Hydrocodone is primarily used to treat severe chronic pain that requires opioid analgesia and is not effectively treated by nonopioid alternatives. Hydrocodone is used in combination formulations to treat nonproductive cough in adults and has antitussive properties. Hydrocodone is an opioid medication commonly used to treat moderate to severe pain or as a cough suppressant in some formulations.
It works by binding to opioid receptors in the brain and spinal cord to reduce the perception of pain. Hydrocodone is often combined with other medications, such as acetaminophen (Tylenol), in products like Vicodin or Norco.
Key Points:
- Uses: Pain relief (acute or chronic pain) and cough suppression.
- Forms: Available in tablets, capsules, and liquid forms.
- Common Side Effects: Drowsiness, dizziness, nausea, constipation, and potential respiratory depression.
- Risk of Abuse: Since hydrocodone is an opioid, it has a high potential for misuse and addiction, which is why it’s classified as a controlled substance in many countries.
Why is Hydrocodone Prescribed?
Hydrocodone is used to relieve severe and persistent pain in people who are expected to need an opioid pain medication around the clock for a long time and who cannot be treated with other pain medications. Hydrocodone extended-release (long-acting) capsules or extended-release tablets should not be used to treat pain that can be controlled by medication that is taken as needed. Hydrocodone is in a class of medications called opiate (narcotic) analgesics. It works by changing the way the brain and nervous system respond to pain.pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate
This monograph only includes information about the use of hydrocodone alone. If you are taking a hydrocodone combination product, be sure to read information about all the ingredients in the hydrocodone-combination monograph and ask your doctor or pharmacist for more information.
How Should Hydrocodone be Used?
Hydrocodone comes as an extended-release (long-acting) capsule and an extended-release (long-acting) tablet to take by mouth. The extended-release capsule is usually taken once every 12 hours. The extended-release tablet is usually taken once daily. Take hydrocodone at around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take hydrocodone exactly as directed by your doctor.
Swallow the extended-release capsules or extended-release tablets one at a time with plenty of water. Swallow each capsule or tablet as soon as you put it in your mouth. Do not presoak, wet, or lick the extended-release tablets before you put them in your mouth.
Your doctor may adjust your dose of hydrocodone during your treatment, depending on how well your pain is controlled and on the side effects that you experience. Talk to your doctor about how you are feeling during your treatment with hydrocodone. Tell your doctor if you feel that your pain is not controlled or if your pain increases, becomes worse, or if you have new pain or an increased sensitivity to pain during your treatment with hydrocodone. Do not take more of it or take it more often than prescribed by your doctor.
Do not stop taking hydrocodone without talking to your doctor. If you suddenly stop taking hydrocodone, you may experience withdrawal symptoms such as restlessness, teary eyes, runny nose, yawning, sweating, chills, hair standing on end, muscle pain, widened pupils (black circles in the middle of the eyes), irritability, anxiety, back or joint pain, weakness, stomach cramps, difficulty falling asleep or staying asleep, nausea, loss of appetite, vomiting, diarrhea, fast breathing, or fast heartbeat. Your doctor will probably decrease your dose gradually.
Off Label Usages of Hydrocodone
Off-label uses refer to situations where a medication is prescribed for conditions other than those approved by regulatory bodies, like the FDA. While hydrocodone is primarily approved for treating pain and cough, it may sometimes be used off-label for other purposes. Here are some of the off-label uses of hydrocodone:
1. Management of Chronic, Non-Cancer Pain
Hydrocodone is typically prescribed for acute pain (such as post-surgical pain or injury-related pain), but it may be used off-label for the long-term management of chronic pain not related to cancer, such as:
- Osteoarthritis
- Fibromyalgia
- Chronic lower back pain
- Neuropathic pain This use is generally approached cautiously due to the risk of tolerance, dependence, and addiction.
2. Restless Legs Syndrome (RLS)
Some healthcare providers may prescribe hydrocodone off-label to help patients with restless legs syndrome, especially when other medications do not provide relief. Opioids like hydrocodone may reduce the discomfort caused by RLS, though this use is less common.
3. Severe Anxiety or Emotional Distress
In certain cases, hydrocodone may be used off-label to treat severe anxiety or emotional distress when standard treatments are ineffective. The calming and sedative effects of hydrocodone could provide temporary relief, though this is highly discouraged due to the potential for dependence and misuse.
4. Diabetic Neuropathy
In certain instances, hydrocodone is used off-label to manage the pain associated with diabetic neuropathy. While other medications like gabapentin or pregabalin are typically preferred, opioids, including hydrocodone, may be prescribed for patients who do not respond to first-line treatments.
