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.

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