Hydrocodone-Acetaminophen: How to Use It Safely for Pain Relief?

Last Updated: June 10, 2020

Authored by Olivier George, Ph.D.

Reviewed by Michael Espelin APRN

Acetaminophen and hydrocodone are two separate medications that are available as a combination drug for the treatment of moderate to moderately severe pain. Acetaminophen is used to treat pain and fever. It is not habit-forming even with prolonged use but can cause liver damage if consumed in large doses. Hydrocodone classification is a narcotic analgesic with a high potential for abuse and addiction. The two medicines together are highly effective in relieving pain, but the use of this combination is not without risk. Let’s find out what is hydrocodone acetaminophen and the uses, potential side effects, drug interactions, and warnings associated with this medicine.

Hydrocodone with Acetaminophen: Indications and Mechanism of Action

Acetaminophen/hydrocodone is a medication that is available in tablet or solution form to be taken by mouth. It is available as a generic drug called hydrocodone bitartrate and acetaminophen. It is also available under brand names such as:

  • Vicodin, Vicodin ES, and Vicodin HP
  • Lortabbottles with hydrocodone acetaminophen prescription pills
  • Lorcet and Lorcet Plus
  • Norco
  • Hycet
  • Zydone
  • Maxidone
  • Verdrocet
  • Xodol
  • Stragesic
  • Zolvit
  • Zamicet

Hydrocodone APAP contains an opioid (narcotic) as well as acetaminophen which is an analgesic (painkiller) and antipyretic (fever reducer). Hydrocodone blocks receptors that give rise to pain signals and decreases a person’s ability to perceive pain. Acetaminophen is a non-narcotic pain reliever that elevates a person’s pain threshold and allows them to tolerate higher levels of pain.
The combination drug is a prescription medication and a controlled substance. Doctors use it to treat moderate to a moderately severe pain that cannot be controlled with other less potent medications. It is prescribed to people who need around-the-clock pain relief requires with an opioid analgesic. Hydrocodone with homatropine (brand name Hycodan) is indicated for symptomatic relief of a cough.
The medicine is available in a number of different strengths under various brand names. For example, hydrocodone acetaminophen 5-325, brand name Norco, contains 5 mg of the opioid and 325 mg of the non-narcotic analgesic. For more severe pain, hydrocodone acetaminophen 10-325 or hydrocodone M367, a more potent formulation with a 10-mg dose of the narcotic analgesic may be used. For moderate pain, a lower dosage, such as hydrocodone acetaminophen 5-300 or hydrocodone 2.5 mg/acetaminophen 325 mg, may be sufficient.

Reducing Risk of Addiction: Correct Administration of Hydrocodone/Acetaminophen

Acetaminophen/hydrocodone contains a narcotic analgesic that has a high potential for abuse and addiction. This drug can be habit-forming even when used at prescribed doses. Here are some rules to take the drug safely and reduce the risk of addiction.

Rules of Intake

  • Take hydrocodone/APAP exactly as prescribed – do not take larger amounts, more frequent doses, or take it for longer than prescribed.
  • Tell doctor about any personal or family history of alcoholism or street drug use.
  • Keep track of the number of tablets received ot know if some are missing.
  • Keep the medication in the bottle it came in, tightly closed, away from light, and out of reach of children.
  • Carry the medicine and prescription when traveling – do not put the bottle in checked bag. Airport x-ray machines are safe.
  • Do not leave the bottle in the glove compartment of car where it may be exposed to extreme temperatures.
  • Do not take an extra dose to make up for a missed dose.
  • Do not mix it with other medications, for example, Xanax and hydrocodone, because this can result in dangerous drug interactions.
  • Do not share prescription or obtain pills from family and friends.
  • Do not stop using the medicine suddenly after prolonged use.
  • Deposit unused medication at pharmacy or flush it down the toilet.

Performing Extreme Actions on Hydrocodone

The combination of narcotic and non-narcotic analgesic medication can impair thinking and slow reactions. It can cause severe drowsiness and dizziness, leading to falls and accidents. That’s why it is a good idea to avoid driving, operating heavy machinery, or performing hazardous activities, such as climbing ladders until  know how body will react to acetaminophen-hydrocodone.

