Hydrocodone is a generic prescription medication used to treat severe pain. It’s approved for severe pain that needs daily, around-the-clock, long-term treatment with an opioid.

Hydrocodone is only used if other treatment options don’t work well enough to relieve the pain or cause troublesome side effects.

This medication is meant to be taken on a regular basis. It’s not suitable for use on an as needed basis.

Drug details

Hydrocodone belongs to a class of drugs called opioid analgesics (pain relievers).

It comes as an extended-release oral tablet and extended-release oral capsule. Extended-release tablets and capsules release the medication slowly over time as they pass through your digestive system.

These forms of hydrocodone are available in the following strengths:

  • extended-release capsule: 10 milligrams (mg), 15 mg, 20 mg, 30 mg, 40 mg, 50 mg
  • extended-release tablet: 20 mg, 30 mg, 40 mg, 60 mg, 80 mg, 100 mg, 120 mg

Brand-name versions

Hydrocodone extended-release tablet comes as the brand name version Hysingla ER. Brand-name versions of hydrocodone extended-release capsule aren’t currently available.

Hydrocodone is a generic drug. A generic drug is an exact copy of the active drug in a brand-name medication. Hysingla ER is the brand-name medication that hydrocodone extended-release tablet is based on. A generic is considered to be as safe and effective as the original drug. Generics tend to cost less than brand-name drugs.

If you’re interested in using Hysingla ER instead of hydrocodone, talk with your doctor. They can tell you if Hysingla ER comes in forms and strengths that can be used for your condition. If you have insurance, you’ll also need to check whether your plan will cover Hysingla ER.

To learn more about how generics compare with brand-name drugs, see this article.

Here are answers to some frequently asked questions about hydrocodone.

How does hydrocodone compare with other similar drugs, such as oxycodone or codeine?

Hydrocodone belongs to a group of drugs called opioid analgesics (pain relievers). There are several other drugs in this group. Examples include morphine (MS Contin, Kadian, others), fentanyl (Fentora, Actiq, others), oxycodone* (Oxycontin, Roxicodone, others), dihydrocodeine, and codeine. These drugs vary in their strength and the forms they come in.

Hydrocodone, oxycodone, and morphine are strong opioids that are only available on prescription. Codeine and dihydrocodeine are weaker opioids that can be found in some prescription pain relievers and cough syrups. Weak opioids are suitable for mild to moderate pain. Doctors prescribe strong opioids for severe pain.

Some, such as hydrocodone, come in extended-release forms. These release the drug slowly into your body over a period of time. They’re used for chronic (long-term, ongoing) pain. Others come in immediate-release forms. These release the drug into your body as soon as you take a dose. These can used on an as-needed basis for acute (short-term) pain or breakthrough pain (sudden worsening of chronic pain). Oxycodone and morphine are available in both immediate and extended-release forms.

All opioids can cause similar side effects, and they all have a risk for misuse and addiction.† However strong opioids such as hydrocodone and oxycodone have a higher risk of these side effects than weaker opioids such as codeine.

To find out more about how hydrocodone compares with other opioids, talk with your doctor.

* To learn more about how hydrocodone compares with oxycodone, see “Hydrocodone oral forms vs oxycodone” below.
Hydrocodone extended-release oral tablet and hydrocodone extended-release oral capsule have a boxed warning for this side effect. This is a serious warning from the FDA. To learn more, see the “Hydrocodone oral forms precautions” section below.

Is hydrocodone an opioid? Is the drug addictive?

Yes, hydrocodone is an opioid. Opioids are powerful pain-relievers that are derived from the opium poppy. These drugs can also have pleasurable effects that can make you want to keep using them. This can make them addictive. With addiction, you have trouble stopping use of a drug, even if it’s causing you harm.

Hydrocodone has a boxed warning for the risk of misuse and addiction. A boxed warning is a serious warning from the Food and Drug Administration (FDA). To learn more about this, see “Hydrocodone oral forms precautions” below.