5. Migraine and Severe Headaches
Although it’s not typically recommended for migraine treatment, hydrocodone may be prescribed off-label for patients with severe migraines or cluster headaches who do not respond to more standard treatments, such as triptans or NSAIDs. However, this is a controversial use due to the risk of rebound headaches and dependency.
6. Cough Suppression in Conditions Not Related to Respiratory Illness
In rare cases, hydrocodone may be used off-label to suppress coughing caused by conditions that are not primarily respiratory, such as GERD (gastroesophageal reflux disease) or post-nasal drip, when other treatments fail.
7. End-of-Life Care (Palliative Care)
Hydrocodone may be used in palliative care to provide comfort for patients experiencing intractable pain or dyspnea (shortness of breath) in conditions like advanced heart failure or chronic obstructive pulmonary disease (COPD). This is done to improve quality of life rather than cure or manage a specific condition.
Risks and Considerations
- Tolerance and Dependence: Long-term use of hydrocodone, even for off-label conditions, can lead to physical dependence and tolerance, requiring higher doses for the same effect.
- Opioid-Induced Hyperalgesia: In some cases, prolonged opioid use can lead to increased sensitivity to pain.
- Legal and Ethical Concerns: Off-label use of opioids like hydrocodone is controversial due to the potential for misuse, addiction, and legal implications.
Alternatives for Off-Label Uses
When considering off-label hydrocodone use, physicians often weigh the risks and explore alternative treatments, such as anticonvulsants, antidepressants, or non-opioid pain relievers, to minimize the risk of dependence and side effects.
What Special Precautions Should I Follow?
Before taking hydrocodone,
- tell your doctor and pharmacist if you are allergic to hydrocodone, any other medications, or any of the ingredients in hydrocodone extended-release capsules or extended-release tablets. Ask your pharmacist or check the Medication Guide for a list of the ingredients.
- tell your doctor or pharmacist if you are taking the following medications or have stopped taking them within the past two weeks: isocarboxazid (Marplan), linezolid (Zyvox), methylene blue, phenelzine (Nardil), selegiline (Emsam, Zelapar), or tranylcypromine (Parnate).
- The following nonprescription or herbal products may interact with hydrocodone: St. John’s wort and tryptophan. Be sure to let your doctor and pharmacist know that you are taking these medications before you start taking hydrocodone. Do not start these medications while taking hydrocodone without discussing it with your healthcare provider.
- tell your doctor if you have any of the conditions mentioned in the IMPORTANT WARNING section, a blockage or narrowing of your stomach or intestines, or paralytic ileus (condition in which digested food does not move through the intestines). Your doctor may tell you not to take hydrocodone.
- tell your doctor if you have or have ever had low blood pressure; difficulty urinating; adrenal insufficiency (condition in which the adrenal glands do not produce enough of certain hormones needed for important body functions); diabetes; seizures; or thyroid, gall bladder, pancreas, liver, or kidney disease.
- tell your doctor if you are breastfeeding. You should not breastfeed while you are taking hydrocodone. Hydrocodone can cause shallow breathing, difficulty or noisy breathing, confusion, more than usual sleepiness, trouble breastfeeding, or limpness in breastfed infants.
- you should know that this medication may decrease fertility in men and women. Talk to your doctor about the risks of taking hydrocodone.
- if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking hydrocodone.
- you should know that hydrocodone may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you.
- you should know that hydrocodone may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position. This is more common when you first start taking hydrocodone. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up.
- you should know that hydrocodone may cause constipation. Talk to your doctor about changing your diet and using other medications to treat or prevent constipation.
What Side Effects can Hydrocodone Cause?
Hydrocodone may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- stomach pain
- dry mouth
- tiredness
- headache
- back pain
- muscle tightening
- ringing in the ears
- difficulty falling asleep or staying asleep
- foot, leg, or ankle swelling
- uncontrollable shaking of a part of the body
- increased sweating
Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNING or SPECIAL PRECAUTIONS sections, call your doctor immediately or get emergency medical treatment:
- chest pain
- agitation, hallucinations (seeing things or hearing voices that do not exist), fever, sweating, confusion, fast heartbeat, shivering, severe muscle stiffness or twitching, loss of coordination, or diarrhea
- nausea, vomiting, loss of appetite, weakness, or dizziness
- inability to get or keep an erection
- irregular menstruation
- decreased sexual desire
- changes in heartbeat
- rash; hives; hoarseness; difficulty breathing or swallowing; or swelling of the face, mouth, tongue or throat
- difficult, frequent, or painful urination
Hydrocodone may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting program online (https://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).
