal impairment: consider low start dose
- HD/PD: not defined
hepatic dosing
- [see below]
- hepatic impairment: consider decr. usual dose
Peds Dosing .
- Dosage forms: TAB: 2.5 mg/325 mg, 5 mg/300 mg, 5 mg/325 mg, 7.5 mg/300 mg, 7.5 mg/325 mg, 10 mg/300 mg, 10 mg/325 mg; SOL: 7.5 mg/325 mg per 15 mL, 10 mg/325 mg per 15 mL
Special Note
- [prescribing info]
- Info: consider prescribing naloxone if risk of opioid overdose or accidental ingestion
pain, moderate-mod. severe
- [2 yo and older, <46 kg]
- Dose: 0.1-0.15 mg/kg/dose hydrocodone PO q4-6h prn; Max: 6 doses/day; 75 mg/kg/day up to 4 g/day acetaminophen from all sources; Info: use lowest effective dose, shortest effective tx duration; taper dose by 25-50% q2-4 days to D/C if long-term use
- [2 yo and older, >46 kg]
- Dose: 2.5-10 mg hydrocodone PO q4-6h prn; Max: 6 doses/day; 4 g/day acetaminophen from all sources; Info: use lowest effective dose, shortest effective tx duration; taper dose by 25-50% q2-4 days to D/C if long-term use
renal dosing
- [adjust dose frequency]
- CrCl 10-50: give usual dose q6h prn; CrCl <10: give usual dose q8-12h prn
- HD: give usual dose q8h prn; supplement after dialysis not defined; PD: give usual dose q8-12h prn; supplement not defined
hepatic dosing
- [see below]
- hepatic impairment: consider decr. usual dose