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Hydrocodone: Uses, Side Effects, Misuse & More

July 2, 2022

Table of Contents

Hydrocodone is a narcotic prescription medication. It is an opioid prescribed to treat moderate to severe pain and occasionally as an antitussive (to reduce cough). It may be  combined with non-opioid pain relievers such as tylenol in combination prescription medications. 

Hydrocodone is classified as Schedule II narcotic by the Drug Enforcement Administration (DEA) due to their high potential for misuse, which can lead to opioid use disorder (OUD).

What Is Hydrocodone?

Hydrocodone is a semi-synthetic opioid drug that is similar to morphine. It has both analgesic (pain relieving) and antitussive (cough suppressant) properties. It works by binding to opioid receptors in the brain to block pain sensations. It also reduces the brain’s cough reflex which is why it serves as an antitussive. This is the same mechanism by which is reduces the central nervous system’s reflex to breathe, which can increase the risk of respiratory suppression and overdose. 

Hydrocodone comes in a variety of prescription medication formulations. It is one of the most commonly prescribed opioid drugs in the United States with over 70 million hydrocodone-containing products dispensed in 2018.

Hydrocodone Types

Hydrocodone is prescribed both as a single medication and as a combination product that also contains a non-opioid pain reliever, such as ibuprofen or acetaminophen. Hydrocodone products are available in tablets, capsules, and oral solutions.

These are common brand names for hydrocodone:

  • Zohydro ER (extended release): hydrocodone
  • Hysingla ER: hydrocodone 
  • Vicodin: hydrocodone/acetaminophen 
  • Lortab: hydrocodone/acetaminophen
  • Norco: hydrocodone/acetaminophen
  • Lorcet: hydrocodone/acetaminophen
  • Ibudone: hydrocodone/ibuprofen
  • Hycotuss: hydrocodone/guaifenesin

Dosage

Hydrocodone dosing will depend on the type and strength of the medication. 

For example, the tablet, solution, capsule, and syrup are generally designed to be taken every four to six hours as needed. The extended-release suspension and extended-release capsule are to be taken once every 12 hours as needed, while the extended-release tablet is designed to be taken once per day to control pain. 

Hydrocodone products can contain varying amounts of the opioid drug too. The Centers for Disease Control and Prevention (CDC) recommends that you do not exceed 20 mg of hydrocodone in a day. For example, if you are taking Vicodin containing 5 mg of hydrocodone and 300 mg of acetaminophen, you should not exceed four doses per day.

Side Effects

Side Effects of Hydrocodone

Hydrocodone and combination products can cause the following potential side effects:

  • Drowsiness
  • Stomach pain
  • Constipation
  • Lightheadedness
  • Dry mouth and throat
  • Sleep difficulties
  • Ear ringing
  • Back pain
  • Muscle tightness
  • Foot or ankle swelling
  • Headache
  • Uncontrollable shaking
  • Painful, difficult, or frequent urination
  • Anxiety
  • Mood changes

These are more serious possible side effects:

  • Itching
  • Chest pain
  • Nausea, vomiting, or loss of appetite
  • Weakness
  • Dizziness
  • Heartbeat irregularities
  • Agitation
  • Hallucinations
  • Decreased sex drive
  • Inability to keep an erection for men
  • Irregular menstruation in women
  • Trouble breathing or swallowing

Precautions When Taking Hydrocodone

When taking a hydrocodone product, be sure to tell your doctor about any other medications or supplements you are taking. Let your doctor know about possible allergies to this medication, or if you are pregnant or breastfeeding. 

Hydrocodone can make you drowsy. You should not operate a motor vehicle until you are aware of how the medication is going to impact you and your ability to drive. 

Additionally, hydrocodone is an extremely addictive medication with a high potential for misuse. When taken regularly over time, even if taken exactly as directed, hydrocodone can still be habit-forming. 

Stopping hydrocodone suddenly can lead to withdrawal symptoms in individuals who have developed dependence. Some individuals may be able to stop hydrocodone immediately without any withdrawal symptoms, while others conversely may experience severe withdrawal.  If you notice physical dependence or withdrawal symptoms, you should wean off slowly with the help of a medical professional.

Interactions

Hydrocodone and combination products can interact with other medications and supplements, and increase the potential side effects and risk for overdose. 

When taken with the following medications, side effects like drowsiness, dizziness, and reduced mental and physical capabilities can increase:

  • Benzodiazepines
  • Antipsychotics
  • Antihistamines
  • Other opioids

Drugs that increase the amount of serotonin in your body can interact with hydrocodone products to raise the odds for potentially life-threatening serotonin syndrome. These medications include the following:

  • Antidepressants, including selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), and Tricyclic Antidepressants (TCAs)
  • Some antibiotics like linezolid
  • Tramadol (another medication for pain)
  • Ondansetron for nausea
  • Triptans taken for migraines

Medications that interact with enzymes in the liver can increase the rate of breathing problems and dizziness. St. John’s wort and tryptophan are supplements that can also have negative interactions with hydrocodone products.

Hydrocodone Overdose

Signs of Hydrocodone Overdose

Close to 50,000 people died from an opioid overdose in 2019 in the United States. An opioid overdose is a serious and potentially life-threatening condition requiring immediate professional medical attention. 