Ways of Hydrocodone/Acetaminophen Drugs Administration

opioid painkiller pills on the pink backgroundTablets and capsules are available with varying amounts of the two medicines, for example, hydrocodone acetaminophen 7.5-325 and hydrocodone acetaminophen 5-500. The tablet or capsule should be swallowed whole with a full glass of water and with food to avoid an upset stomach. Crushing, breaking, or dissolving an extended-release formulation can lead to too much of the medication being released at once, causing serious problems including overdose and death.
Correct administration of the liquid formulation requires measurement with a medicine cup, dosing syringe, or measuring spoon for exact dosing. The drug should be stored at room temperature (60-85 degrees Fahrenheit).

Hydrocodone Acetaminophen Side Effects

Like most medications, this combination pain reliever is also associated with a number of adverse effects. Some of the most common side effects of acetaminophen hydrocodone include:

  • Drowsiness
  • Dizziness or lightheadedness
  • Nausea, vomiting, stomach pain
  • Constipation
  • Difficulty urinating
  • Rash or itching
  • Dry mouth
  • Back pain
  • Muscle tightening
  • Ringing in the ears
  • Difficult or painful urination
  • Insomnia
  • Uncontrollable shaking of some part of the body
  • Foot or ankle swelling

To manage these side effects, individuals who have been prescribed hydrocodone acetaminophen 5-325 (or other dosages) should avoid getting up quickly to prevent dizziness. It is a good idea to eat a high fiber diet and stay well hydrated (unless otherwise instructed) to prevent constipation. Any rash that develops while on this medicine should be checked out by a healthcare provider. If any of the above symptoms persist for longer than one week, it is essential to consult a physician.

Some of the serious adverse effects of this combination of medicines include:

  • Swelling of the face, mouth, or throat man holding the upper right part of the body because of pain
  • Severe skin rash or itchiness
  • Yellowing of the skin
  • Pain or swelling in the right upper quadrant of the abdomen
  • Tiredness
  • Confusion
  • Lack of appetite
  • Trouble breathing

Some of the adverse effects of this drug are potentially life-threatening and constitute a medical emergency. Call 911 and seek immediate medical care if someone who is on this medicine experiences:

  • Nausea, vomiting, sweating, weakness
  • Slowed breathing
  • Slowed heart rate
  • Very low blood pressure
  • Unresponsiveness

FDA and Other Warnings for Hydrocodone Bitartrate and Acetaminophen

The Food and Drug Administration (FDA) has issued a black box warning for hydrocodone-acetaminophen to warn patients and doctors that the medicine is dangerous because:

  • It is habit-forming and can lead to misuse, abuse, and addiction with an associated risk of overdose and death.
  • It can slow down or stop breathing.
  • It can be fatal if accidentally ingested by a child or by someone without a prescription.
  • It can cause neonatal withdrawal syndrome in a newborn baby if used by a pregnant woman while she is expecting – these withdrawal symptoms can be life-threatening for the infant.
  • It can interact with other medications and result in potentially lethal adverse effects.
  • It can cause liver failure due to excessive doses of acetaminophen.
  •  It can result in deep sedation, coma, and death when used in combination with other CNS depressants such as alcohol or benzodiazepines.

In addition to the FDA’s black box warning, there are certain other dangerous effects of hydrocodone/acetaminophen including:

  • Severe allergic reaction with difficulty breathing, swelling of the tongue and throat, hives, skin rash, itching, and vomiting.
  • Adrenal problems with symptoms including nausea, vomiting, loss of appetite, fatigue, weakness, and lightheadedness.

If one develops any of these symptoms, call 911 immediately or go to the nearest ER. If one have had an allergic reaction to this combination of medicines before, tell doctor about it because taking it again could prove fatal.

Who Should Avoid Hydrocodone/APAP?

People with certain medical conditions should avoid taking the combination of acetaminophen and hydrocodone:

  • In individuals with head injuries, this medicine can lead to breathing problems or increased pressure in the brain.
  • In people with constipation, ulcerative colitis, or intestinal obstruction, the drug can exacerbate gastrointestinal symptoms.
  • In individuals with severe kidney disease, the medication can build up in the body and cause breathing trouble and other side effects.
  • In people with lung conditions, taking hydrocodone acetaminophen can worsen breathing difficulties.
  • In individuals with the severe liver disease, the drug can build up in the body and lead to liver failure.
  • In men with prostate enlargement, the medicine can cause difficulty with urination.
  • In asthmatic men and women, the medicine may lead to uncontrolled asthma – if it must be prescribed to someone with breathing trouble, the first few doses may need to be given in a medically monitored setting where adverse effects can be managed.
  • The drug is a category C, which means its effects on the fetus are not well understood. Babies born to women who take opioid-containing medications, such as hydrocodone with acetaminophen, are at risk of withdrawal symptoms after birth.
  • In breastfeeding women, the medicine is passed through breast milk to the baby and can lead to side effects such as tiredness and slowed breathing.
  • In elderly individuals, the effect of the medication may be amplified due to decreased liver, kidney, and heart function – a lower dose may be sufficient in older individuals.