Can I take hydrocodone with ibuprofen?

Yes, you can usually take hydrocodone with ibuprofen (Advil, Motrin). This can be helpful if you have inflammation associated with your pain.

Ibuprofen is a different kind of pain reliever than hydrocodone. It’s a type of drug called a non-steroidal anti-inflammatory drug (NSAID). Unlike hydrocodone, it reduces inflammation as well as pain. It doesn’t interact with hydrocodone or cause the same kinds of side effects as hydrocodone.

However, ibuprofen isn’t suitable for everyone. If you want to take hydrocodone with ibuprofen, check with doctor or pharmacist first. They can recommend if the combination is right for you.

What is the half-life of hydrocodone?

Hydrocodone has a half-life of about 8 hours. A drug’s half-life is how long it takes your body to clear half a dose of the drug from your system.

It typically takes about five half-lives for your body to fully clear a drug from your system. So, for hydrocodone, it typically takes about 1.5 to 2 days for the drug to be removed from your body.

You may wonder how hydrocodone compares with other medications that are prescribed for similar uses. To find out how hydrocodone compares with oxycodone, see this article.

Hydrocodone can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking hydrocodone. These lists do not include all possible side effects.

For more information about the possible side effects of hydrocodone, talk with your doctor or pharmacist. They can give you tips on how to manage any side effects that may be concerning or bothersome.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs it has approved. If you’d like to notify the FDA about a side effect you’ve had with hydrocodone, you can do so through MedWatch.

Mild side effects

Below is a partial list of mild side effects of hydrocodone. To learn about other mild side effects, talk with your doctor or pharmacist, or view the prescribing information for the extended-release oral tablet and extended-release oral capsule.

Mild side effects of hydrocodone can include:

Most of these side effects may go away within a few days to a couple of weeks. However, if they become more severe or don’t go away, talk with your doctor or pharmacist.

* For more information about allergic reaction and hydrocodone, see “Allergic reaction” below.

Serious side effects

Serious side effects from hydrocodone aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

Serious side effects can include:

  • reduced mental and physical ability to drive safely
  • severe hypotension (very low blood pressure)
  • adrenal gland problems
  • QT prolongation (a type of abnormal heart rhythm)*
  • choking or blockage of the esophagus with the extended-release tablet (see “How to take hydrocodone oral forms” to reduce the risk of this side effect)
  • risk of misuse or addiction
  • risk of serious respiratory depression
  • risk of accidental ingestion†
  • risk of drug interactions that can result in a fatal overdose†
  • risk of use with benzodiazepines and other CNS depressants, including alcohol†
  • risk of neonatal opioid withdrawal syndrome
  • severe allergic reaction§

* This side effect was only reported with hydrocodone extended-release tablets. It’s not expected with the extended-release capsules.
Hydrocodone extended-release oral tablet and hydrocodone extended-release oral capsule have a boxed warning for this side effect. This is a serious warning from the FDA. To learn more, see the “Hydrocodone oral forms precautions” section below.
‡ Hydrocodone has a boxed warning for this side effect. This is a serious warning from the FDA. To learn more, see the “Hydrocodone oral forms and pregnancy or breastfeeding” section below.
§ For details about allergic reaction and hydrocodone, see “Allergic reaction” below.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking hydrocodone. This was a rare side effect in clinical trials of this drug.

Symptoms of a mild allergic reaction can include:

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:

  • swelling under your skin, typically in your eyelids, lips, hands, or feet
  • swelling of your tongue, mouth, or throat
  • trouble breathing

Call your doctor right away if you have an allergic reaction to hydrocodone, as the reaction could become severe. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

The hydrocodone dosage your doctor prescribes will depend on several factors. These include:

  • the severity of your pain
  • what pain relievers you have already been taking
  • your age
  • the form of hydrocodone you take
  • your kidney and liver function
  • other medical conditions you may have
  • your risk for misuse and addiction*
  • side effects you may have with hydrocodone

* Hydrocodone extended-release oral tablet and hydrocodone extended-release oral capsule have a boxed warning for this side effect. This is a serious warning from the FDA. To learn more, see the “Hydrocodone oral forms precautions” section below.

