substances/chemicals as, “drugs with a high potential for abuse, with use potentially leading to severe psychological or physical dependence,” and rescheduling hydrocodone- combination analgesics to Schedule II intentionally made prescribing these analgesics more difficult (e.g., refills are not allowed on Schedule II and prescriptions must be written not verbal) which encouraged more physician oversight (U.S. Drug Enforcement Administration, 2019). As of today, only codeine with acetaminophen products may be “called in” as the only opioid-containing analgesics listed as Schedule III. For those practitioners who are still not deterred there are two other points to consider. All 50 States now require dentists to query their States’ Prescription Drug Therapy Monitoring Program (PDMP) prior to prescribing any controlled substance (and usually documenting this step). Some States have even gone a step further to insist that, “the hand that writes the Table 3: Opioid-Based Analgesics Used for Orofacial Pain Generic Name Codeine Fentanyl
opioid order must also write the naloxone order (Washington State Legislature, 2021). In other words, the dentist must coprescribe the reversal agent for a potential opioid overdose, naloxone, with any narcotic- containing prescription. Secondly, the number of doses of the opioid being prescribed requires attention. While the ADA supports statutory limits on opioid dosage and duration of no more than seven days for the treatment of acute pain, consistent with Centers for Disease Control and Prevention (CDC) evidence-based guidelines, individual State Boards of Dentistry may be even more restrictive in their legislation. If changing current prescribing habits based on new data and guidelines is not enough for individual clinicians, then recent legal cases in which prescribers have been indicted for manslaughter due to narcotic overprescribing may be the impetus for change (Donaldson & Goodchild, 2018a).
Hydrocodone
Hydromorphone Dilaudid 2, 4, 8 mg tablets; 1 mg/mL oral solution Exalgo 8, 12, 16, 32 mg extended-release (ER) tablets
Brand name(s) and available strengths (mg)
Multiple Generics 15, 30, 60 mg tablets; 6 mg/mL oral solution.
Duragesic 12, 25, 37.5, 50, 62.5, 75, 100 mcg/hr transdermal patches Abstral 100, 200, 300, 400, 600, 800 mcg sublingual tablets Actiq 200, 400, 600, 800, 1200, 1600 mcg transmucosal lozenges Fentora 100, 200, 400, 600, 800 mcg buccal tablets Lazanda 100, 300, 400 mcg/ 100 mcL nasal spray Subsys 100, 200, 400, 600, 800, 1200, 1600 mcg sublingual spray
For treatment of pain, hydrocodone is available as extended-release products: Hysingla ER 20, 30, 40, 60, 80, 100, 120mg ER tablets Zohydro ER 10, 15, 20, 30, 40, 50mg ER capsules Immediate-release formulations are only available in combination with acetaminophen or ibuprofen. The efficacy of the combination of hydrocodone and acetaminophen is similar to that of codeine plus acetaminophen.
Duration of action Usual adult starting dosages
4 hours
≥1 hour (72 hours/patch)
12-24 hours
4-6 hours (24 hours per ER Tablet)
15-60 mg q4h
100-200 mcg
Hysingla: 20mg q24h Zohydro: 10mg q12h
2 mg q6-8h
Notes
60 mg PO equivalent to 650 mg of aspirin or acetaminophen; 10% of people lack the enzyme (CYP 2D6) needed to make codeine active.
Starting dose determined by previous opioid dosage; long- acting formulations are generally not recommended for opioid- naïve patients.
Extended-release formulations are generally not recommended for opioid-naïve patients.
Starting dose determined by previous opioid dosage; long- acting formulations are generally not recommended for opioid-naïve patients.
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Book Code: DHFL2624
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