Hydrocodone (Oral)

Overview

Hydrocodone is a medication that helps ease severe pain. It's a prescription medication that belongs to a category of drugs known as narcotic analgesics, which work by altering the way the nervous system and brain respond to pain.

Hydrocodone is available in tablet form and extended-release capsule under the brand names Hysingla ER, Zohydro ER and Hycodan. It's used up to twice daily, depending on which form you're taking.

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

Common Hydrocodone side effects include vomiting, constipation, nausea, anxiety, lightheadedness, rash, itching, and mood changes. Hydrocodone may also cause dizziness and drowsiness. Please don't use heavy machinery or drive a car until you're aware of how this medication affects you.

Conditions Treated

  • Chronic pain
  • Severe pain

Type Of Medicine

  • Narcotic analgesic

Side Effects

Aside from its useful effects, Hydrocodone may bring on some undesirable effects. Not all of the effects listed below may happen, but if they do happen they may require medical care.

Check with your physician right away if you suffer any of the effects below while using Hydrocodone.

Less common:

  • Ear congestion
  • Cough
  • Chills
  • Pain or body aches
  • Labored or difficult breathing
  • Fear or nervousness
  • Nasal congestion
  • Runny nose
  • Sneezing
  • Loss of voice
  • Rapid weight gain
  • Tightness in chest
  • Tingling of feet or hands
  • Unusual tiredness/weakness
  • Unusual weight loss/gain

Get emergency medical assistance at once if you develop any of these overdose symptoms while using Hydrocodone.

Symptoms of overdose:

  • Blurred vision
  • Change in consciousness
  • Blue fingernails or lips
  • Cold, clammy skin
  • Confusion
  • Constricted pupil
  • Decreased responsiveness or awareness
  • Pale skin
  • Weak muscle tone
  • Increased sweating
  • Unusual drowsiness or sleepiness
  • Slow/irregular heartbeat
  • Fainting, dizziness, or lightheadedness
  • Slow or fast, shallow, or irregular breathing
  • Dizziness, lightheadedness, or faintness when suddenly standing up from a sitting/lying position
  • Coughing that occasionally produces frothy pink sputum

Some Hydrocodone side effects may happen that normally don't require medical treatment. These effects may clear as you adjust to Hydrocodone during treatment. Also, your healthcare provider may suggest ways to relieve or prevent some of the effects. Please check with your healthcare provider if you've got queries about these side effects, if they're troublesome or if they persist.

More common:

  • Nausea
  • Difficulty with passing stool (bowel movements)

Less common:

  • Dry mouth
  • Bladder pain
  • Stomach or abdominal discomfort or pain
  • Cloudy or bloody urine
  • Vomiting
  • Muscle spasms
  • Side or lower back pain
  • Itching skin
  • Frequent need to urinate
  • Burning, painful, or difficult urination

This list doesn't contain all of Hydrocodone side effects. For more information, please consult your pharmacist and doctor.

Dosage

Follow all instructions found on the prescription label. This medication can stop or slow down breathing, particularly when you begin using it or whenever your doctor changes your dose. Don't take Hydrocodone in larger quantities than prescribed or beyond the prescribed duration. Tell your healthcare provider if Hydrocodone doesn't seem to be effective in easing your pain.

Even at standard doses, Hydrocodone can be habit-forming. Don't share this medication with anyone else, especially anyone who has had drug addiction or abused drugs before. Misuse of narcotic medication can lead to overdose, addiction or even death, particularly in children or other people using Hydrocodone without a prescription.

Your dose needs could be different if you've recently taken a similar narcotic pain medication and you're tolerant to it. Please talk to your healthcare provider if you aren't sure whether you're narcotic-tolerant.

Don't open, break or crush an extended-release capsule. To avoid the risk of a potentially deadly dose, swallow it whole.

Don't stop taking Hydrocodone suddenly after using it for a long time or you may suffer awful withdrawal symptoms. Please ask your physician how to stop taking Hydrocodone safely.

Never break or crush a Hydrocodone tablet or capsule to make a solution to inject into a vein or inhale the powder. This practice has caused death due to misuse of prescription medication.

Seek emergency medical care or call your poison control agency at 1-800-222-1222. An overdose of Hydrocodone can be deadly, especially for a child or anyone else taking the medication without prescription. Hydrocodone overdose symptoms can include slow heart rate and breathing, muscle weakness, drowsiness, cold, clammy skin, fainting and pinpoint pupils.