Forms and strengths

Hydrocodone comes as an extended-release oral tablet and extended-release oral capsule. Extended-release tablets and capsules release the medication slowly over time as they pass through your digestive system.

These forms of hydrocodone are available in the following strengths:

  • extended-release capsule: 10 milligrams (mg), 15 mg, 20 mg, 30 mg, 40 mg, 50 mg
  • extended-release tablet: 20 mg, 30 mg, 40 mg, 60 mg, 80 mg, 100 mg, 120 mg

Dosage details

Typically, your doctor will start you on a low dosage. Then they’ll adjust it over time to reach the amount that’s right for you. Your doctor will ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.

Dosage for severe pain

Here’s hydrocodone dosage information for severe pain.

FormExtended-release capsuleExtended-release tablet
Strengths10 milligrams (mg), 15 mg, 20 mg, 30 mg, 40 mg, 50 mg20 mg, 30 mg, 40 mg, 60 mg, 80 mg, 100 mg, 120 mg
Starting dose if you haven’t already been taking an opioid10 mg20 mg
Starting dose if you’re switching to hydrocodone from another opioidYour doctor will calculate your dose based on the opioid(s) you’re switching from and the dose(s) you takeYour doctor will calculate your dose based on the opioid(s) you’re switching from and the dose(s) you take
How oftentwice a day (every 12 hours)once a day (every 24 hours)
Administered byself (see below)self (see below)

Hydrocodone extended-release capsules should be swallowed whole with enough water to make sure you swallow the capsule right away. Don’t crush, chew, suck, open, or dissolve the capsule or its contents.

Hydrocodone extended-release tablets should be swallowed whole with enough water to make sure you swallow the tablet right away. Don’t pre-soak, lick, or wet the tablet before putting it in your mouth. Don’t crush, dissolve, chew, or suck the tablet. If you need to take more than one tablet for your prescribed dose, take the tablets one at a time.

What if I miss a dose?

If you miss a dose, skip the missed dose, and take your next dose at your usual time. Do not take two doses together to make up for a missed dose. This can lead to overdose and death.

Note that if you miss a dose, your pain will likely come back. Talk with your doctor about how to relieve this pain.

To help make sure that you don’t miss a dose, try using a medication reminder. This can include setting an alarm or using a timer. You could also download a reminder app on your phone.

Will I need to use this drug long term?

Hydrocodone is meant to be used as a long-term treatment. If you and your doctor determine that hydrocodone is safe and effective for you, you’ll likely take it long term.

Hydrocodone has a boxed warning for the risk of use with alcohol. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). It alerts doctors and patients about drug effects that may be dangerous.

You should not drink alcohol with hydrocodone extended-release capsules. Extended-release capsules release the medication slowly over time as the capsule passes through your digestive system. Drinking alcohol with this form of hydrocodone can cause all the medication to be released from the capsules at once. This could cause overdose and death.

You should avoid drinking alcohol with hydrocodone extended-release tablets. Alcohol doesn’t affect the way the medication is released from the tablets. However, drinking alcohol with hydrocodone can cause extreme sleepiness, respiratory depression (slow, shallow breathing), coma, and even death.

IF you’re concerned about avoiding alcohol while you’re taking hydrocodone, talk with your doctor.

Hydrocodone can interact with several other medications. It can also interact with certain supplements as well as certain foods.

Different interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase side effects or make them more severe. Drug-condition interactions can also cause certain effects. For information about these interactions, see the “Hydrocodone oral forms precautions” section below.

Hydrocodone and other medications

Before taking hydrocodone, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

Below is a table of medications that can interact with hydrocodone. This table does not contain all drugs that may interact with hydrocodone.

