Table 10. Oral Opioids for Acute Pain in Opioid-Naïve Adults
Medication
Available Oral Strengths
Moderate Pain
Severe Pain
Clinical Considerations
Codeine-acetaminophen • Tylenol with codeine
Tablets : 15 mg/300 mg 30 mg/300 mg 60 mg/300
1 to 2 tablets every 4 hours as needed for pain
Increasing doses do not improve efficacy and result in more adverse effects. 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
1 to 2 tablets PO every 6 hours as needed
1 to 2 tablets PO every 4 to 6 hours as needed
• Lorcet • Lortab • Norco • Vicodin
Oral solution: 7.5 mg/325 mg per 15 mL 10 mg/300 mg per 15 mL 10 mg/325 mg per 15 mL
Oxycodone- acetaminophen*
Tablets: 2.5 mg/325 mg 5 mg/325 mg 7.5 mg/325 mg 10 mg/325 mg
1 to 2 tablets PO every 6 hours as needed
1 to 2 tablets PO every 4 to 6 hours as needed
Dosage limited by acetaminophen maximum dose (4,000 mg/day [from all sources]).w
• Endocet • Percocet • Primlev • Roxicet • Xolox
Oral solution: 5 mg/325 mg per 5 mL
Tablets: 37.5 mg/325 mg
1 to 2 tablets PO every 6 hours needed
1 to 2 tablets PO every 4 hours as needed
Only FDA-approved for 5 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 5 tablets/day.
Tramadol-acetaminophen • Ultracet Ibuprofen-hydrocodone • lbudone
1 tablet PO every 4 to 6 hours as needed
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 6 hours
Do not exceed 4 tablets/24 hours.
The duration of therapy should not exceed 7days.
Codeine (Only available as generic)
Tablets: 15 mg, 30 mg, 60 mg
15 to 60 mg PO every 4 hours as needed
Increasing doses do not improve efficacy and results in increased adverse effects. 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.
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