Author: Ruben Bermea, LPC

If you experience severe pain or a serious cough, your doctor may prescribe hydrocodone. The most frequently prescribed opioid in the U.S., hydrocodone is used in several hundred prescription medications, most containing other medicines to treat pain and cold symptoms.¹ Some of the most common prescriptions for this medication combine hydrocodone with acetaminophen under the brand names Vicodin and Lortab.¹  Before you decide to use hydrocodone, you may want to consider the short- and long-term health effects this substance can cause.

In This Article:

• A Schedule 2 Opioid Drug
• Hydrocodone vs. Oxycodone
• Hydrocodone Side Effects
• Hydrocodone Dependence and Addiction
• Hydrocodone Overdose Risk
• Withdrawing Safely from Hydrocodone Use
• Treatment for Hydrocodone Misuse

A Schedule 2 Opioid Drug

Designated as a Schedule 2 substance by the U.S. Drug Enforcement Administration (DEA), hydrocodone comes from a class of drugs known as opioids.² Schedule 2 drugs have valid medical use, but also have the potential for misuse and a high risk of addiction and harmful effects when misused. In addition to being classified as an opioid analgesic to relieve pain, hydrocodone is also in a class of medications call antitussives, which treat coughs. Studies show that hydrocodone is as effective as codeine for suppressing coughs and nearly equal to morphine in relieving pain.¹

Doctors prescribe opioid-based medications for acute pain management when other treatments do not work. Along with pain management, doctors may also prescribe hydrocodone combined with other medicines such as guaifenisen, carbinoxamine, chlorpheniramine, and pseudoephedrine to treat cough and cold symptoms.³

In 2018, the U.S. Food and Drug Administration (FDA) required drug manufacturers to include pediatric safety labels on prescription cough and cold medications with hydrocodone in them. The labels limit the use of these products to adults ages 18 years and older.³

Hydrocodone comes in a number of different forms, including capsules, tablets, solutions, syrup, or liquids.³ Your doctor will tell you exactly when you should take this medication and will likely start you off at the lowest therapeutic dose if you have not taken opioid medications recently or in the past.³

Tell your doctor about any other medications, vitamins, supplements, or substances that you take. These can impact the effect that hydrocodone has on your body.³

Hydrocodone vs. Oxycodone

Both hydrocodone and oxycodone are semi-synthetic Schedule 2 opioids manufactured from naturally occurring opium sources, such as morphine and codeine.² Both medications are also combined with acetaminophen in prescription medications to treat acute pain.

Studies show that hydrocodone and oxycodone are equally effective in managing symptoms of pain with similar side effects.⁴ However, certain side effects may be more pronounced in one drug versus the other. For example, studies show that nausea and dizziness occur more often in people using oxycodone.⁴ On the other hand, constipation may be more likely when taking hydrocodone.⁵ Your doctor can help you determine whether you are more likely to do better on hydrocodone vs. oxycodone.

Both of these medications were ranked in the top 10 drugs involved in overdose deaths from 2011 to 2016.⁶ Hydrocodone and oxycodone both have the potential for dependence, misuse, addiction, and overdose.¹

Hydrocodone Side Effects

Hydrocodone side effects can range from mild to severe and some can occur even when taking hydrocodone as prescribed.³ These side effects can impact several systems in your body, including respiratory, cardiovascular, gastrointestinal, and neurologic functions.³

Some hydrocodone side effects include:³

• Breathing problems
• Shortness of breath
• Drop or increase in blood pressure
• Fluid build up in different parts of your body
• Anxious mood
• Sleepiness or problems getting to sleep
• Low energy
• Headache
• Chills
• Skin rash
• Sweating
• Itchiness
• Indigestion
• Inflammation in stomach and intestines
• Stomach pain
• Vomiting
• Diarrhea
• Problems urinating
• Urinary tract infection
• Ringing sounds in the ear

Your risk of hydrocodone side effects can increase dramatically if you take more of the medication than prescribed or for a longer period than prescribed. The risk of harmful effects also increases if you alter the form of the medication to increase its potency, such as by crushing hydrocodone pills into a powder for injection into the body.³

If you are pregnant or are breastfeeding, opioid medication use holds risk for both you and your child.³ Hydrocodone can lead to drowsiness, central nervous system (CNS) problems, and life-threatening respiratory problems for a newborn child. Even small doses of hydrocodone can have harmful effects on infants since they have a high sensitivity to this medication.³

Opioids can have widely different effects on different patients.³ Regular monitoring by your doctor can ensure that you get the amount of this medication that you need while balancing your risk of experiencing side effects. Report any new side effects you experience to your prescribing doctor, especially those associated with an allergic reaction—such as rash and breathing issues—and those related to neurological health—such as headache and ringing in the ears.

Hydrocodone Dependence and Addiction

Even if you take hydrocodone as prescribed, you will be at risk for developing drug tolerance to this medication because of how opioids affect the body.⁷ You develop tolerance when your body adapts to the dose you are taking. To achieve the same desired effect then requires larger or more frequent doses.

Doctors are aware of this natural process, which is why they usually prescribe opioid medications such as hydrocodone for limited time periods and monitor their patients’ use of opioids. Using opioid medications for an extended period of time can lead to physical or mental drug dependence.²

A telltale sign of dependence is when you experience withdrawal symptoms if you suddenly stop using the medication or significantly reduce its dosage.² Dependence can lead to misuse of hydrocodone if you use more of the drug than prescribed. Misuse of hydrocodone is recognized as an addiction, known clinically as an opioid use disorder, when a number of clinical criteria appear.