Since Hydrocodone is taken to relieve pain, you aren't likely to skip a dose. However, if your next dose is just moments away, skip any dose that you missed. Don't take extra medication to compensate for any missed dose.

Interactions

Hydrocodone can possibly interact with several other medicines. Some of the medications that may interact with Hydrocodone include:

  • Antidepressants
  • Alcohol
  • Antipsychotic medications
  • Antihistamines
  • Sleep medicines
  • Barbiturates, such as Secobarbital (Seconal), Phenobarbital (Luminal), Pentobarbital (Nembutal), Butalbital (Fiorinal, Fioricet) and Amobarbital (Amytal)
  • Benzodiazepines, such as Triazolam (Halcion), Temazepam (Restoril), Midazolam (Versed), Lorazepam (Ativan), Flurazepam (Dalmane), Estazolam (ProSom), Diazepam (Valium), Clorazepate (Tranxene), Clonazepam (Klonopin), Chlordiazepoxide (Librax, Limbitrol, Librium) and Alprazolam (Xanax XR, Xanax)
  • Other opiates or narcotics, such as oxycodone (Oxycontin, OxyIR) and morphine (MSIR, MS Contin)

Hydrocodone interactions explained:

The sections below thoroughly explain the potentially adverse interactions that may happen when you combine Hydrocodone with any of the above drugs. Remember that Hydrocodone is not prescribed alone; it's always prescribed with at least another active ingredient (like Acetaminophen). Depending on the other active elements in some medications, there could be other interactions with products containing Hydrocodone.

Alcohol

You shouldn't ingest alcohol while using Hydrocodone. Hydrocodone interacts with alcohol, potentially raising the risk of severe side effects, including confusion, extreme drowsiness, difficulty with breathing and memory loss.

Antidepressant medicines

Combining Hydrocodone with an antidepressant may raise your chances of developing these side effects: difficulty breathing, memory loss and confusion. Serious side effects can also develop. Please consult your healthcare professional before using an antidepressant with Hydrocodone. You may need to be closely monitored and your doses of medicines may require adjustment.

Antihistamines

Many antihistamines bring on serious drowsiness and may cause serious issues when taken together with other medicines that bring on drowsiness, including Hydrocodone. Make sure to check with physician before taking an antihistamine with Hydrocodone.

Antipsychotic medications, barbiturates and benzodiazepines

Combining Hydrocodone with antipsychotic medication, barbiturates or benzodiazepines may up your chances of developing side effects, including difficulty with breathing, memory loss, confusion and drowsiness. Serious side effects can also happen. Consult your healthcare professional before using antipsychotic medication, barbiturates or benzodiazepines together with Hydrocodone.

Other opiates or narcotics

Exercise extreme caution when taking other opiates or narcotics together with Hydrocodone, as severe side effects may occur. Do not use these medicines together without your healthcare professional's permission and supervision.

Sleep medications

Hydrocodone may cause serious drowsiness and taking it with any sleep medicine may result in dangerous effects. In most cases, it's not advisable to combine sleep medicines with Hydrocodone, unless your healthcare professional specifically tells you to.

Not all Hydrocodone drug interactions were covered in this section. Therefore, make sure to talk to your healthcare professional or pharmacist about any specific interactions that could apply to you.

Warnings

Before taking Hydrocodone:

Tell your pharmacist and doctor if you have allergies to Hydrocodone, any of the elements in Hydrocodone extended-release tablets or extended-release capsules, or any other medications. Check the list of ingredients on the Medication Guide or ask your pharmacist.

Tell your pharmacist and doctor which medications (non-prescription and prescription), nutritional supplements and vitamins you're using or plan to use. Make sure to name any of these medications:

