Hydrocodone

Hydrocodone is a prescription medication used to relieve severe pain. Hydrocodone belongs to a group of drugs called narcotic analgesics. These work by changing the way that the brain and nervous system respond to pain.

Extended-release forms are used to relieve severe pain in adults who require around-the-clock, long-term treatment.

This medication comes in an extended-release capsule and tablet form and is taken up to two times a day, depending on which formulation you are taking.

Do not chew, divide, crush, dissolve, or break hydrocodone extended-release capsules and tablets. Swallow the capsules and tablets whole.

This medication is also available in many combination products. This medication page refers to the single-ingredient preparation.

Common side effects of hydrocodone include nausea, vomiting, constipation, lightheadedness, anxiety, mood changes, rash, and itching.

Hydrocodone can also cause drowsiness and dizziness. Do not drive or operate heavy machinery until you know how hydrocodone affects you.

Hydrocodone is a prescription medication used to relieve severe pain when other pain treatments such as non-opioid pain medicines do not treat the pain well enough or cannot be tolerated. 

Extended-release forms are used to relieve severe pain in adults who require around-the-clock, long-term treatment.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Hydrocodone may be found in some form under the following brand names:

• Hysingla ER

• Vantrela ER

• Zohydro ER

Serious side effects have been reported with hydrocodone. See the "Hydrocodone Precautions” section.

Common side effects of hydrocodone include the following:

• Nausea
• Vomiting
• Constipation
• Drowsiness
• Dizziness
• Lightheadedness
• Headache
• Fuzzy thinking
• Anxiety
• Abnormally happy or abnormally sad mood
• Dry throat
• Difficulty urinating
• Rash
• Itching
• Narrowing of the pupils
• Upper respiratory tract infection

This is not a complete list of hydrocodone side effects. Ask your doctor or pharmacist for more information.

Tell your doctor if you have any side effect that bothers you or that does not go away.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:

• Antidepressants
• Antihistamines
• Antipsychotics (medications for mental illness)
• Ipratropium (Atrovent)
• Medications for irritable bowel disease, motion sickness, Parkinson's disease, seizures, ulcers, or urinary problems
• Monoamine oxidase (MAO) inhibitors, including isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate)
• Medications that could lead to serotonin syndrome such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), desvenlafaxine (Pristiq), nefazodone (Serzone), paroxetine (Paxil, Pexeva), sertraline (Zoloft), venlafaxine (Effexor), trimipramine (Surmontil), isocarboxazid (Marplan), amitriptyline (Elavil), nortriptyline (Pamelor, Aventyl), protriptyline (Vivactil), and clomipramine (Anafranil), and linezolid (Zyvox)
• Mixed agonists/antagonists and partial agonist analgesics such as butorphanol, nalbuphine, pentazocine, buprenorphine
• Sedatives
• Sleeping pills
• Tranquilizers
• Medications that may alter heart electrical activity

This is not a complete list of hydrocodone drug interactions. Ask your doctor or pharmacist for more information.

Serious side effects have been reported with hydrocodone including the following:

• Life-threatening respiratory depression. Tell your healthcare provider right away if you have some or all of the following symptoms of respiratory depression:
  • Slowed or irregular breathing
  • Chest tightness
• Adrenal Insufficiency. Tell your healthcare provider right away if you have some or all of the following signs and symptoms of adrenal insufficiency:
  • nausea
  • vomiting
  • lack of appetite 
  • fatigue
  • weakness
  • dizziness
  • low blood pressure.
• Severe Hypotension. Tell your healthcare provider right away if you have some or all of the following signs and symptoms of low blood pressure:
  • feeling dizzy after standing up
  • blurry vision
  • weakness
  • fainting
  • confusion
  • nausea
• QT Prolongation. Tell your healthcare provider right away if you have some or all of the following signs and symptoms of QT prolongation:
  • dizziness 
  • fainting or feeling faint
  • skipping a heart beat

Hydrocodone can cause dizziness and drowsiness. Do not drive or operate heavy machinery until you know how hydrocodone affects you.

Do not take hydrocodone if you:

• are allergic to hydrocodone or to any of its ingredients
• are taking any other products containing hydrocodone or other narcotic medications, such as morphine or codeine
• have severe asthma, trouble breathing, or other lung problems
• have a bowel blockage or narrowing of the stomach or intestines

Medications can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of hydrocodone, there are no specific foods that you must exclude from your diet when receiving this medication.

Do not drink alcohol or take products containing alcohol while taking hydrocodone.