Dangerous Interactions: Avoid Mixing Hydrocodone / Acetaminophen with These Drugs

alcoholic drink and hydrocodone apap pillsHydrocodone bitartrate and acetaminophen can interact with a number of different medications, herbal supplements, and vitamins. Some of these drug interactions are dangerous because they alter the way the medicine works or increase its concentration in the blood. For example, mixing alcohol and hydrocodone can be lethal because both are central nervous system depressants that can cause respiratory depression, profound sedation, coma, and death.
Interactions can be avoided by carefully telling healthcare providers about all the prescription medications and over-the-counter supplements one takes. Some of the drugs that cause interactions with acetaminophen and hydrocodone bitartrate include:

  • Other opioids, antihistamines, benzodiazepines, antipsychotics, sedatives, and tranquilizers that cause drowsiness and reduced mental function.
  • Antidepressants (SSRIs, MAOIs, TCAs, and SNRIs), triptans used to treat migraines, ondansetron for nausea, tramadol pain medication, and antibiotic linezolid that increase serotonin and can lead to fatal serotonin syndrome.
  • Rifampin, phenytoin, carbamazepine that increase the activity of certain liver enzymes so that less acetaminophen hydrocodone is available and a higher dose is needed to control pain.
  • Erythromycin (antibiotic), ketoconazole (antifungal), and ritonavir (HIV medicine) that inhibit certain liver enzymes and can lead to increased blood concentrations with a risk of drowsiness and breathing problems.

Chasing a Hydrocodone Acetaminophen High: Potential for Abuse and Addiction

Opioid narcotics are powerful substances that act on receptors in the brain and depress the central nervous system. Hydrocodone acetaminophen 10-325 and other formulations of the drug can be habit-forming even when used with a doctor’s prescription. This is because prolonged use of opiates causes the brain to stop producing endorphins, a neurotransmitter that is naturally present in the body and activates opiate receptors to reduce the perception of pain. Opiate abuse leads to an inability of the body to naturally manage pain, leading to a need for higher amounts of hydrocodone-acetaminophen.

Recovery from Opioid Addiction

There are a number of drug addiction treatment options for individuals who are addicted to hydrocodone acetaminophen 7.5-325 or other formulations of the medication. Naloxone is used to rescue people who are overdosing on opioids. Medically assisted detox with buprenorphine and naloxone (Suboxone) can reverse the effects of opiates during withdrawal and control cravings. Methadone can help relieve withdrawal symptoms and make detoxification less uncomfortable. If one has an addiction to hydrocodone acetaminophen, help is at hand. The important thing is to understand the negative consequences of using and start drug rehab without delay.

Page Sources

  1. Michael A. Grasso, Zachary D.W. Dezman, Angela C. Comer, David A. Jerrard, The Decline in Hydrocodone/Acetaminophen Prescriptions in Emergency Departments in the Veterans Health Administration Between 2009 to 2015, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4957666/
  2. Chang AK, Bijur PE, Munjal KG, John Gallagher E., Randomized clinical trial of hydrocodone/acetaminophen versus codeine/acetaminophen in the treatment of acute extremity pain after emergency department discharge, https://www.ncbi.nlm.nih.gov/pubmed/24628747
  3. Rodriguez RF, Castillo JM, Del Pilar Castillo M, Nuñez PD, Rodriguez MF, Restrepo JM, Rodriguez JM, Ortiz Y, Angel AM, Codeine/acetaminophen and hydrocodone/acetaminophen combination tablets for the management of chronic cancer pain in adults: a 23-day, prospective, double-blind, randomized, parallel-group study, https://www.ncbi.nlm.nih.gov/pubmed/17617281

Published on: September 21st, 2018

Updated on: June 10th, 2020

About Author

Olivier George, Ph.D.

Olivier George is a medical writer and head manager of the rehab center in California. He spends a lot of time in collecting and analyzing the traditional approaches for substance abuse treatment and assessing their efficiency.

Medically Reviewed by

Michael Espelin APRN

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.


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