Hydrocodone ER (q12h)

ZOHYDRO ER

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Pronunciation: hye-droe-KOE-doen

Hydrocodone ER (q12h) ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Hydrocodone ER (q12h) ballicule

Hydrocodone ER (q12h) VICODIN / NORCO mascot mnemonic cartoon — Visual mnemonic: Hydrocodone ER (q12h) mascot
**“Viking Hydrant code”**
Viking for Vicodin (combo with acetaminophen)

What it isFirst single-agent hydrocodone (ZOHYDRO ER, 2013) — q12h ER capsule with no acetaminophen, freeing dosing from APAP hepatotoxicity limits.

Why this oneSame molecule and receptor pharmacology as the parent card — the formulation (and its label) is the difference.

What limits itClass warnings of the parent molecule apply unchanged.

Hydrocodone ER (q12h) molecular structure (skeletal formula) — Molecular structure: Hydrocodone ER (q12h)

Hydrocodone ER (q12h) prescription history

Animated chart of estimated U.S. prescriptions per year, Opioid analgesics (1900–2026). Hydrocodone ER (q12h) enters in 2013 (estimated).

FDA-approved for

chronic pain (around-the-clock) (2013)

Classes and tags

Clinical profile

Therapeutic safety burden3 / 4

Overdose danger4 / 4

Weight-gain liability0 / 4

Sedation liability2 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk2 / 4

Legacy pregnancy categoryC

Defining liabilityRespiratory depression, dependence and overdose; risk rises sharply with sedatives or impaired clearance.

FDA label

Read the full label on DailyMed ↗

BOXED WARNING Addiction, abuse, and misuse; life-threatening respiratory depression; accidental ingestion; interaction with alcohol; concomitant benzodiazepines/CNS depressants; neonatal opioid withdrawal syndrome; opioid analgesic REMS; CYP3A4 interaction

FDA dosing	Population	Start	Target	Max
Severe and persistent pain requiring an opioid analgesic, not adequately treated with alternatives (incl. IR opioids); not for prn use	Adults (opioid non-tolerant)	10 mg q12h	Individualized	Undefined (single dose >40 mg or total daily dose >80 mg only in opioid-tolerant patients)
Severe and persistent pain (conversion from other opioids)	Adults (opioid-tolerant / converting)	Oral hydrocodone: half the total daily dose q12h; other oral opioids: Table 1 conversion, reduce by 25%, round down, divide q12h; fentanyl patch: start 18 h after removal, ~10 mg q12h per 25 mcg/hr	Individualized	Undefined

Titration Increase by 10 mg q12h (20 mg/day) every 3 to 7 days

Renal Use a low initial dose; regularly evaluate for respiratory depression, sedation, and hypotension

Hepatic Mild–moderate: no starting-dose adjustment; severe: initiate 10 mg q12h and titrate carefully

Every 12 hours dosing; single dose >40 mg or total daily dose >80 mg only for opioid-tolerant patients (≥ one week of ≥60 mg oral morphine/day or equivalent)

Instructions

Swallow capsules whole; do not cut, break, chew, crush, or dissolve
Administer orally every 12 hours; not for as-needed (prn) use
Do not consume alcohol or alcohol-containing products
Discuss/prescribe an opioid overdose reversal agent (naloxone, nalmefene)
To discontinue in physically dependent patients: patient-specific taper, initial reduction no greater than 10% to 25% of total daily dose, then reduce every 2 to 4 weeks; briefer-use patients may tolerate a faster taper; pause or slow if withdrawal; do not stop abruptly

Available strengths

ER cap 10, 15, 20, 30, 40, 50 mg

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

Addiction, abuse, and misuse
Life-threatening respiratory depression
Concomitant benzodiazepines/CNS depressants (incl. alcohol)
Neonatal opioid withdrawal syndrome
Opioid analgesic REMS
CYP3A4 inhibitors/inducers
Opioid-induced hyperalgesia and allodynia
Respiratory depression in chronic pulmonary disease or elderly, cachectic, debilitated patients
Adrenal insufficiency
Severe hypotension
Increased intracranial pressure, brain tumors, head injury, impaired consciousness
Gastrointestinal complications
Seizures in seizure disorders
Withdrawal
Driving and operating machinery

Adverse reactions

Constipation
Nausea
Somnolence
Fatigue
Headache
Dizziness
Dry mouth
Vomiting
Pruritus
Abdominal pain
Peripheral edema
Upper respiratory tract infection

Pregnancy Prolonged use during pregnancy may cause neonatal opioid withdrawal syndrome; not recommended during or immediately prior to labor

Lactation Breastfeeding not recommended (risk of sedation and respiratory depression in the infant)

Cost

Hydrocodone ER (q12h) (ZOHYDRO ER)

What pharmacies pay · NADAC 9/30/26

Strength		#/mo	generic $/mo	CostPlus
10 mg	ER cap	60 BID		not offered
15 mg	ER cap	60 BID	$476.82	not offered
20 mg	ER cap	60 BID	$412.49	not offered
30 mg	ER cap	60 BID	$432.69	not offered
40 mg	ER cap	60 BID		not offered
50 mg	ER cap	60 BID		not offered