The recommended duration for wearing the patch is seven days, except during the titration phase
For patients who have not taken opioids before, the initial dose should be a five mcg/hr patch, which may be supplemented with immediate-release opioids and non-opioid analgesics for breakthrough pain
The dosage of the patch should not be increased until the patient has been on the same dose for at least 72 hours Upward titration may be initiated based on the need for additional short-acting analgesics, with a minimum interval of 72 hours between dosage adjustments To prevent QT prolongation, which can occur with higher doses, the maximum dose should not exceed one 20 mcg/hr transdermal system
Extended-release tablet initial dosing
Patients who have not previously taken opioids or do not have a tolerance: should begin with a dose of 5 mg administered orally every 12 hours.
The dosage should then be adjusted gradually in increments of 5 to 10 mg after every 3 to 7 days until a level is reached that effectively relieves pain while minimizing any potential adverse effects
Patients who have developed tolerance to opioids:
Patients who have been taking a minimum dosage of 60 mg/day orally for morphine, 25 mcg/hr transdermal fentanyl, 30 mg/day orally for oxycodone, 8 mg/day orally for hydromorphone, 25 mg/day orally for oxymorphone, or an equivalent amount of another opioid for a period of one week or more.
Indicated for Chronic Pain
For patients of non-opioid tolerant/first opioid analgesic:
Initial dose: 10 mg of oxycodone /5 mg of naloxone orally two times a day
Titration from the present dose by enhancing 10 mg of oxycodone /5 mg of naloxone two times a day every one-two day as per requirement
It should not exceed 80 mg of oxycodone /40 mg of naloxone in a day (i.e., 40 mg of oxycodone /20 mg of naloxone two times a day)
For patients of opioid tolerant:
>60 mg every day orally morphine
>25 mcg every hour transdermal fentanyl
>30 mg every day orally oxycodone
>8 mg every day orally hydromorphone
>25 mg every day orally oxymorphone
Or
Equianalgesic dosage of other opioids
Changing to oxycodone/naloxone
Changing from another oral oxycodone:
As Targiniq ER two times a day, administer ½ of the patient’s total daily oral oxycodone
It should not exceed 80 mg of oxycodone /40 mg of naloxone in a day (i.e., 40 mg of oxycodone /20 mg of naloxone two times a day)
Changing from transdermal buprenorphine:
For transdermal buprenorphine < 20 mcg every hour: 10 mg of oxycodone /5 mg of naloxone two times a day
It should not exceed 80 mg of oxycodone /40 mg of naloxone in a day (i.e., 40 mg of oxycodone /20 mg of naloxone two times a day)
Changing from transdermal fentanyl:
18 hours following removing the transdermal fentanyl patch, you may start oxycodone/naloxone
Nearly 10 mg of oxycodone /5 mg of naloxone two times a day have to be substituted for every 25 mcg every hour of transdermal fentanyl patch
It should not exceed 80 mg of oxycodone /40 mg of naloxone in a day (i.e., 40 mg of oxycodone /20 mg of naloxone two times a day)
Changing from methadone:
The ratio between other opioids and methadone may differ widely as a function of the prior dose exposure
Methadone consists of the long half-life and may accumulate in the plasma
Changing from other opioids:
Discontinue all other opioid medications when starting oxycodone/naloxone
morphine 20 mg-<70 mg orally: 10 mg of oxycodone /5 mg of naloxone orally two times a day
morphine 70 mg-<110 mg orally: 20 mg of oxycodone /10 mg of naloxone orally two times a day
morphine 110 mg-<150 mg orally: 30 mg of oxycodone /15 mg of naloxone orally two times a day
morphine 150 mg-160 mg orally: 40 mg of oxycodone /20 mg of naloxone orally two times a day
As the primary opioid pain reliever & for patients with no opioid tolerance
Hysingla (R)ER
Starting dose: The recommended dose is 20 mg by oral route one time a day
Zohydro (R)ER
Starting dose: The recommended dose is 10 mg by oral route two times a day
Titration and maintenance
When adjusting the dosage of hydrocodone capsules ER, 10 mg increments shall be used two times a day or every three to seven days
adjusting to the dosage of hydrocodone tablets ER shall occur in increments of 10-20 mg one time a day or an interval of every three to five days
If the side effects become intolerable, the dosage could be lowered
ER capsules hydrocodone
Only those who are tolerant to opioids may take the capsules of 50 mg, one dose above 40 mg, or the entire dose in a day exceeding 80 mg
ER Tablets hydrocodone
Individuals who are tolerant to opioids are the only ones who may utilize a day dose of more than or equivalent to 80 mg
Conversion from hydrocodone oral formulations
The complete day dose of hydrocodone as tablet ER is one time daily by oral route
Indicated for opioid tolerance indiviulas with chronic pain
Stop taking any other extended-release opioids or reduce them gradually
25-100 mcg applied every hour 3days until sufficient analgesia is obtained
60 mg/day of morphine + 25 mcg/day transdermal fentanyl + 30 mg/day orally oxycodone + 8 mg/day orally hydromorphone + 25 mg/day orally oxymorphone + 60 mg/day orally hydrocodone or equivalent analgesic dose of another opioid for week or more are considered opioid tolerant
Indicated for opioid tolerance indiviulas with chronic pain
Stop taking any other extended-release opioids or reduce them gradually
25-100 mcg applied every hour 3days until sufficient analgesia is obtained
60 mg/day of morphine + 25 mcg/day transdermal fentanyl + 30 mg/day orally oxycodone + 8 mg/day orally hydromorphone + 25 mg/day orally oxymorphone + 60 mg/day orally hydrocodone or equivalent analgesic dose of another opioid for week or more are considered opioid tolerant
Indicated for opioid tolerance indiviulas with chronic pain
Stop taking any other extended-release opioids or reduce them gradually
25-100 mcg applied every hour 3days until sufficient analgesia is obtained
60 mg/day of morphine + 25 mcg/day transdermal fentanyl + 30 mg/day orally oxycodone + 8 mg/day orally hydromorphone + 25 mg/day orally oxymorphone + 60 mg/day orally hydrocodone or equivalent analgesic dose of another opioid for week or more are considered opioid tolerant
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