What Should I Know About Storage and Disposal of Hydrocodone?
Keep this medication in the container it came in, tightly closed, and out of reach of children, and in a location that is not easily accessible by others, including visitors to the home. Store it at room temperature and away from excess heat and moisture (not in the bathroom). You must immediately dispose of any medication that is outdated or no longer needed through a medicine take-back program.. If you do not have a take-back program nearby or one that you can access promptly, flush any hydrocodone tablets or capsules that are outdated or no longer needed down the toilet. Talk to your pharmacist about the proper disposal of your medication.
It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. https://www.upandaway.org
In case of emergency/overdose
In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can’t be awakened, immediately call emergency services at 911.
While taking hydrocodone, you should talk to your doctor about having a rescue medication called naloxone readily available (e.g., home, office). Naloxone is used to reverse the life-threatening effects of an overdose. It works by blocking the effects of opiates to relieve dangerous symptoms caused by high levels of opiates in the blood. Your doctor may also prescribe you naloxone if you are living in a household where there are small children or someone who has abused street or prescription drugs. You should make sure that you and your family members, caregivers, or the people who spend time with you know how to recognize an overdose, how to use naloxone, and what to do until emergency medical help arrives. Your doctor or pharmacist will show you and your family members how to use the medication. Ask your pharmacist for the instructions or visit the manufacturer’s website to get the instructions. If symptoms of an overdose occur, a friend or family member should give the first dose of naloxone, call 911 immediately, and stay with you and watch you closely until emergency medical help arrives. Your symptoms may return within a few minutes after you receive naloxone. If your symptoms return, the person should give you another dose of naloxone. Additional doses may be given every 2 to 3 minutes, if symptoms return before medical help arrives.
Symptoms of overdose may include the following:
- slow or shallow breathing
- difficulty breathing
- sleepiness
- muscle weakness
- cold, clammy skin
- narrowed or widened pupils (dark circles in the middle of the eyes)
- slowed heartbeat
- unable to respond or wake up
- unusual snoring
What other information should I know?
Keep all appointments with your doctor and laboratory. Your doctor will order certain lab tests to check your body’s response to hydrocodone.
Before having any laboratory test (especially those that involve methylene blue), tell your doctor and the laboratory personnel that you are taking hydrocodone.
This prescription is not refillable. Be sure to schedule appointments with your doctor on a regular basis so that you do not run out of hydrocodone if your doctor wants you to continue taking this medication. If you continue to have pain after you finish your hydrocodone prescription, call your doctor.
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
Brand Names of Hydrocodone
- Hysingla®
- Zohydro ER®
Detail Listing of Drugs That Contain Hydrocodone
Hydrocodone is often combined with other active ingredients to enhance pain relief or provide additional effects, such as fever reduction or cough suppression. Below is a detailed list of drugs that contain hydrocodone, grouped by their common combinations and brand names:
1. Hydrocodone and Acetaminophen (Paracetamol) Combination
This is one of the most common combinations used to treat moderate to severe pain. Acetaminophen enhances the pain-relieving effect of hydrocodone.
- Vicodin
- Norco
- Lortab
- Lorcet
- Zydone
- Hycet (oral solution)
2. Hydrocodone and Ibuprofen Combination
This combination pairs hydrocodone with ibuprofen, a non-steroidal anti-inflammatory drug (NSAID), for pain relief and reduction of inflammation.
- Vicoprofen
- Reprexain
- Ibudone
3. Hydrocodone as a Cough Suppressant (Antitussive)
In some formulations, hydrocodone is used to suppress coughing, particularly in cases where the cough is severe or persistent.
- Tussionex Pennkinetic (Hydrocodone/Chlorpheniramine)
- Hydrocodone is paired with chlorpheniramine, an antihistamine, to suppress cough and relieve allergy symptoms.
- Hycodan (Hydrocodone/Homatropine)
- Homatropine is added to discourage overuse of hydrocodone.
4. Extended-Release Hydrocodone Formulations
These are used for managing severe, chronic pain that requires around-the-clock treatment, without the need for an immediate-release medication.
- Hysingla ER
- Zohydro ER
5. Hydrocodone and Antihistamine Combinations
These drugs are used to manage cough and cold symptoms by combining hydrocodone’s cough-suppressing properties with an antihistamine to reduce allergy symptoms.
- Tussigon (Hydrocodone/Homatropine)
- FlowTuss (Hydrocodone/Guaifenesin)
6. Hydrocodone-Only Formulations
While uncommon, some formulations contain only hydrocodone, without additional active ingredients. These are often used in extended-release forms for pain management.