Medication type or medication nameMedication examples
benzodiazepines*alprazolam (Xanax)
diazepam (Valium)
lorazepam (Ativan)
monoamine oxidase inhibitors (MAOIs)• linezolid (Zyvox)
• phenelzine (Nardil)
• tranylcypromine
selective serotonin reuptake inhibitor (SSRI) antidepressantsfluoxetine (Prozac)
paroxetine (Paxil)
sertraline (Zoloft)
serotonin norepinephrine reuptake inhibitor (SNRI) antidepressantsduloxetine (Cymbalta)
venlafaxine (Effexor XR)
tricyclic antidepressantsamitriptyline
• imipramine (Tofranil)
certain other antidepressantsmirtazapine (Remeron)
• nefazodone
trazodone
certain antibiotics*• clarithromycin
• erythromycin (Ery-Tab, Eryc, others)
• rifampin (Rifadin, Rimactane)
certain antifungals* • itraconazole (Sporanox, Tolsura)
ketoconazole
certain HIV medications*• atazanavir (Reyataz, Evotaz)
• fosamprenavir (Lexiva)
• ritonavir (Norvir)
certain seizure medications*• carbamazepine (Tegretol, Carbatrol, others)
gabapentin (Neurontin)
• phenytoin (Dilantin)
sleeping pills*• daridorexant (Quviviq)
• eszopiclone (Lunesta)
• zolpidem (Ambien)
antipsychotics*• clozapine (Clozaril)
• haloperidol (Haldol)
• risperidone (Risperdal)
certain muscle relaxants*baclofen (Lyvispah, Lioresal, others)
cyclobenzaprine
other opioids*• morphine (MS Contin, Kadian, others)
oxycodone (Oxycontin, Roxicodone, others)
tramadol (Conzip)
partial opioid agonists and mixed opioid agonists/antagonists• pentazocine
buprenorphine (BuTrans, Sublocade, others)
• butorphanol
triptans for migraine• almotriptan (Axert)
• eletriptan (Relpax)
sumatriptan (Imigran)
anticholinergics• glycopyrrolate
• oxybutynin (Oxytrol, Ditropan XL, others)
• trihexyphenidyl
laxatives• lactulose
• senna

Your doctor or pharmacist can provide you with more information about the interactions between these medications and hydrocodone. If you have questions about any drug interactions that may affect you, your doctor or pharmacist can also address those.

* Hydrocodone extended-release oral tablet and hydrocodone extended-release oral capsule have a boxed warning for this interaction. This is a serious warning from the FDA. To learn more, see the “Hydrocodone oral forms precautions” section below.

Other interactions

Other types of interactions, such as those with herbs, supplements, foods, lab tests, and vaccines, may also occur with the use of hydrocodone. The following table lists some of these interactions.

Cause of interactionExamples
herbs and supplementsSt. John’s wort
foodsgrapefruit and grapefruit juice

Your doctor can provide you with details about these interactions with hydrocodone.

With long-term use of hydrocodone, it’s possible to become dependent on the drug. With dependence, your body relies on a drug to function normally, either physically or mentally. If you suddenly stop taking a drug that you’re physically dependent on, this can cause withdrawal symptoms.

Withdrawal symptoms that you may have if you suddenly stop taking hydrocodone can include:

  • restlessness
  • runny nose
  • yawning
  • body aches
  • irritability
  • anxiety
  • tremor
  • trouble sleeping
  • diarrhea
  • sweating

You shouldn’t suddenly stop taking hydrocodone without talking with your doctor first. To avoid withdrawal symptoms, your doctor will usually recommend gradually reducing your dose of hydrocodone. This allows your body to readjust to not having the medication before you stop taking it.

The Food and Drug Administration (FDA) approves prescription drugs such as hydrocodone to treat certain conditions.

Hydrocodone for severe pain

Hydrocodone is FDA-approved for use in adults to treat severe pain that needs daily, around-the-clock, long-term treatment with an opioid.

Hydrocodone is only used if other treatment options don’t work well enough to relieve the pain or cause troublesome side effects.

