Hydrocodone ER (q24h)
HYSINGLA ER
Pronunciation: hye-droe-KOE-doen (hye-SING-la)
“Viking Hydrant code”
Viking for Vicodin (combo with acetaminophen)
What it isExtended-release full mu-opioid agonist; around-the-clock chronic pain when alternatives are inadequate.
Why this oneIt is an abuse-deterrent once-daily tablet; manipulation resistance cannot prevent oral misuse or addiction.
What limits itRespiratory depression, dependence, and fatal overdose remain possible; benzodiazepines and other depressants magnify risk.
FDA-approved for
- chronic pain (around-the-clock) (2014)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Severe and persistent pain requiring an opioid analgesic (not for as-needed use) | Adults (opioid-naive) | 20 mg QD | Individualized | ≥80 mg only for opioid-tolerant patients |
Titration May titrate every 3 to 5 days (increments of 10-20 mg)
Renal No adjustment for mild; moderate/severe impairment and ESRD: initiate at one-half the starting dose and titrate carefully
Hepatic No adjustment for mild/moderate; severe impairment: initiate at one-half the starting dose
Opioid-tolerant defined as ≥60 mg oral hydrocodone/day (or equivalent) for ≥1 week
Instructions
- Administer orally once daily (every 24 hours)
- Swallow tablets whole one at a time with enough water; do not crush, chew, dissolve, pre-soak, lick, or wet
- Do not abruptly discontinue in physically dependent patients; taper gradually
- Discuss opioid overdose reversal agent access
Available strengths
- ER tab 20, 30, 40, 60, 80, 100, 120 mg
- ER cap 10, 15, 20, 30, 40, 50 mg
Contraindications
- Significant respiratory depression
- Acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment
- Known or suspected gastrointestinal obstruction, including paralytic ileus
Cautions
- Opioid-induced hyperalgesia and allodynia
- Life-threatening respiratory depression in COPD/elderly/cachectic/debilitated patients
- Adrenal insufficiency
- Severe hypotension (avoid in circulatory shock)
- QTc prolongation (avoid in congenital long QT)
- Increased intracranial pressure/head injury
- GI obstruction risk in dysphagia/GI disorders
- Seizures
- Withdrawal on abrupt discontinuation
Adverse reactions
- Constipation
- Nausea
- Vomiting
- Fatigue
- Upper respiratory tract infection
- Dizziness
- Headache
- Somnolence
Pregnancy May cause neonatal opioid withdrawal syndrome with prolonged use; insufficient data on birth-defect risk
Lactation Hydrocodone present in human milk; breastfeeding not recommended during treatment
Cost
| Strength | #/mo | generic $/mo | brand $/mo | CostPlus | |
|---|---|---|---|---|---|
| 20 mg | ER tab | 30 qd | $240.58 | — | not offered |
| 30 mg | ER tab | 30 qd | — | $580.95 | not offered |
| 40 mg | ER tab | 30 qd | — | $784.84 | not offered |
| 60 mg | ER tab | 30 qd | — | $1,085.24 | not offered |
| 80 mg | ER tab | 30 qd | — | $1,459.65 | not offered |
| 100 mg | ER tab | 30 qd | — | $1,862.85 | not offered |
| 120 mg | ER tab | 30 qd | — | not offered |
Other forms: Hydrocodone ER (q12h) (ZOHYDRO ER)
Available combined with: hydrocodone / acetaminophen
⚠ BOXED WARNINGS
- Addiction, abuse and misuse
- Life-threatening respiratory depression
- Risk from concomitant use with benzodiazepines
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityRespiratory depression, dependence and overdose; risk rises sharply with sedatives or impaired clearance.
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