Before taking hydrocodone, tell your doctor about all of your medical conditions. Especially tell your doctor if you:

• are allergic to hydrocodone or to any of its ingredients
• have or have had lung disease
• had recent surgery
• have croup
• have a head injury
• have any conditions that increase pressure in your brain
• have an enlarged prostate
• have a narrowing of the urethra
• have Addison’s disease
• have glaucoma
• have liver problems
• have kidney problems
• have thyroid disease
• have intestinal disease
• are pregnant or breastfeeding

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

Hydrocodone falls into category C. In animal studies, pregnant animals were given this medication and had some babies born with problems. No well-controlled studies have been done in humans. Therefore, this medication may be used if the potential benefits to the mother outweigh the potential risks to the unborn child.

Tell your doctor if you are breastfeeding or plan to breastfeed.

Hydrocodone has been detected in human breast milk. Because of the possibility for adverse reactions in nursing infants from hydrocodone, a choice should be made whether to stop nursing or to stop the use of this medication. The importance of the drug to the mother should be considered.

Take hydrocodone exactly as prescribed.

• Hydrocodone comes in extended release capsule form and is taken twice daily.
• Hydrocodone comes in a extended release tablet and is taken once a day or twice a day depending on the specific medication you have been given. 

Do not chew, divide, dissolve, or break extended release hydrocodone capsules and tablets. Swallow the capsules and tablets whole.

This medication is also available in many combination products. This medication page refers to the single-ingredient preparation.

Call your healthcare provider if the dose you are taking does not control your pain.

Take this medication exactly as prescribed by your doctor. Follow the directions on your prescription label carefully.

The dose your doctor recommends may be based on the following:

• other medical conditions you have
• other medications you are taking
• how you respond to this medication

The recommended starting dose of Zohydro (hydrocodone extended release capsules) for the treatment of severe pain is 10 mg every 12 hours. 

The recommended starting dose of Hysingla (hydrocodone extended release tablets) for the treatment of severe pain is 20 mg once a day.

The recommended starting dose of Vantrela (hydrocodone extended release tablets) for the treatment of severe pain is 15 mg every 12 hours. 

The dose will be increased as needed and based on several factors. 

Your doctor may reduce the dose by one half if you have kidney or liver problems.

If you take too much hydrocodone, call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away.

If hydrocodone is administered by a healthcare provider in a medical setting, it is unlikely that an overdose will occur. However, if an overdose is suspected, seek emergency medical attention.

• Store hydrocodone at room temperature
• Keep this and all medicines out of the reach of children.

WARNING: ADDICTION, ABUSE, AND MISUSE; LIFE-THREATENING RESPIRATORY DEPRESSION; ACCIDENTAL INGESTION; NEONATAL OPIOID WITHDRAWAL SYNDROME; INTERACTION WITH ALCOHOL; and CYTOCHROME P450 3A4 INTERACTION

Addiction, Abuse, and Misuse
Hydrocodone exposes patients and other users to the risks of opioid addiction, abuse, and misuse, which can lead to overdose and death. Assess each patient’s risk prior to prescribing hydrocodone and monitor all patients regularly for the development of these behaviors or conditions.

Life-threatening Respiratory Depression
Serious, life-threatening, or fatal respiratory depression may occur with use of this medication. Monitor for respiratory depression, especially during initiation of hydrocodone or following a dose increase. Instruct patients to swallow capsules whole; crushing, chewing, or dissolving hydrocodone capsules can cause rapid release and absorption of a potentially fatal dose of hydrocodone.

Accidental Ingestion
Accidental ingestion of even one dose of hydrocodone, especially by children, can result in a fatal overdose of hydrocodone.

Neonatal Opioid Withdrawal Syndrome
Prolonged use of hydrocodone during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated, and requires management according to protocols developed by neonatology experts. If opioid use is required for a prolonged period in a pregnant woman, advise the patient of the risk of neonatal opioid withdrawal syndrome and ensure that appropriate treatment will be available.

Interaction with Alcohol
Instruct patients not to consume alcoholic beverages or use prescription or non-prescription products that contain alcohol while taking hydrocodone. The co-ingestion of alcohol with hydrocodone may result in increased plasma levels and a potentially fatal overdose of hydrocodone.

The concomitant use of hydrocodone with all cytochrome P450 3A4 inhibitors may result in an increase in hydrocodone plasma concentrations, which could increase or prolong adverse drug effects and may cause potentially fatal respiratory depression. In addition, discontinuation of a concomitantly used cytochrome P450 3A4 inducer may result in an increase in hydrocodone plasma concentration. Monitor patients receiving hydrocodone and any CYP3A4 inhibitor or inducer.