Signs of an opioid use disorder include:⁷

• Spending large amounts of time seeking this medication
• Exaggerating symptoms to acquire or continue a prescription
• Using hydrocodone in risky situations
• Using hydrocodone despite negative impacts on your health
• Spending less time on important life activities because of use
• Problems with relationships, school, work, or other areas of life
• Needing more of the medication to achieve the desired effect
• Having difficulty not using hydrocodone, even when you want to

Talk with your doctor about any history of substance misuse or dependence you may have experienced in the past. Your doctor can discuss the best treatment options for you and help you weigh the risks and benefits of hydrocodone use. Your doctor may choose to prescribe a non-opioid pain reliever and cough suppressant instead.

Hydrocodone Overdose Risk

Overdose is one of the greatest risks of misusing hydrocodone. Hydrocodone overdose occurs when a person takes more of this medication than their body can safely manage.

Signs of opioid overdose include:^2,3

• Slowed or stopped breathing
• Reduced or ceased heartbeat
• Extremely small pupils
• Drop in blood pressure
• Fainting or extreme dizziness
• Blue or purple lips or fingernail beds
• Inability to speak
• Pale face or clammy skin
• Unusual snoring

These symptoms can become life-threatening when untreated or lead to long-lasting health problems beyond the overdose event.² If you have taken too much of this medication, seek medical attention immediately.

Using hydrocodone with other opioids, alcohol, and other CNS depressants can increase your risk of side effects and overdose.³

If overdose does occur, naloxone is an opioid overdose antidote that can be life-saving by restoring breathing. This medication is available in a nasal form for at-home use. Ask your doctor about accessing naloxone if you are concerned about the risk of opioid overdose while using hydrocodone.

Withdrawing Safely from Hydrocodone Use

Not everyone who takes hydrocodone will develop a substance use disorder. A substance use disorder can only develop when a person misuses hydrocodone or uses it beyond its legitimate medical benefits.⁷ However, using this medication for its relaxing effects or to “feel good” may constitute misuse when you are no longer experiencing pain or acute cough, even if you have some of your prescription left.

If you use this medication and want to stop, a qualified medical professional can walk you through the process of safely discontinuing opioid use. Your doctor can help you taper off of this medication by gradually reducing the amount you take over time.

Be aware that the period of abstinence shortly after stopping this medication can raise your risk of overdose.⁸ That’s because when using this medication for an extended period of time, your tolerance to it increases. However, after you stop using an opioid medication, your tolerance to it will quickly drop. If you then start using the medication again, as some people do to avoid uncomfortable withdrawal symptoms, the dose you used to take may be more than your body can safely manage. This can put you at greater risk for overdose.

Treatment for Hydrocodone Misuse

Treatment options for hydrocodone misuse range from outpatient services to inpatient hospitalization depending on how severe your symptoms are.¹¹ For people who experience side effects from taking this medication as prescribed, managing hydrocodone use may only require regular doctor’s visits. For people experiencing symptoms of addiction, or who are at higher risk of overdose, inpatient hospitalization can offer a safe place to recover from hydrocodone use.¹⁰

If you’re struggling with opioid use disorder, a residential treatment program can help you build coping skills, develop a relapse prevention plan, and lead you to lasting recovery. The combination of medication management, evidence-based mental health counseling, stress management training, relationship building skills, and medical treatment found in residential treatment programs can open the door to renewed living.¹⁰

As you complete treatment, inpatient or outpatient, joining a peer recovery group can help you maintain your sobriety.¹¹

For more information about available recovery options for hydrocodone misuse, get help today at 800-934-1582(Who Answers?)

Resources

1. S. Drug Enforcement Administration. Hydrocodone.
2. S. Drug Enforcement Administration. (2020). Drugs of Abuse: A DEA Resource Guide/2020 Edition. U.S. Department of Justice.
3. Cofano, S., & Yellon, R. (2021, August 13). Hydrocodone. StatPearls Publishing.
4. Chang, A.K., Bijur, P.E., Holden, L., & Gallagher, E.J. (2015). Comparative analgesic efficacy of oxycodone/acetaminophen versus hydrocodone/acetaminophen for short-term pain management in adults following ED discharge. Academic Emergency Medicine, 22(11), 1254-1260.
5. Marco, C. A., Plewa, M. C., Buderer, N., Black, C., & Roberts, A. (2005). Comparison of Oxycodone and Hydrocodone for the Treatment of Acute Pain Associated with Fractures: A Double-blind, Randomized, Controlled Trial. Academic Emergency Medicine, 12(4), 282–288.
6. Hedegaard, H., Bastian, B., Trinidad, J., Spencer, M., & Warner, M. (2018, December 12). Drugs Most Frequently Involved in Drug Overdose Deaths: United States, 2011–2016. National Vital Statistics Reports, 67(9).
7. American Psychiatric Association. (2013). Substance-related and addictive disorders. In: Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
8. Hoey, N.M. (2019). Overdose. Salem Press Encyclopedia of Health.
9. Miller, W. R., Forcehimes, A. A., & Zweben, A. (2011). Treating Addiction: A Guide for Professionals, 2^nd Ed. The Guilford Press.