  • Antihistamines (found in cold and cough medications)
  • Amiodarone (Pacerone, Nexterone, Cordarone)
  • Azithromycin (Zmax, Zithromax)
  • Chlorpromazine
  • Butorphanol
  • Citalopram (Celexa)
  • Dextromethorpan (in Nuedexta, found in various cough medications)
  • Cyclobenzaprine (Amrix)
  • Haloperidol (Haldol)
  • Dronedarone (Multaq)
  • Levofloxacin (Levaquin)
  • Lithium (Lithobid)
  • Laxatives like Lactulose (Constulose, Cholac, Enulose, etc.)
  • Medications for Parkinson's disease, irritable bowel syndrome, urinary problems and ulcers
  • Medicines for migraine headaches, including Zolmitriptan (Zomig), Sumatriptan (in Treximet, Imitrex), Naratriptan (Amerge), Rizatriptan (Maxalt), Frovatriptan (Frova), Almotriptan (Axert), Eleptriptan (Relpax)
  • Nalbuphine
  • Pentazocine (Talwin)
  • Mitazapine (Remeron)
  • Trazodone (Oleptro)
  • 5 HT3 Serotonin blockers, including Dolasetron (Anzemet), Alosetron (Lotronex), Palonosetron (Aloxi), Granisetron (Kytril), Ondansetron (Zuplenz, Zofran), or Granisetron (Kytril)
  • Selective serotonin-reuptake inhibitors, including Sertraline (Zoloft), Paroxetine (Pexeva, Prozac, Brisdelle), Escitalopram (Lexapro), Citalopram (Celexa), Fluoxetine (in Symbyax, Sarafem, Prozac), Fluvoxamine (Luvox)
  • Serotonin & norepinephrine-reuptake inhibitors including Venlafaxine (Effexor), Milnacipran (Savella), Duloxetine (Cymbalta), and Desvenlafaxine (Pristiq, Khedezla)
  • Tricyclic antidepressants, incluyding Doxepin (Silenor), Desipramine (Norpramin), Amitriptyline, Imipramine (Tofranil), Clomipramine (Anafranil), Protriptyline (Vivactil), Trimipramine (Surmontil) and Nortriptyline (Pamelor)

Also inform your pharmacist and doctor if you're using or receiving these medicines or have stopped using them in the last two weeks: Tranylcypromine (Parnate), Selegiline (Elderpry, Zelepar, Emsam), Linezolid (Zyvox), Rasagiline (Azilect), Phenelzine (Nardil) and Methylene Blue.

Hydrocodone could also interact with many other medicines, so make sure to report to your doctor all medicines you're using, even those not listed above. Your doctor can carefully monitor you for side effects or alter the dosages of your medications.

Tell your physician which herbal medications you're using, especially Tryptophan and St John's Wort.

Inform your physician if you suffer from any of these conditions: paralytic ileus (a condition where digested food doesn't move via the intestine) or a narrowing or blockage of your intestines or stomach. Your physician may tell you to not use Hydrocodone.

Also, inform your physician if you've ever had or have lung disease, like chronic obstructive pulmonary disease (a group of diseases that attack the airways and lungs), any condition that raises pressure in the brain or a head injury. If you develop any of the following symptoms, call up your doctor at once or seek emergency medical assistance: shortness of breath, lengthy pauses between breaths or slow breathing.

Tell your physician if you've ever had or have low blood pressure, seizures, difficulty with urination or gall bladder, pancreas, kidney, liver or thyroid disease. If you're using the extended-release Hydrocodone tablets, also inform your physician if you've ever had or have difficulty with swallowing, esophageal cancer (a cancer that starts in the tube connecting the stomach and mouth), colon cancer (a cancer that starts in your large intestine), heart rhythm problems like QT Syndrome (a condition that raises the chances of suffering an abnormal heartbeat that can cause sudden death or fainting) or heart failure (a condition where the heart can't pump adequate blood to other body parts).

Let your physician know if you're breastfeeding.

Hydrocodone may reduce fertility in both men and women. Please discuss the risks of using Hydrocodone with your doctor.

If you're having an operation, such as dental surgery, inform the dentist or doctor attending to you that you're using Hydrocodone.

Hydrocodone can make you drowsy. Please don't operate machinery or drive a vehicle until you're aware of how Hydrocodone affects you.

You need to know that Hydrocodone can cause fainting, lightheadedness and dizziness when you stand up too fast from a lying or sitting position. This usually happens when you start using Hydrocodone for the first time. To avoid this issue, slowly wake up, rest your feet a little and then stand up.

You need to know that Hydrocodone can cause constipation. Consult your doctor about altering your diet and taking other medicines to prevent or treat constipation.

Your pharmacist or doctor will hand you the Medication Guide (patient information sheet) when you start Hydrocodone treatment and every time you have your prescription filled. Carefully read the information and ask your pharmacist and doctor if you've got any questions. Also, you can visit the FDA site or the manufacturer's site to get the patient information sheet.

Please discuss the pros and cons of using Hydrocodone with your doctor.

Unless your physician tells you otherwise, keep taking your usual diet.

