What is the typical dose of hydrocodone (opioid) and acetaminophen (pain reliever) for managing moderate to severe pain?

Hydrocodone-Acetaminophen Dosing for Moderate to Severe Pain

The typical dose of hydrocodone-acetaminophen for managing moderate to severe pain is 5 mg/325 mg, one to two tablets every 4-6 hours as needed, not exceeding 8 tablets per day. 1

Standard Dosing Recommendations

• For hydrocodone 5 mg/acetaminophen 325 mg: One to two tablets every four to six hours as needed for pain, with a maximum daily limit of 8 tablets 2, 1
• For hydrocodone 7.5 mg/acetaminophen 325 mg: One tablet every four to six hours as needed for pain, with a maximum daily limit of 6 tablets 1
• For hydrocodone 10 mg/acetaminophen 325 mg: One tablet every four to six hours as needed for pain, with a maximum daily limit of 6 tablets 1

Dosing Principles

• Always use the lowest effective dose for the shortest duration consistent with treatment goals 2, 1
• Prescribe as "as needed" (e.g., hydrocodone 5 mg/acetaminophen 325 mg, one tablet not more frequently than every 4 hours as needed for moderate to severe pain) rather than on a scheduled basis 2
• Titrate individually based on pain severity, patient response, and risk factors for addiction, abuse, and misuse 1
• Monitor patients closely for respiratory depression, especially within the first 24-72 hours of initiating therapy 1

Maximum Daily Acetaminophen Considerations

• Total daily acetaminophen intake should not exceed 4000 mg to avoid hepatotoxicity 1
• When calculating total daily acetaminophen intake, consider all sources of acetaminophen, including over-the-counter medications 2

Special Populations

• For elderly patients or those with hepatic or renal impairment, consider starting with lower doses and careful titration 2
• In patients with renal impairment, use opioids with caution and at reduced doses and frequency 2

Appropriate Use Context

• Opioid therapy has an important role for acute pain related to:

  • Severe traumatic injuries (including crush injuries and burns) 2
  • Invasive surgeries typically associated with moderate to severe postoperative pain 2
  • Other severe acute pain when NSAIDs and other therapies are contraindicated or likely to be ineffective 2

• Nonopioid therapies are at least as effective as opioids for many common acute pain conditions, including:

  • Low back pain, neck pain, musculoskeletal injuries 2
  • Minor surgeries with minimal tissue injury 2
  • Dental pain, kidney stone pain, and headaches including episodic migraine 2

Duration of Therapy

• For acute pain, prescribe only for the expected duration of pain severe enough to require opioids 2
• If opioids are taken around the clock for more than a few days, implement a taper to minimize withdrawal symptoms 2
• For patients already on long-term opioid therapy who develop acute pain, use nonopioid medications when possible 2

Monitoring and Safety

• Follow patients closely for respiratory depression, especially within the first 24-72 hours 1
• Common adverse effects include constipation, dizziness, vomiting, and dry mouth 3
• Consider prescribing preventive medications for common opioid side effects (e.g., laxatives for constipation) 2

Common Pitfalls to Avoid

• Exceeding the maximum daily acetaminophen dose of 4000 mg 1
• Using opioid-acetaminophen combinations as first-line therapy when nonopioid alternatives may be effective 2
• Prescribing on a scheduled basis rather than as-needed 2
• Failing to taper if used around the clock for more than a few days 2