To obtain the initial hydrocodone extended-release tablet dose, use the following conversion factors (CF) to convert selected oral opioids and then reduce that dose by 25%.CONVERSION FROM ORAL HYDROCODONE FORMULATIONS: Administer patient's total daily oral hydrocodone dose as extended-release tablet orally once a day.Daily dose greater than or equal to 80 mg are reserved for use in opioid tolerant individuals.Hydrocodone Extended-Release (ER) TABLETS: Example: Sum the total daily dose of prior oral opioid multiply that sum by the CF to obtain 24-hour oral hydrocodone requirement divide 24-hour requirement by 2 (round down, if necessary ) and give 1 dose orally every 12 hours.ĬONVERSION 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.These CFs cannot be used to convert from hydrocodone extended-release to the selected oral opioid as doing so will result in overestimation of the oral opioid dose and may result in fatal respiratory depression.Alternatively, the following conversion factors (CF) may be used to convert selected oral opioids to the hydrocodone extended-release capsule: Hydrocodone, CF=1 Oxycodone, CF=1 Methadone, CF= 1, Oxymorphone, CF=2 Hydromorphone, CF=2.67 Morphine, CF=0.67 Codeine, CF=0.1.Published potency tables can be used to estimate a patient's 24-hour oral hydrocodone requirement however, due to substantial inter-patient variability, it is best to underestimate a patient's 24-hour requirement and provide rescue medication as the dose is titrated.The 50 mg capsules, a single dose greater than 40 mg, or a total daily dose greater than 80 mg are reserved for opioid tolerant individuals.Hydrocodone Extended-Release (ER) CAPSULES: Discontinue all other around the clock opioid drugs when initiating therapy with extended-release hydrocodone. If unacceptable side effects occur, the dose may be reduced.īreakthrough 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 helpfulĭOSE CONVERSIONS: Dose conversions should be done carefully and with close monitoring due to large patient variability in regards to opioid analgesic response.Dose adjustments to hydrocodone extended-release tablets should be made in 10 to 20 mg increments every 24 hours, every 3 to 5 days. Dose adjustments to hydrocodone extended-release capsules should be made in 10 mg increments every 12 hours, every 3 to 7 days.Individually titrate to a dose that provides adequate analgesia and minimizes adverse reactions. An opioid tolerant patient is one who has been receiving for 1-week or longer at least: oral morphine 60 mg/day, fentanyl transdermal patch 25 mcg per hour, oral oxycodone 30 mg/day, oral hydromorphone 8 mg/day, oral oxymorphone 25 mg/day, or an equianalgesic dose of another opioid.Use of higher starting doses in patients who are not opioid tolerant may cause fatal respiratory depression monitor patients closely for respiratory depression, especially during the first 24 to 72 hours.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.Īs First Opioid Analgesic and For Patients who are NOT Opioid Tolerant:Įxtended-Release Capsules (Zohydro(R) ER): Initial dose: 10 mg orally every 12 hoursĮxtended-Release Tablets (Hysingla(R) ER): Initial dose: 20 mg orally every 24 hours
0 Comments
Leave a Reply. |
Details
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |