What is the recommended dosing for Norco (hydrocodone and acetaminophen) 10mg?

Norco 10mg Dosing

For Norco 10mg (hydrocodone 10mg/acetaminophen 325mg), prescribe one tablet every 4-6 hours as needed for moderate to severe pain, with a maximum of 6 tablets per 24 hours. 1

Standard Dosing Regimen

• The FDA-approved dosing for Norco 10mg is one tablet every 4-6 hours as needed, not to exceed 6 tablets daily 1
• Prescribe as "as needed" rather than scheduled dosing (e.g., "one tablet not more frequently than every 4 hours as needed for moderate to severe pain") 2, 3
• This equates to a maximum daily dose of 60mg hydrocodone and 1,950mg acetaminophen 1

Critical Safety Thresholds

• The total daily acetaminophen dose from all sources must not exceed 4,000mg to prevent hepatotoxicity 2, 3
• At 60mg hydrocodone daily (6 tablets of Norco 10mg), this equals 60 morphine milligram equivalents (MME), which approaches the 50 MME/day threshold requiring heightened monitoring 2
• Before prescribing any opioid dosage ≥50 MME/day, implement additional precautions including increased follow-up frequency and offer naloxone with overdose prevention education 2

Appropriate Clinical Context

Norco 10mg should only be prescribed when nonopioid therapies have failed or are contraindicated 2, 3:

• Opioids are appropriate for severe traumatic injuries, invasive surgeries with moderate-to-severe postoperative pain, and severe acute pain when NSAIDs are contraindicated 2
• Nonopioid therapies (NSAIDs, acetaminophen) are at least as effective for common conditions including low back pain, neck pain, musculoskeletal injuries, minor surgeries, dental pain, and kidney stones 2, 3

Duration of Therapy

• Prescribe only for the expected duration of pain severe enough to require opioids, typically 3-7 days for acute pain 2, 3
• If taken around the clock for more than a few days, implement a taper when discontinuing to prevent withdrawal 2, 3
• The minimum quantity needed should be prescribed, typically no more than 20 tablets for acute pain episodes 4

Special Population Adjustments

Elderly patients (≥65 years) and those with hepatic or renal impairment require dose reduction 2:

• Start with lower doses in geriatric patients due to smaller therapeutic window between safe dosages and respiratory depression 2
• Consider formulations with lower opioid content (e.g., hydrocodone 2.5mg/acetaminophen 325mg) when additional caution is needed 2
• In hepatic impairment, limit total daily acetaminophen to 2,000-3,000mg 4

Monitoring Requirements

• Check the prescription drug monitoring program (PDMP) before prescribing to identify patients at risk for opioid misuse or dangerous drug combinations 3, 4
• Monitor closely for respiratory depression, especially within the first 24-72 hours of initiating therapy 1
• Reassess pain control, functional improvement, and adverse effects at each follow-up 1
• Consider prescribing naloxone if the patient or household members have overdose risk factors 4

Common Pitfalls to Avoid

• Do not prescribe Norco as first-line therapy when nonopioid alternatives may be effective 2, 3
• Do not prescribe on a scheduled basis (e.g., "every 4 hours") rather than as-needed 2, 3
• Do not fail to account for acetaminophen from other sources including over-the-counter medications 3
• Do not abruptly discontinue after around-the-clock use for more than a few days without tapering 1
• Do not increase dosage without careful reassessment, as overdose risk increases progressively with higher doses while benefits plateau 2

Starting Dose Considerations

• For opioid-naïve patients, the lowest starting dose is often 5-10 MME per single dose or 20-30 MME/day 2
• Norco 10mg provides 10 MME per tablet, making it a higher starting dose that should be reserved for patients with severe pain or those already tolerating lower opioid doses 2
• Consider starting with Norco 5mg (5 MME per tablet) for most opioid-naïve patients before escalating to the 10mg formulation 2