Hydrocodone extended-release tablets and capsules are meant to be taken on a regular basis. These dose forms release the medication slowly over time as they pass through your digestive system. They’re not suitable for use on an as needed basis for short-term pain.

Severe pain explained

You feel pain when your brain receives messages from sensory nerves around your body. These messages are usually sent as a result of tissue damage.

Pain can be described as mild, moderate, or severe, and there are several rating scales that healthcare professionals use to help you describe your pain. For example, numerical scales may go from zero to ten, with zero being no pain and ten being the worst pain imaginable. On this scale, pain rated above six is defined as severe pain.

Severe pain interferes with some or all of your usual daily activities. You may need to stay in bed or a chair due to the pain. This type of pain can occur following injuries and with conditions such as cancer, arthritis, and lower back pain.

Pain can also be described as acute or chronic. Acute pain is sudden pain that’s short-lived. Chronic pain is ongoing pain that lasts longer than 12 weeks. Some people may have chronic pain and acute pain. For example, you may take a regular pain-reliever to control chronic pain. But you may also occasionally have episodes of breakthrough pain, where your pain gets worse for a short time.

Hydrocodone extended-release capsules and tablets provide steady, continuous pain relief, so they’re suitable for relieving chronic pain. They don’t work quickly enough to relieve acute or breakthrough pain.

Hydrocodone and children

Hydrocodone extended-release tablets and capsules are not FDA-approved for use in children under 18 years old. It’s not known if the medication is safe or effective in this age group.

When you get hydrocodone from the pharmacy, the pharmacist will add an expiration date to the label on the bottle. This date is typically 1 year from the date they dispensed the medication.

The expiration date helps guarantee that the medication is effective during this time. The current stance of the Food and Drug Administration (FDA) is to avoid using expired medications. If you have unused medication that’s gone past the expiration date, talk with your pharmacist about whether you might still be able to use it.

Storage

How long a medication remains good can depend on many factors, including how and where you store it.

Hydrocodone extended-release tablets and capsules should be stored at room temperature in a tightly sealed container away from light. Avoid storing this medication in areas where it could get damp or wet, such as bathrooms.

Be sure to store hydrocodone extended-release tablets or capsules in a safe place and out of the sight and reach of children. If hydrocodone is taken accidentally by someone it’s not prescribed for, especially a child, this can cause a fatal overdose. Overdose can happen even with just one dose.*

* Hydrocodone extended-release oral tablet and hydrocodone extended-release oral capsule have a boxed warning for this risk. A boxed warning is a serious warning from the Food and Drug Administration (FDA). To learn more, see “Hydrocodone oral forms precautions” below.

Disposal

If you no longer need to take hydrocodone and have leftover medication, it’s important to dispose of it safely. This helps prevent others, including children and pets, from taking the drug by accident. It also helps keep the drug from harming the environment.

Because hydrocodone is an opioid with a high risk for misuse, addiction, and accidental overdose*, it’s very important that you dispose of unused medication properly. The best way to safely dispose of unused or expired hydrocodone is by finding a drug take back location.

Drug take back locations are under the supervision of the Drug Enforcement Administration (DEA) to ensure all returned medications are properly destroyed. Examples of drug take back locations include pharmacies that choose to participate. You can use either the DEA website or Google Maps to find a drug take back site near you.

If a drug take back location isn’t an option for you, the Food and Drug Administration (FDA) states that it’s OK to flush hydrocodone down the toilet. This ensures hydrocodone isn’t accidentally indigested by someone else.

This article provides several useful tips on medication disposal. You can also ask your pharmacist for information about how to dispose of your medication.

* Hydrocodone extended-release oral tablet and hydrocodone extended-release oral capsule have a boxed warning for this risk. A boxed warning is a serious warning from the Food and Drug Administration (FDA). To learn more, see “Hydrocodone oral forms precautions” below.