FDA warnings on Hydrocodone:

Misuse, abuse and addiction

Hydrocodone exposes users and patients to the dangers of opioid misuse, abuse and addiction, which may cause an overdose and even death. Healthcare providers should assess the risk of each patient before prescribing Hydrocodone and regularly monitor all patients for the occurrence of these conditions or behaviors.

Accidental ingestion

Accidentally ingesting even a single Hydrocodone dose, especially by children, can lead to a deadly overdose of Hydrocodone.

Life-threatening respiratory depression

Severe, life-threatening or deadly respiratory depression can happen with the intake of Zohydro ER. Healthcare providers should monitor patients for respiratory depression, particularly during the start of Hydrocodone treatment or after an increase in dose. Patients should swallow Hydrocodone capsules whole; dissolving, chewing, breaking, or crushing capsules may cause a potentially deadly dose of Hydrocodone to be rapidly released and absorbed.

Neonatal narcotic withdrawal syndrome

Using Hydrocodone for a long time during pregnancy may cause neonatal narcotic withdrawal syndrome, which can be potentially fatal if not detected and treated and needs management based on the protocols established by neonatology professionals. If narcotic use is needed for a long period by a pregnant woman, the patient should be advised about the dangers of neonatal narcotic withdrawal syndrome and appropriate treatment must be made available.

Interaction with alcohol

Patients are instructed not to take alcoholic drinks or use non-prescription or prescription products that have alcohol while using Hydrocodone. Ingesting Hydrocodone and alcohol at the same time may increase plasma levels, as well as causing a potentially deadly overdose of Hydrocodone.

Storage

Keep Hydrocodone at room temperature, away from light, heat, and moisture. Store it where other people can't reach.

Keep track of Hydrocodone. Hydrocodone is likely to be abused and you should know if anyone else is taking your medication without a prescription or improperly.

Dispose of leftover Hydrocodone tablets and capsules responsibly. Ask your local pharmacist where you can find a medicine take-back disposal plan.

Summary

Hydrocodone can stop or slow down your breathing. Do not take Hydrocodone in large quantities or beyond the duration prescribed. Don't open, break or crush an extended-release Hydrocodone pill. Make sure to swallow it whole to avoid risking a potentially deadly dose.

Even at normal doses, Hydrocodone can be habit-forming. Don't share Hydrocodone with anybody else, especially anyone with a history of drug addiction or abuse. Keep Hydrocodone in a cool dry place, where no one can reach.

Hydrocodone can interact with some medicines and result in a serious condition known as serotonin syndrome. Make sure your healthcare provider knows if you as well take herbal products, medicine for mental illness, depression, Parkinson's disease, serious infections, migraine headaches or prevention of vomiting and nausea or stimulant medicine. Ask your healthcare professional before changing when or how you use your medicines.

Misusing narcotic medications may lead to overdose, addiction or death, particularly in a person or child using Hydrocodone without a prescription.

You shouldn't take Hydrocodone if you suffer from breathing problems or asthma, or a narrowing or blockage in your intestines or stomach.

If you're pregnant and are using Hydrocodone, your baby may get dependent on the medication. This may cause potentially fatal withdrawal symptoms in your baby after they are born. Infants born dependent on addictive medication may require medical care for weeks. Please tell your physician if you plan to get pregnant or are pregnant.

Do not nurse an infant while you're taking Hydrocodone. This drug can pass into human milk and lead to breathing problems, drowsiness or death of a breastfeeding baby.

Long-term use of narcotic medication can impact fertility in both men and women. However, it's not clear whether the effects of narcotics on fertility are eternal.

Call your local poison control agency at 1-800-222-1222 or seek emergency medical treatment if you believe that a Hydrocodone overdose has occurred. An overdose of Hydrocodone can be deadly, especially for any person or child using the medication without a prescription. Here are some Hydrocodone overdose symptoms: slow heart rate and breathing, muscle weakness, severe drowsiness, cold, clammy skin, fainting and pinpoint pupils.

Don't take alcohol while taking Hydrocodone. Doing so can result in dangerous effects or death.

Hydrocodone can interfere with your thinking or responses. Avoid operating machinery or driving until you're aware of how Hydrocodone will affect you. Severe drowsiness or dizziness may lead to falls or other kinds of accidents.

Hydrocodone is highly likely to trigger breathing difficulties in senior citizens, as well as people who are malnourished, seriously ill or otherwise debilitated.