1.1. Adults
Analgesic hydrocodone dosages should be determined based on pain severity and patient response/ tolerance. In individuals with severe pain or those who have become tolerant to the analgesic effects of hydrocodone, it may be necessary to exceed the usual dosage. Reduced hydrocodone dosages are indicated in high-risk patients and the elderly. The maximum daily dosage for the acetaminophen/ hydrocodone combination is restricted by the maximum acetaminophen dose of 4 g daily to limit the risk of hepatic damage and severe hypersensitivity reactions associated with acetaminophen use 2-4.
Hydrocodone exerts antitussive effects by directly acting on receptors in the cough center at dosages lower than those required for analgesia 2,3,6,7.
Recommended adult hydrocodone dosages as monotherapy and combination therapy are summarized in Tables 12,3,8,9 and 22-7,10. Dosages exceeding these recommendations will be reviewed.
Table 1: Recommended Adult Hydrocodone Dosages: Monotherapy
| Drug/Indication | Dosage Forms/Strengths | Usual Dosage Regimen | Maximum Recommended Dose |
|---|---|---|---|
| Analgesic hydrocodone extended-release capsule (Zohydro® ER, generics) | 10 mg, 15 mg, 20 mg, 30 mg, 40 mg, 50 mg extended-release, abuse-deterrent capsules | 20 mg to 100 mg every 12 hours | maximum dose not defined; doses should be titrated per patient to maximize analgesia and minimize adverse drug reactions |
| Analgesic hydrocodone extended-release tablet (Hysingla® ER, generics) | 20 mg, 30 mg, 40 mg, 60 mg, 80 mg, 100 mg, 120 mg extended-release, abuse-deterrent tablets | 20 mg to 120 mg every 24 hours | maximum dose not defined; doses should be titrated per patient to maximize analgesia and minimize adverse drug reactions |
Table 2: Recommended Adult Hydrocodone Dosages: Combination Therapy
| Drug/Indication | Dosage Forms/Strengths | Usual Dosage Regimen | Maximum Recommended Dose |
|---|---|---|---|
| Analgesic hydrocodone bitartrate/ acetaminophen (Lortab®, Norco®, generics) | 5 mg/300 mg, 7.5 mg/300 mg, 10 mg/300 mg, 2.5 mg/325 mg, 5 mg/325 mg, 7.5 mg/325 mg, 10 mg/325 mg tablets; 7.5 mg/325 mg/15 ml or 10 mg/325 mg/15 ml solution; 10 mg/300 mg/15 ml elixir | 2.5-10 mg every 4-6 hours as needed | 60 mg/4000 mg daily* |
| Analgesic hydrocodone bitartrate/ ibuprofen (Vicoprofen®, Ibudone®, Reprexain®, generics) | 2.5 mg/200 mg, 5 mg/200 mg, 7.5 mg/200 mg, 10 mg/200 mg tablets | 2.5-10 mg every 4-6 hours as needed | 5 tablets per day [maximum hydrocodone dose (10mg/200 mg): 50 mg daily]** |
| Antitussive hydrocodone bitartrate/homatropine (Hydromet®, generics) | 5 mg/1.5 mg/5ml solution or 5 mg/1.5 mg tablet | 5 mg every 4-6 hours as needed | 30 mg daily |
| Antitussive hydrocodone polistirex/chlorpheniramine polistirex (TussiCaps®) | 10 mg/ 8 mg extended-release capsules | 1 capsule every 12 hours | 20 mg/16 mg every 24 hours |
| Antitussive hydrocodone polistirex/chlorpheniramine polistirex (Tussionex® Pennkinetic®, generics) | 10 mg/8 mg+/5 ml extended-release oral suspension | 10 mg/8 mg+ every 12 hours | 20 mg/16 mg+ daily |
Legend:
- *dosage limit based on maximum acetaminophen daily dose; varies by product
- **short-term use (less than 10 days) recommended
- +dosed as hydrocodone bitartrate and chlorpheniramine maleate