As with all medications, the cost of hydrocodone can vary. The actual price you’ll pay depends on your insurance plan, your location, and the pharmacy you use.

Before approving coverage for hydrocodone, your insurance company may require you to get prior authorization. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug. The insurance company will review the prior authorization request and decide whether the drug will be covered.

If you’re not sure whether you’ll need prior authorization for hydrocodone, contact your insurance company.

Financial and insurance assistance

Financial assistance to help you pay for hydrocodone may be available.

Medicine Assistance Tool and NeedyMeds are two websites offering resources that may help decrease the price you pay for hydrocodone. They also offer tools to help you find low cost healthcare, as well as educational resources. To learn more, visit their sites.

Mail-order pharmacies

Hydrocodone may be available through a mail-order pharmacy. Using this service may help lower the drug’s cost and allow you to get your medication without leaving home.

If you’re interested in this option, check with your doctor, pharmacist, or insurance company. Some Medicare plans may help cover the cost of mail-order medications.

If you don’t have insurance, you can ask your doctor or pharmacist about online pharmacy options.

You should take hydrocodone according to the instructions your doctor gives you.

Hydrocodone extended-release tablets and capsules release the medication slowly over time as they pass through your digestive system. The tablets and capsules must be swallowed whole, as described below. Taking them in any other way can cause all the medication to be released at once. This can lead to overdose and death.

  • Hydrocodone extended-release tablets should be swallowed whole with enough water to make sure you swallow the tablet right away. Don’t pre-soak, lick, or wet the tablet before putting it in your mouth. Don’t crush, dissolve, chew, or suck the tablet. If you need to take more than one tablet for your prescribed dose, take the tablets one at a time.
  • Hydrocodone extended-release capsules should be swallowed whole with water. Don’t crush, chew, suck, or dissolve the capsule or its contents.

When to take

Hydrocodone extended-release tablets should be taken once a day, at the same time each day.

Hydrocodone extended-release capsules should be taken twice a day, 12 hours apart, at the same times each day.

Taking the medication around the same time of day helps keep a steady level of the drug in your body. This helps hydrocodone work effectively.

To help make sure that you don’t miss a dose, try using a medication reminder. This can include setting an alarm or using a timer. You could also download a reminder app on your phone.

Accessible labels and containers

If your prescription label is hard to read, talk with your doctor or pharmacist. Some pharmacies offer labels that have large print, braille, or a code you scan with a smartphone to convert text to speech. If your local pharmacy doesn’t have these options, your doctor or pharmacist may be able to direct you to one that does.

If you have trouble opening medication bottles, ask your pharmacist if they can put hydrocodone in an easy-open container. They also may be able to recommend tools that can make it simpler to open lids.

Taking hydrocodone with food

You can take hydrocodone either with or without food.

Can hydrocodone be crushed, split, or chewed?

No, it can’t. Hydrocodone extended-release tablets and capsules must be swallowed whole. Do not crush, split, chew, or dissolve these dose forms, as this can cause overdose and in some cases death.

If you have trouble swallowing hydrocodone, talk with your doctor. They will likely prescribe a different medication for your pain.

Here’s some information on the safety of using hydrocodone during pregnancy and breastfeeding (also known as chestfeeding).

Hydrocodone and pregnancy

Taking hydrocodone during labor and delivery can also cause extreme sleepiness and breathing problems in the baby after the birth.

It’s not known if hydrocodone can increase the risk of congenital anomalies (commonly known as birth defects) or pregnancy loss if taken during pregnancy.

If you’re pregnant or plan to become pregnant, talk with your doctor before taking hydrocodone.

They can explain the treatment options available for treating your pain during pregnancy.

Risk of neonatal opioid withdrawal syndrome

Hydrocodone extended-release tablets and capsules have a boxed warning for the risk of neonatal opioid withdrawal syndrome (NOWS). A boxed warning is a serious warning from the Food and Drug Administration (FDA).

