Table 5: Oral Opioids for Acute Pain in Opioid-Naïve Adults
Available Oral Strengths Tablets: • 15 mg/300 mg • 30 mg/300 mg • 60 mg/300 mg
Medication
Moderate Pain Severe Pain
Clinical Considerations
Codeine- acetaminophen • Tylenol with Codeine
1 to 2 tablets every four hours as needed for pain.
Incremental efficacy decreases and increases in adverse reactions with increasing doses. Limit codeine to no more than 60 mg/dose. Do not exceed codeine 360 mg/24 hours. The maximum dose of acetaminophen is 4,000 mg/day (from all sources). Metabolism of codeine to morphine (its active form) varies between patients; drug interactions may affect response. Dosage limited by acetaminophen maximum dose (4,000 mg/day [from all sources]).
Hydrocodone- acetaminophen
Tablets: • 2.5 mg/325 mg • 5 mg /300 mg • 5 mg/325 mg • 7.5 mg/300 mg • 7.5 mg /325 mg • 10 mg/300 mg • 10 mg/325 mg Oral solution: • 7.5 mg/325 mg per 15 mL • 10 mg/300 mg per 15 mL • 10 mg/325 mg per 15 mL Tablets: • 2.5 mg/325 mg • 5 mg/325 mg • 7.5 mg/325 mg • 10 mg/325 mg Oral solution: • 5 mg/325 mg per 5 mL Tablets: • 37.5 mg/325 mg
1 to 2 tablets PO every six hours as needed.
1 to 2 tablets PO every four to six hours as needed.
• Lorcet • Lortab • Norco • Vicodin
Oxycodone- acetaminophen*
1 to 2 tablets PO every six hours as needed.
1 to 2 tablets PO every four to six hours as needed.
Dosage limited by acetaminophen maximum dose (4,000 mg/day [from all sources]).
• Endocet • Percocet • Primlev • Roxicet • Xolox
Tramadol- acetaminophen • Ultracet
1 to 2 tablets PO every six hours needed.
1 to 2 tablets PO every four hours as needed. 1 tablet PO every four to six hours as needed.
Only FDA-approved for five days or less of treatment of acute pain. Maximum dose: Eight tablets/24 hours. FDA-approved for short-term, acute, severe pain (<10 days). Do not exceed five tablets/day. Do not exceed four tablets/24 hours. The duration of therapy should not exceed seven days A decrease in incremental efficacy and an increase in adverse reactions with increasing doses. Limit codeine to no more than 60 mg/dose. Do not exceed 360 mg codeine/24 hours. Metabolism of codeine to morphine (its active form) varies between patients; drug interactions may affect response. Used only for severe, acute pain, not as a first-line acute pain agent. Start with a low dose and titrate carefully.
Ibuprofen-hydrocodone • lbudone
Tablets: • 5 mg/200 mg • 7.5 mg/200 mg • 10 mg/200 mg
• Reprexain • Vicoprofen • Xylon
Ibuprofen-oxycodone (Only available as generic)
Tablets: • 5 mg/400 mg
1 tablet PO every six hours.
Codeine (Only available as generic)
Tablets: • 15 mg • 30 mg • 60 mg
15 to 60 mg PO every four hours as needed.
Hydromorphone * • Dilaudid
Tablets: • 2 mg • 4 mg • 8 mg
2 to 4 mg PO every four to six hours as needed.
Oral Solution: • 5 mg/5 mL
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Book Code: RPUS3024
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