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Author: Admin | 2025-04-28
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.Hydrocodone Extended-Release (ER) TABLETS:Daily dose greater than or equal to 80 mg are reserved for use in opioid tolerant individuals.CONVERSION FROM ORAL HYDROCODONE FORMULATIONS: Administer patient's total daily oral hydrocodone dose as extended-release tablet orally once a day.CONVERSION FROM OTHER ORAL OPIOIDS: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.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%. Tramadol, CF=0.1; Oxycodone, CF=1; Methadone, CF= 1.5, Oxymorphone, CF=2; Hydromorphone, CF=4; Morphine, CF=0.5; Codeine, CF=0.15.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.Example: Sum the total daily dose of prior oral opioid; multiply that sum by the CF to obtain 24-hour oral hydrocodone requirement; reduce that hydrocodone requirement by 25% to account for interpatient variability, round down, if necessary; administer calculated dose orally once a day.CONVERSION FROM TRANSDERMAL FENTANYL: Remove the transdermal fentanyl patch and 18 hours later initiate hydrocodone extended-release tablets at 20 mg every 24 hours for each 25 mcg/hr fentanyl transdermal patch; monitor closely as there is limited documented experience with this conversion.CONVERSION FROM TRANSDERMAL BUPRENORPHINE: Patients receiving transdermal buprenorphine 20 mcg/hr or less should initiate extended-release hydrocodone tablets at 20 mg every 24 hours; monitor closely as there is limited documented experience with this conversion.Comments:When converting from methadone, close monitoring is of particular importance due to methadone's long half-life.Use: For the management of pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate.Renal Dose AdjustmentsExtended-release capsules: Initial dose should be lowered; monitor closely for respiratory depression and sedationExtended-release tablets: Lower the initial dose to one-half the normal starting dose; monitor closely for respiratory depression and sedationLiver Dose AdjustmentsExtended-release capsules:Mild to moderate hepatic impairment: No dose adjustment recommendedSevere hepatic impairment: 10 mg orally every 12 hours; monitor closely for respiratory depression and sedationExtended-release tablets: Lower the initial dose to one-half the normal starting dose; monitor closely for respiratory depression and sedationDose AdjustmentsAbrupt discontinuation should be avoided in the physically dependent patient:Extended-release capsules: Titrate the dose down every 2 to 4 days; a more gradual titration may be needed in patients showing signs and symptoms of opioid withdrawalExtended-release tablets: Titrate the dose down every 2 to 4 days; the titrated dose should be at least 50% of the prior dose; after reaching 20 mg once a day for 2 to 4 days, the extended-release tablets can be discontinued.Concomitant Use with CNS depressants: Lower the recommended starting dose by 20% to 30% and consider a lower
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