Taking hydrocodone for long periods of time during pregnancy can cause neonatal opioid withdrawal syndrome (NOWS). With NOWS, the newborn baby has opioid withdrawal symptoms, which can be life-threatening if not treated.

With NOWS, the newborn baby may have symptoms such as:

  • crying for long periods
  • high-pitched crying
  • irritability (getting easily upset)
  • trouble sleeping
  • shaking
  • vomiting
  • diarrhea
  • not gaining weight

Hydrocodone and breastfeeding

Hydrocodone can pass into breast milk. It could cause serious side effects in a child who’s breastfed. Your doctor will likely recommend that you don’t breastfeed your child while you’re taking hydrocodone. Talk with them about other healthy ways to feed your child.

If you want to breastfeed, talk with your doctor about other treatment options for your pain that may be safer for use while breastfeeding.

Hydrocodone and birth control

It’s not known if hydrocodone can increase the risk of congenital anomalies (commonly known as birth defects) or pregnancy loss if taken during pregnancy. However, if hydrocodone is used for long periods during pregnancy, the newborn baby may have opioid withdrawal symptoms. If you’re sexually active and you or your partner can become pregnant, talk with your doctor about your birth control needs while you’re using hydrocodone.

For more information about taking hydrocodone during pregnancy, see the “Hydrocodone and pregnancy” section above.

This drug comes with several precautions. These are considered drug-condition interactions.

FDA warnings

This drug has boxed warnings. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). It alerts doctors and patients about drug effects that may be dangerous.

Risk of misuse and addiction.

Hydrocodone is a schedule II controlled substance that has a risk of misuse and addiction.

With misuse, a drug is taken in a way that’s not prescribed, usually for pleasurable effects. With addiction, you have trouble stopping use of the drug, even if it’s causing harm. It’s possible to become addicted to hydrocodone even if you take it as prescribed.

Misuse and addiction can cause serious side effects, overdose, and even death. Due to these risks, the Food and Drug Administration (FDA) requires a Risk Evaluation and Mitigation Strategy (REMS) program for hydrocodone. REMS programs educate doctors about potentially harmful drug effects and ensure certain requirements are met before prescribing potentially harmful drugs. They also help educate consumers on how to safely use these drugs.

Before prescribing hydrocodone, your doctor will assess your risk of misuse and addiction. For example, you may have a raised risk for hydrocodone misuse and addiction if you’ve misused or been addicted to drugs or alcohol in the past. You may also have a raised risk if you have a mental health condition such as depression.

You should only take hydrocodone as prescribed by your doctor. Don’t increase your dosage or take it more often or in a different way than prescribed. Talk with your doctor if you have any symptoms of hydrocodone misuse or addiction while using this drug. These may include:

  • taking hydrocodone in higher doses, more often, or in a different way than prescribed
  • craving the drug
  • having trouble with work, relationships, or health due to use of hydrocodone
  • spending a lot of time trying to obtain hydrocodone

Risk of serious respiratory depression.

Hydrocodone can cause serious, life threatening, or even fatal respiratory depression (slow, shallow breathing). This side effect can occur with hydrocodone overdose. However, it can also occur when the medication is taken as prescribed. The risk is highest when starting treatment and if your doctor increases your dosage.

While taking hydrocodone, you should watch for signs of respiratory depression. It’s helpful to have people you live with or are close to watch for these signs as well. If you have slow, shallow breathing or your breathing stops, you or another person should call 911 or your local emergency number right away.

While you’re using hydrocodone, your doctor may prescribe naloxone (Narcan) to keep on hand. Narcan is a nasal spray that can be used in an emergency to reverse the effects of hydrocodone. To learn more, talk with your doctor.

Risk of accidental ingestion.

If hydrocodone is taken accidentally by someone it’s not prescribed for, especially a child, this can be fatal even with just one dose. Be sure to store hydrocodone extended-release tablets and capsules in a safe place and out of the sight and reach of children.

Risk of drug interactions that can result in fatal overdose.