- Zohydro ER (extended-release)
- Hysingla ER (extended-release)
Notes:
- Combination with Acetaminophen: These products should be used cautiously due to the risk of liver damage from acetaminophen if taken in high doses.
- Extended-Release Forms: Zohydro ER and Hysingla ER are designed for long-lasting pain relief and are typically reserved for severe pain requiring continuous management.
- Addiction Risk: Due to its opioid nature, hydrocodone-containing drugs have a high potential for abuse and addiction.
These medications are only available via prescription and are classified as controlled substances due to their abuse potential. They are typically prescribed only when non-opioid pain relievers are not effective.
Important Warning of Taking Hydrocodone:
Hydrocodone combination products may be habit forming. Take your hydrocodone combination product exactly as directed. Do not take more of it, take it more often, or take it in a different way than directed by your doctor. While taking hydrocodone combination products, discuss with your healthcare provider your pain treatment goals, length of treatment, and other ways to manage your pain. Tell your doctor if you or anyone in your family drinks or has ever drunk large amounts of alcohol, uses or has ever used street drugs, or has overused prescription medications, or has had an overdose, or if you have or have ever had depression or another mental illness. There is a greater risk that you will overuse a hydrocodone combination product if you have or have ever had any of these conditions. Talk to your healthcare provider immediately and ask for guidance if you think that you have an opioid addiction or call the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-HELP.
Hydrocodone may cause serious or life-threatening breathing problems, especially during the first 24 to 72 hours of your treatment and any time your dose is increased. Your doctor will monitor you carefully during your treatment. Tell your doctor if you have or have ever had slowed breathing or asthma. Your doctor will probably tell you not to take a hydrocodone combination product. Also tell your doctor if you have or have ever had lung disease such as chronic obstructive pulmonary disease (COPD; a group of diseases that affect the lungs and airways), a head injury, a brain tumor, or any condition that increases the amount of pressure in your brain. The risk that you will develop breathing problems may be higher if you are an older adult or are weak or malnourished due to disease. If you experience any of the following symptoms, call your doctor immediately or get emergency medical treatment: slowed breathing, long pauses between breaths, or shortness of breath.
When a hydrocodone combination product was used in children, serious and life-threatening breathing problems such as slow or difficulty breathing and deaths were reported. Hydrocodone should never be used to treat pain or a cough in children younger than 18 years of age. If your child is currently prescribed a cough and cold medicine containing hydrocodone, talk to your child’s doctor about other treatments.
Do not allow anyone else to take your medication. Hydrocodone combination products may harm or cause death to other people who take your medication, especially children. Keep hydrocodone combination products in a safe place so that no one else can take it accidentally or on purpose. Be especially careful to keep hydrocodone out of the reach of children. Keep track of how much hydrocodone combination product is left so you will know if any medication is missing.ª
Taking certain medications with a hydrocodone combination product may increase the risk of serious or life-threatening breathing problems, sedation, or coma. Tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Your doctor may need to change the dosages of your medications and will monitor you carefully. If you take a hydrocodone combination product with other medications and you develop any of the following symptoms, call your doctor immediately or seek emergency medical care: unusual dizziness, lightheadedness, extreme sleepiness, slowed or difficult breathing, or unresponsiveness. Be sure that your caregiver or family members know which symptoms may be serious so they can call the doctor or emergency medical care if you are unable to seek treatment on your own.
Drinking alcohol, taking prescription or nonprescription medications that contain alcohol, or using street drugs during your treatment with a hydrocodone combination product increases the risk that you will experience these serious, life-threatening side effects. Do not drink alcohol, take prescription or nonprescription medications that contain alcohol, or use street drugs during your treatment.
Tell your doctor if you are pregnant or plan to become pregnant. If you take a hydrocodone combination product regularly during your pregnancy, your baby may experience life-threatening withdrawal symptoms after birth. Tell your baby’s doctor right away if your baby experiences any of the following symptoms: irritability, hyperactivity, abnormal sleep, high-pitched cry, uncontrollable shaking of a part of the body, vomiting, diarrhea, or failure to gain weight.
Your doctor or pharmacist will give you the manufacturer’s patient information sheet (Medication Guide) when you begin treatment with a hydrocodone combination product and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (https://www.fda.gov/Drugs/DrugSafety/ucm085729.htm) or the manufacturer’s website to obtain the Medication Guide.
Talk to your doctor about the risks of taking a hydrocodone combination product.