Hydrocodone Dosing for Humerus Fracture

Initial Dosing Strategy

The CDC recommends starting opioid-naïve patients at the lowest dose, typically 20-30 morphine milligram equivalents (MME) per day; hydrocodone 5 mg taken 4 times daily equals 20 MME/day (using the 1.0 conversion factor for hydrocodone) 2
Prescribe as PRN (as-needed) rather than scheduled dosing to minimize total opioid exposure and reduce the risk of tolerance and dependence, as suggested by Praxis Medical Insights 1

Ensure total daily acetaminophen does not exceed 3,900 mg from all sources; explicitly counsel patients to avoid other acetaminophen-containing products to prevent hepatotoxicity, according to Praxis Medical Insights 1
Avoid scheduled dosing: Do not prescribe opioids on a fixed schedule, as this unnecessarily increases total opioid exposure and risk of adverse effects, as recommended by Praxis Medical Insights 1

Consider oxycodone if hydrocodone is ineffective: A randomized trial in fracture patients found no difference in pain scores between hydrocodone 5 mg/acetaminophen 325 mg and oxycodone 5 mg/acetaminophen 325 mg at 30 and 60 minutes, though constipation was higher with hydrocodone 3, 4
Nonopioid alternatives should be considered first: NSAIDs or acetaminophen alone may be equally effective for many musculoskeletal injuries and should be tried before opioids when not contraindicated, as suggested by Praxis Medical Insights 1

Do not overprescribe: Prescribing 10-15 tablets of hydrocodone 5 mg/acetaminophen 325 mg for 3-5 days is typically sufficient for most humerus fractures, according to Praxis Medical Insights 1
Do not use extended-release formulations: These are only for opioid-tolerant patients with chronic pain, never for acute fracture pain, as recommended by Praxis Medical Insights 1
Do not fail to counsel on safe storage and disposal: Unused opioids are a major source of diversion and nonmedical use, as reported by the CDC 2