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Analgesics - Opioids

Pharmacy Help Desk - (800) 522-0114 option 4

Opioid Prescribing guidelines can be found at www.okhca.org/opg 

Prescribing guidelines and quantity limits for Analgesic, NSAIDs, and Antipyretics 

Date of Quantity Limit Implementation  

Medications Affected  

Phase 1 - November 2014

  • Hydromorphone Immediate Release Products
  • Morphine Immediate Release Products
  • Codeine and Codeine Combination Products
  • Oxymorphone Immediate Release Products
 

Phase 2 - December 2014

  • Oxycodone Immediate Release Products
  • Oxycodone Combination Products
 

Phase 3 -January 2015

  • Hydrocodone Combination Products
  • Butalbital Combination Products
 

 Short Acting Opioid Analgesics - Alphabetically by Generic Name (Oral and Topical ONLY) 

Drug Generic Name

Drug Brand Name

 Quantity Limit Amount per 30 Days

Acetaminophen/Codeine

Tylenol with Codeine # 2®, Tylenol with Codeine #3®, Tylenol with Codeine #4®

120 

   

Codeine Acetaminophen, Aspirin, Butalbital Combination Products 

Cogesic®, Fioricet®, Fiorinal with Codeine® Ascomp® 

180 

Dihydrocodeine acetaminophen, aspirin, caffeine combination products

Synalgos®, Trezix®

120 

Codeine Sulfate

Codeine

120 

Fentanyl oncology formulations

Actiq®, Subsys®

Fentora®

Abstral®

120

112

128

Hydrocodone – Acetaminophen

Norco®, Vicodin®, Lorcet®, Maxidone®, Xodol®, Zamicet®, Primlev®

120 

Hydrocodone-Ibuprofen

Vicoprofen®, Reprexian®, Ibudone®

120 

Hydromorphone HCL

Dilaudid®

120 

Meperidine

Demerol®, Meperitab®

64 per 8 days

Morphine Sulfate Immediate Release

MSIR®

120 

Oxycodone - Acetaminophen

Percocet®, Magnacet®, Roxicet®

120 

Oxycodone - Aspirin

Percodan®, Endodan®

120 

Oxycodone - Ibuprofen

Combunox®, Xylon-10®

120 

Oxycodone - Acetaminophen

Percocet®, Magnacet®

120 

Oxycodone Immediate Release

OxyIR®, Roxicodone®, Oxecta®

120 

Oxymorphone Immediate Release

Opana IR®

120 

Tapentadol

Nucynta®

120 

Tramadol

Ultram®

240 

Tramadol- Acetaminophen

Ultracet®

180 

 Long Acting Opioid Analgesics - Alphabetically by Generic Name (Oral and Topical ONLY) 

Drug Generic Name 

Drug Brand Name 

Quantity Limit Amount per 30 Days 

Buprenorphine transdermal

Butrans®

10 

Fentanyl transdermal system

Duragesic®

10 

Hydrocodone Extended Release

Zohydro ER®, Xartemis XR®

60* and 120**

Hydromorphone Extended Release

Exalgo®

30*

Levorphanol

Levo-dromoran®

60 

Morphine Controlled Release

MS Contin®

90

Morphine Extended Release Capsule

Avinza®

30

Morphine Extended Release Capsule

Kadian®

60

Morphine Sulfate- Naltrexone 

Embeda®

60

Oxycodone Controlled Release

Oxycontin®

60  

Oxymorphone Extended Release

Opana ER®

60

Tapentadol 

Nucynta ER®

60

Tramadol Extended Release

Ultram ER®, Ryzolt®, ConZip®

30

 * Special PA or other restrictions apply
** Xartemis XR special PA or other restrictions apply

Clinical Notes: 

Acetaminophen Hepatotoxicity 

  • Acetaminophen has been associated with severe hepatotoxicity following acute and chronic ingestion.
  • Maximum recommended dose of acetaminophen for adults is (4) four grams/day.
  • Be sure to consider and ask about all potential sources of acetaminophen (e.g., OTC,  combination analgesics) when determining daily acetaminophen dose.
  • Risk may increase with concurrent alcohol use, underlying liver disease, and/or the fasting state.

Constipation 

  • Common adverse effect with chronic opioid use; prescribe stool softener +/- laxative with narcotic.

Black Box Warning – Long-acting opioid analgesics
The FDA requests that practitioners who prescribe extended-release and long-acting opioid analgesics should be used ONLY for pain severe enough to require daily, around-the-clock long-term opioid treatment for which alternative therapies are inadequate.  Due to the risk of addiction, abuse, and misuse, these drugs should be reserved for patients in whom non-opioid alternatives or immediate-release opioids have not been tolerated or ineffective in managing pain.
The FDA has approved class-wide label changes for ALL extended release and long acting opioid products.  In addition, a the black box warning cautions that long-term maternal use of opioid analgesics during pregnancy can lead to neonatal opioid withdrawal syndrome, which can be life-threatening.
Please reserve these medications for only the most severe pain and consider tapering and withdrawing these products whenever possible. 

For more information visit the FDA website here:  http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm363722.htm 

Click here to view an infographic on Prescription Drug Abuse in Oklahoma.

Last Modified on Dec 21, 2020
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