Is hydrocodone (hydrocodone)-acetaminophen 10-325, 2 tablets every 8 hours equivalent to long-acting oxycodone (oxycondone)?

Opioid Dose Equivalence Calculation

Hydrocodone-acetaminophen 10-325 mg, 2 tablets every 8 hours (60 mg hydrocodone daily) is equivalent to approximately 40 mg of long-acting oxycodone per day, which would typically be dosed as OxyContin 20 mg twice daily. 1, 2

Morphine Milligram Equivalent (MME) Calculation

The CDC Clinical Practice Guideline provides standardized conversion factors for calculating opioid equivalence: 1

• Hydrocodone conversion factor: 1.0 1
• Oxycodone conversion factor: 1.5 1

Your Current Regimen

• Hydrocodone 10 mg × 2 tablets = 20 mg per dose 2
• Dosed every 8 hours = 3 doses per day
• Total daily hydrocodone: 60 mg 2
• Total daily MME: 60 mg × 1.0 = 60 MME/day 1

Equivalent Long-Acting Oxycodone Dose

• Using the conversion factors: 60 mg hydrocodone ÷ 1.0 × 1.5 = 90 MME from oxycodone perspective 1
• Converting to oxycodone dose: 90 MME ÷ 1.5 = 60 mg oxycodone equivalent 2
• However, oxycodone is approximately 1.5 times more potent than hydrocodone on a milligram basis 2
• Therefore: 60 mg hydrocodone ≈ 40 mg oxycodone daily 2

Critical Conversion Cautions

The CDC explicitly warns against using calculated MME doses directly for opioid conversions. 1 When converting between opioids:

• The new opioid should be dosed substantially lower than the calculated MME dose to avoid overdose due to incomplete cross-tolerance and individual pharmacokinetic variability 1
• A typical reduction of 25-50% from the calculated equivalent dose is standard practice when rotating opioids 1
• Equianalgesic conversions are only estimates and cannot account for individual genetic and pharmacokinetic variability 1

Long-Acting Oxycodone Formulation Considerations

Extended-release oxycodone (OxyContin) is dosed twice daily and should only be used in opioid-tolerant patients. 2 Key considerations:

• OxyContin is indicated for chronic pain management, not acute pain 2
• It is not intended for "as-needed" use 2
• The patient on 60 mg daily hydrocodone would be considered opioid-tolerant 2
• Typical conversion: OxyContin 20 mg twice daily (40 mg total daily) would be the starting point, with further titration based on response 2

Dosage Threshold Warning

This regimen places the patient at 60 MME/day, which approaches the CDC's 50 MME/day threshold requiring careful reassessment. 1 Important considerations:

• The CDC recommends pausing and carefully reassessing benefits versus risks before increasing dosages to ≥50 MME/day 1
• Many patients do not experience additional benefit in pain or function from increasing opioid dosages to ≥50 MME/day but face progressive increases in risk 1
• Dosages beyond 50 MME/day show diminishing returns in benefits relative to risks 1

Practical Conversion Approach

If converting from the current hydrocodone regimen to long-acting oxycodone: 1, 2

1. Calculate the theoretical equivalent: 40 mg oxycodone daily
2. Reduce by 25-50% for safety: Start with 20-30 mg oxycodone daily
3. Typical dosing: OxyContin 10-15 mg twice daily
4. Provide immediate-release opioid for breakthrough pain during titration
5. Reassess within 1-4 days and adjust based on pain control and adverse effects

Common Pitfalls to Avoid

• Never use calculated MME directly as the conversion dose without reduction for incomplete cross-tolerance 1
• Do not prescribe extended-release formulations to opioid-naïve patients 2
• Monitor for acetaminophen toxicity in the current regimen (1,950 mg daily from 6 tablets) 1
• Ensure adequate breakthrough pain coverage during any opioid rotation 1