Question about max dosage variability per package insert

[Curiousone1111]

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Hi everyone,

I know the max dose for tramadol is 400mg/day and the max dose for apap is 4g/day (rx). Why is it that for tramadol/apap which comes as 37.5mg/325mg, that the max is listed as 8 pills per day? That’s only 300 mg tramadol and 2600mg apap.
Unless that’s just initial use and it can go up to ~400mg with 10 pills=375mg/day of tramadol and 3250mg of apap. Sorry, never filled this before and just got curious while coming across the drug.

Similar story with hydrocodone/apap. Different strengths come with different max. I remember asking my rph once when I was a student and she didn’t know/didn’t pay attention to the different max dosages per formulation. I.e. hydrocodone 7.5mg/apap 325 has max of 6 tabs so max of 45mg hydrocodone/day… vs. hydrocodone 5mg/apap 300mg has max of 8 tabs so max 40mg hydrocodone/day vs. hydrocodone 10mg/apap 325 has a max of 6 tabs so 60mg/day. I thought opioids didn’t have ceiling doses anyway as long as you didn’t exceed the daily apap component, but I’m just not understanding why there are different max dosages when the ingredients are the same hydrocodone and apap. For some reason I also recall the max of hydrocodone being 60mg a day but these obviously vary and I just don’t get why. Thanks a bunch!

 

[zelman]

I think you may be conflating the FDA approved dose upper limit and the maximum safe dose.

 

[JustFillIt]

Hi everyone,

I know the max dose for tramadol is 400mg/day and the max dose for apap is 4g/day (rx). Why is it that for tramadol/apap which comes as 37.5mg/325mg, that the max is listed as 8 pills per day? That’s only 300 mg tramadol and 2600mg apap.
Unless that’s just initial use and it can go up to ~400mg with 10 pills=375mg/day of tramadol and 3250mg of apap. Sorry, never filled this before and just got curious while coming across the drug.

Similar story with hydrocodone/apap. Different strengths come with different max. I remember asking my rph once when I was a student and she didn’t know/didn’t pay attention to the different max dosages per formulation. I.e. hydrocodone 7.5mg/apap 325 has max of 6 tabs so max of 45mg hydrocodone/day… vs. hydrocodone 5mg/apap 300mg has max of 8 tabs so max 40mg hydrocodone/day vs. hydrocodone 10mg/apap 325 has a max of 6 tabs so 60mg/day. I thought opioids didn’t have ceiling doses anyway as long as you didn’t exceed the daily apap component, but I’m just not understanding why there are different max dosages when the ingredients are the same hydrocodone and apap. For some reason I also recall the max of hydrocodone being 60mg a day but these obviously vary and I just don’t get why. Thanks a bunch!

something else to remember - tramadol is capped at 300mg/day in the elderly

 

[ValeRx]

Max dose of APAP is also relative. In our hospital here, it's 3g per day.

 

[JustFillIt]

Max dose of APAP is also relative. In our hospital here, it's 3g per day.

However, I would stay below 4g and use this dose temporarily if needed.

“relative” is a relative term…. Relatively speaking - I would be careful to not allow someone’s relativity stretch them too far