Hydrocodone is a narcotic pain medication. It is an opioid prescribed to treat moderate to severe pain. It may be combined with non-opioid pain relievers, such as Tylenol, in combination prescription medications such as Vicodin.
Hydrocodone is classified as Schedule II narcotic by the Drug Enforcement Administration (DEA) due to its high potential for misuse, which can lead to opioid use disorder (OUD).[1]
Side effects of hydrocodone can occur with both legitimate use and misuse. They include constipation and digestive issues, drowsiness, mood swings, body aches, and breathing issues, among others.
What Is Hydrocodone?
Hydrocodone is a semi-synthetic opioid drug. It works by binding to opioid receptors in the brain to block pain sensations.
Like other opioids, it also reduces the brain’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 80 million hydrocodone-containing products dispensed in 2018.[2]
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 (Vicodin). Hydrocodone products are available in various forms, such as 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
Hydrocodone Dosages & Precautions
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 for longer periods of time.
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.[3] 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.
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.
Side Effects of Misuse & Abuse
Hydrocodone and combination products can cause the following potential side effects:[4]
- 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 can occur with both legitimate medical use and misuse, but they are more likely with misuse.
These are more serious possible side effects that may occur in some people:
- 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
With continued misuse, the risk for overdose increases, and this can be fatal.
Hydrocodone Overdose
Close to 50,000 people died from an opioid overdose in 2019 in the United States.[5] An opioid overdose is a serious and potentially life-threatening condition that requires 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
An opioid overdose should promptly be treated with naloxone (Narcan). If you have Narcan on hand, use it immediately and call 911.
Withdrawal Symptoms
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 may experience severe withdrawal.
If you notice physical dependence or withdrawal symptoms, you should consult a medical professional to help with the withdrawal process. Withdrawal is more likely if you have been using hydrocodone for a prolonged period, but can occur as soon as even a few weeks of using the medication regularly in certain individuals.
Withdrawal symptoms 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
Treatment for Hydrocodone Misuse
Opioid use disorder is a treatable condition. Treatment options include both behavioral and pharmacological therapies.
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. Medication for Addiction Treatment (MAT) involves using prescription medications, such as Suboxone, to decrease cravings, minimize withdrawal symptoms, and support a sustained recovery.[7] Medication is combined with therapy in this model, and it is considered the gold standard in treatment for hydrocodone addiction.[8]
Peer support groups can 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.
By: Elena Hill, MD, MPH
Is Suboxone treatment a fit for you?
Citations
- DEA to Publish Final Rule Rescheduling Hydrocodone Combination Products. Drug Enforcement Administration. https://www.dea.gov/press-releases/2014/08/21/dea-publish-final-rule-rescheduling-hydrocodone-combination-products. August 2014. Accessed February 2023.
- Hydrocodone. Drug Enforcement Administration. https://www.deadiversion.usdoj.gov/drug_chem_info/hydrocodone.pdf. October 2019. Accessed February 2023.
- About CDC’s Opioid Prescribing Guideline. Centers for Disease Control and Prevention. https://www.cdc.gov/opioids/healthcare-professionals/index.html. February 2021. Accessed February 2023.
- Hydrocodone. National Library of Medicine. https://medlineplus.gov/druginfo/meds/a614045.html. March 2022. Accessed February 2023.
- Drug Overdose Deaths. Centers for Disease Control and Prevention. https://www.cdc.gov/drugoverdose/deaths/index.html. March 2021. Accessed February 2023.
- 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. https://www.samhsa.gov/data/report/2020-nsduh-annual-national-report. October 2021. Accessed February 2023.
- Medications to Treat Opioid Use Disorder: Research Report. National Institute on Drug Abuse. https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction/overview. December 2021. Accessed February 2023.
- Use of Medication for Opioid Use Disorder Among US Adolescents and Adults With Need for Opioid Treatment, 2019. JAMA Network Open. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2790432. March 2022. Accessed February 2023.
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