Hydrocodone 10/325mg cannot be bought online through professional home delivery hubs as a Schedule II controlled substance requiring a valid EPCS prescription from a DEA-registered US healthcare provider for moderate-to-severe acute pain unresponsive to non-opioids; prescription-free home delivery constitutes federal felony distribution under 21 U.S.C. § 841(a)(1) with mandatory minimum 5-40 year imprisonment penalties.​
Hydrocodone/acetaminophen 10/325mg initiates at 1 tablet q4-6h maximum 6 tablets/day (60mg hydrocodone, 1950mg APAP ceiling) under 2025 CDC guidelines capping acute prescriptions ≤3-7 days across 48 states, mandating synchronous HIPAA video NRS ≥7/10 + multi-state PDMP clearance—no home hub bypasses post-12/31/2025 in-person exam or EPCS no-refill limits.​
Hydrocodone bitartrate 10mg (mu Ki 50nM), Tmax 1.3h, t½ 3.8h CYP2D6/3A4 metabolized to hydromorphone; black box respiratory depression OR12 naloxone mandate >50 MME, overdose RR<8/min SpO2<88%—taper 10-25% weekly COWS; APAP hepatotoxicity ceiling 4g/day absolute.​
Diagnostic: NRS ≥7/10 + PEG ≤4 functional impairment 3 months excluding mimics.
Video: PDMP zero fills 12mo, ORT <7, UDS negative, QTc <500ms.
Risk Mitigation: Naloxone 4mg nasal household co-prescription.
EPCS: #42 tabs 10/325mg zero refills ≤7 days signature delivery.
Follow-up: ≥30% NRS reduction q7d + UDS/pill counts.​
| Incidence Prevalence | Primary Toxicity Cluster | Dose-Dependent Risk Factors | Evidence-Based Reversal ​ |
|---|---|---|---|
| 40-60% | Constipation >3d no BM, nausea/vomiting | >30 MME initiation week 1 | Methylnaltrexone 12mg SC docusate 100mg TID ondansetron 4mg |
| 20-40% | Sedation RASS ≥-2, respiratory RR 8-12/min | CYP3A4i x3 exposure elderly | Naloxone 0.4mg IV q2min titration caffeine reversal |
| 10-25% | Pruritus >20% BSA, hyperalgesia NRS escalation | >90 MME continuous >90d | Rotational analgesia tapentadol/nabilone gabapentin 300mg TID |
| 5-15% | Delirium CAM+ >2 features, hypogonadism | >120 MME testosterone <300ng/dL | Haloperidol 0.5mg q6h testosterone replacement q12w labs |
| 1-5% | Overdose apnea RR<6 SpO2<85% | >150 MME accidental pediatric | Naloxone 2mg IN x3 q2-3min intubation GCS<8 ​ |
Critical Pharmacokinetic Interactions: CYP3A4 inhibitors (ketoconazole x4 AUC), benzodiazepines OR15 respiratory arrest, alcohol GABA synergy.​
48 states enforce ≤7-day acute initial supply, 37 states >90 MME specialist consultation required, 28 states mandatory PDMP pre-prescription verification, 17 states naloxone co-prescribe >50 MME or benzo polypharmacy; DEA quota restrictions Q4 2025 limit hydrocodone production 15% targeting diversion signatures (cash multi-pharmacy >$400/mo, early fills <75% days supply).​
| MME Daily Equivalent | Overdose Hospitalization OR | Diversion Probability | Mandatory Interventions ​ |
|---|---|---|---|
| 1-49 MME | Reference OR 1.0 | 5-8% baseline | PDMP check/naloxone education |
| 50-89 MME | OR 1.7-2.2 | 15-20% multi-pharmacy | q14d UDS monitoring |
| 90-119 MME | OR 2.4-3.1 | 25-30% cash threshold | Specialist referral non-opioid rotation |
| ≥120 MME | OR 4.5-8.9 | 40-50% doctor shopping | Opioid cessation COWS taper ​ |
Professional home delivery hub legal absent EPCS? Negative—Ryan Haight felony 5-40 years minimum incarceration.​
Acute prescription maximum days supply? ≤7 days across 48 states.​
APAP hepatotoxicity ceiling with 10mg hydrocodone dosing? 1950mg daily (6 tabs maximum).​
Respiratory death OR benzodiazepine co-exposure? OR15 quantified FDA surveillance.​
PDMP AI diversion detection sensitivity? 95% multi-pharmacy signatures.​
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