What is the maximum daily dose of Norco (hydrocodone and acetaminophen)?

Maximum Daily Dose of Norco (Hydrocodone/Acetaminophen)

The maximum daily dose of Norco (hydrocodone/acetaminophen) is 6 tablets per day for the 7.5/325 mg and 10/325 mg strengths, and 8 tablets per day for the 5/325 mg strength, as specified in the FDA drug label. 1

Dosage Guidelines by Strength

Norco Strength	Maximum Tablets Per Day	Maximum Hydrocodone Per Day	Maximum Acetaminophen Per Day
5/325 mg	8 tablets	40 mg	2600 mg
7.5/325 mg	6 tablets	45 mg	1950 mg
10/325 mg	6 tablets	60 mg	1950 mg

Key Considerations for Dosing

Hydrocodone Component

• Hydrocodone is a strong opioid (WHO level III) with potential for respiratory depression, especially at higher doses 2
• The FDA label specifically states that the maximum daily dosage should not exceed 6 tablets for 7.5/325 mg and 10/325 mg strengths, and 8 tablets for 5/325 mg strength 1
• Doses should be individualized based on pain severity, patient response, and risk factors for addiction, abuse, and misuse 1

Acetaminophen Component

• The acetaminophen component in Norco must be carefully monitored to prevent hepatotoxicity
• Current guidelines recommend not exceeding 3000-4000 mg of acetaminophen daily 2, 3
• A more conservative approach recommends a maximum daily dose of 3000 mg of acetaminophen 3, 4
• Patients with liver disease should receive reduced doses of acetaminophen (2000-3000 mg daily) 2, 3

Morphine Milligram Equivalent (MME) Considerations

The CDC provides conversion factors to calculate morphine milligram equivalents (MME):

• Hydrocodone has a conversion factor of 1.0 2
• At the maximum daily dose of 60 mg hydrocodone (from 10/325 mg tablets), this equals 60 MME
• The CDC recommends caution when prescribing ≥50 MME/day 2

Important Safety Warnings

• Use the lowest effective dosage for the shortest duration consistent with treatment goals 1
• Monitor patients closely for respiratory depression, especially within the first 24-72 hours of initiating therapy 1
• Be aware of potential drug interactions, particularly with CYP3A4 and CYP2D6 inhibitors, which can increase hydrocodone plasma concentration 1
• Avoid abrupt discontinuation in physically dependent patients 1
• Counsel patients about the risks of opioid addiction, abuse, and misuse 1

Special Populations

• For elderly patients or those with hepatic impairment, consider starting at lower doses and titrating slowly 3
• For patients with severe hepatic or renal disease, monitor with serial liver and/or renal function tests 1

Common Pitfalls to Avoid

1. Exceeding acetaminophen limits: Many patients take other acetaminophen-containing products concurrently, which can lead to unintentional overdose
2. Failure to recognize tolerance: Long-term users may develop tolerance requiring dose adjustments
3. Overlooking drug interactions: Medications that inhibit CYP3A4 or CYP2D6 can significantly increase hydrocodone levels
4. Abrupt discontinuation: Can lead to withdrawal symptoms in physically dependent patients

By adhering to these maximum daily dose guidelines and considering individual patient factors, clinicians can optimize pain management while minimizing risks associated with Norco therapy.