Hydrocodone ER (q24h)

FDA label

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Titration May titrate every 3 to 5 days (increments of 10-20 mg)

Renal No adjustment for mild; moderate/severe impairment and ESRD: initiate at one-half the starting dose and titrate carefully

Hepatic No adjustment for mild/moderate; severe impairment: initiate at one-half the starting dose

Opioid-tolerant defined as ≥60 mg oral hydrocodone/day (or equivalent) for ≥1 week

Instructions

• Administer orally once daily (every 24 hours)
• Swallow tablets whole one at a time with enough water; do not crush, chew, dissolve, pre-soak, lick, or wet
• Do not abruptly discontinue in physically dependent patients; taper gradually
• Discuss opioid overdose reversal agent access

Contraindications

• Significant respiratory depression
• Acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment
• Known or suspected gastrointestinal obstruction, including paralytic ileus

Cautions

• Opioid-induced hyperalgesia and allodynia
• Life-threatening respiratory depression in COPD/elderly/cachectic/debilitated patients
• Adrenal insufficiency
• Severe hypotension (avoid in circulatory shock)
• QTc prolongation (avoid in congenital long QT)
• Increased intracranial pressure/head injury
• GI obstruction risk in dysphagia/GI disorders
• Seizures
• Withdrawal on abrupt discontinuation

Adverse reactions

• Constipation
• Nausea
• Vomiting
• Fatigue
• Upper respiratory tract infection
• Dizziness
• Headache
• Somnolence

Pregnancy May cause neonatal opioid withdrawal syndrome with prolonged use; insufficient data on birth-defect risk

Lactation Hydrocodone present in human milk; breastfeeding not recommended during treatment