Signs of an overdose on hydrocodone include the following:

  • Difficulty breathing
  • Drowsiness and inability to stay awake
  • Bluish tint to skin and lips
  • Lack of coordination and balance
  • Nausea and/or vomiting
  • Dizziness
  • Changes in blood pressure and heart rate
  • Mental confusion
  • Pinpoint pupils

Withdrawal Symptoms

Regular use of hydrocodone can also lead to physical and psychological dependence that can cause withdrawal symptoms when the medication is stopped. These side effects can include the following:

  • Nausea and vomiting
  • Diarrhea
  • Fatigue
  • Chills and goosebumps
  • Headache
  • Sweating
  • Dizziness
  • Muscle aches
  • Stomach cramps and pain
  • Anxiety
  • Irritability
  • Restlessness
  • Mental confusion and trouble concentrating
  • Depression
  • Sleep issues

Hydrocodone Misuse & Opioid Use Disorder

In 2020, nearly 5 million people in the United States ages 12 or older misused a hydrocodone product. Hydrocodone is one of the most misused prescription opioid painkillers, as close to 2% of Americans aged 12 and older misused a hydrocodone product in the previous year. 

Any use of a hydrocodone product outside of the way it was prescribed and intended to be taken is misuse. This includes:

  • Chewing the tablet or capsule.
  • Taking more than the dosage prescribed.
  • Continuing to take hydrocodone after the prescription has run out.
  • Altering the medication or taking it in any way other than directed.
  • Mixing hydrocodone with other medications.

Among people ages 12 and older in the United States in 2020, approximately 2.3 million had a prescription pain reliever use disorder. Hydrocodone is a highly addictive and commonly misused prescription opioid painkiller.

Signs of Opioid Use Disorder

OUD is defined as compulsive use of a substance and an inability to stop using it despite negative consequences. Signs of opioid use disorder can include the following:

  • Multiple unsuccessful attempts to stop using hydrocodone
  • Continuing to use the medication even when knowing it will have negative social, emotional, and physical effects
  • Using hydrocodone in situations that are potentially risky
  • Giving up important activities or opportunities that were a previous priority due to hydrocodone use
  • Inability to fulfill school, home, or work obligations consistently
  • Mood and personality changes
  • Alterations in sleeping and eating patterns
  • Lack of attention to physical hygiene or personal appearance
  • Needing to take more hydrocodone to feel the effects (tolerance)
  • Withdrawal symptoms when the medication wears off (dependence)
  • Strong desires to use the substance (cravings)
  • A lot of time spent trying to obtain hydrocodone, using it, and recovering from its effects
  • Social withdrawal and/or changes in social circles

Side Effects of Hydrocodone Misuse

Hydrocodone is a potent opioid narcotic medication that can cause sedation and dangerously low heart rate, blood pressure, body temperature, and respiration rates. 

It can lead to fatal overdose when misused, as it can suppress the life-sustaining functions of the central nervous system. This is compounded if the medication is mixed with other CNS depressant substances, such as alcohol or benzodiazepines.

Hydrocodone is also extremely habit-forming. Even when it is used exactly as directed, physical and psychological dependence can form, causing significant withdrawal symptoms when the medication is stopped. Misuse of hydrocodone increases the risk for dependence and OUD. 

Treatment Options for OUD

Opioid use disorder is a treatable condition. Treatment options include behavioral therapies, such as cognitive behavioral therapy (CBT), which teaches coping mechanisms and life skills for managing triggers and negative thoughts and emotions. 

Medication is often an important component of a complete treatment plan. Medications for Addiction Treatment (MAT) involves using prescription medications to decrease cravings, minimize withdrawal symptoms, and support a sustained recovery.

Peer support groups can also help to provide a healthy outlet and understanding community in recovery for opioid use disorder. Treatment options can range from inpatient, or residential, programs to outpatient models, depending on what is best for the individual. 

Treatment should be personalized and tailored to fit the needs of each individual. If you or a loved one are interested in learning more about MAT for OUD, please reach out to Bicycle Health.

Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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Citations

  1. DEA to Publish Final Rule Rescheduling Hydrocodone Combination Products. Drug Enforcement Administration (DEA). https://www.dea.gov/press-releases/2014/08/21/dea-publish-final-rule-rescheduling-hydrocodone-combination-products. August 2014. Accessed March 2022.
  2. Hydrocodone. Drug Enforcement Administration (DEA). https://www.deadiversion.usdoj.gov/drug_chem_info/hydrocodone.pdf. October 2019. Accessed March 2022.
  3. About CDC’s Opioid Prescribing Guideline. Centers for Disease Control and Prevention (CDC). https://www.cdc.gov/opioids/providers/prescribing/guideline.html. February 2021. Accessed March 2022.
  4. Hydrocodone. U.S. National Library of Medicine (NLM). https://medlineplus.gov/druginfo/meds/a614045.html. March 2022. Accessed March 2022. 
  5. Drug Overdose Deaths. Centers for Disease Control and Prevention (CDC). https://www.cdc.gov/drugoverdose/deaths/index.html. March 2021. Accessed March 2022.
  6. Key Substance Use and Mental Health Indicators in the United States: Results from the 2020 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration (SAMHSA). https://www.samhsa.gov/data/report/2020-nsduh-annual-national-report. October 2021. Accessed March 2022.

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