Hydrocodone is broken down by an enzyme (type of protein) in your liver called cytochrome P450 (CYP) 3A4. Certain drugs can reduce the activity of this enzyme. These are called CYP3A4 inhibitors. Examples include certain HIV medications, antibiotics, and antifungals.

Taking hydrocodone with a CYP3A4 inhibitor can cause hydrocodone to build up in your body. This could lead to overdose and death.

Certain drugs can increase the activity of the CYP3A4 enzyme (type of protein). These drugs are referred to as CYP3A4 inducers. An example of a CYP3A4 inducer is phenytoin (Dilantin). If you need to take a CYP3A4 inducer with hydrocodone, your doctor may prescribe a higher hydrocodone dose so that it works effectively. However, in this case, it’s very important that you do not stop taking the CYP3A4 inducer without telling your doctor. If you need to stop taking the CYP3A4 inducer drug, your doctor will likely also lower your hydrocodone dose to help prevent overdose.

Before taking hydrocodone, be sure to tell your doctor about any other medications, herbs, or supplements that you take. If you take a drug that interacts with hydrocodone, your doctor may prescribe a different dosage of hydrocodone than usual. They may also monitor you more closely for side effects.

Risk of use with benzodiazepines and other CNS depressants, including alcohol.

Benzodiazepines are drugs used to treat anxiety and insomnia (trouble falling asleep or staying asleep). Examples include alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan). These effects are also possible if hydrocodone is used with other central nervous system (CNS) depressants, such as zolpidem (Ambien) and alcohol.

Taking hydrocodone with benzodiazepines or another CNS depressant can cause extreme sleepiness, respiratory depression, coma, and even death. Due to these risks, your doctor will likely not prescribe hydrocodone with a benzodiazepine or CNS depressant unless there are no suitable alternatives.

If your doctor prescribes hydrocodone with a benzodiazepine or CNS depressant, they’ll use the lowest possible dose of both drugs for the shortest possible time. They’ll also likely prescribe naloxone (Narcan) for you to keep on hand. Narcan is a nasal spray that can be used in an emergency to block the effects of opioids.

If you take hydrocodone with a benzodiazepine or another CNS depressant, it’s a good idea to tell people you live with or people you’re close to. If you develop any of the following symptoms, you or another person should administer Narcan and call 911 or a local emergency number right away:

  • you become extremely sleepy or unresponsive
  • you have slow, shallow breathing
  • your breathing stops

You should not drink alcohol with hydrocodone extended-release capsules. Alcohol can cause all the medication to be released from these capsules at once, which could cause overdose and death. Avoid drinking alcohol with hydrocodone extended-release tablets. Drinking alcohol with the tablets can cause extreme sleepiness, respiratory depression, coma, and even death. For more information, see the “Hydrocodone oral forms and alcohol” section above.

Risk of neonatal opioid withdrawal syndrome. Prolonged use of hydrocodone during pregnancy can cause neonatal opioid withdrawal syndrome (NOWS) in the newborn baby. For more information on this warning, see the “Hydrocodone oral forms and pregnancy or breastfeeding” section above.

Other precautions

In addition to the boxed warnings mentioned above, hydrocodone has other warnings.

If any of the following medical conditions or other health factors pertain to you, be sure to talk with your doctor before taking hydrocodone.

  • if you’re pregnant or thinking about becoming pregnant
  • if you’re breastfeeding/chestfeeding or thinking about breastfeeding/chestfeeding
  • if you’ve had an allergic reaction to either drug or any of its ingredients
  • if you have a history of seizures
  • if you have liver or kidney problems, such as chronic kidney disease or alcoholic liver disease
  • if you have adrenal gland problems
  • if you have breathing problems such as chronic obstructive pulmonary disease (COPD) or sleep apnea
  • if you’re very weak and frail
  • if you have low blood pressure
  • if you have heart problems such as a slow heart rate, heart failure, or long QT syndrome (a type of abnormal heart rhythm)
  • if you have a head injury or brain tumor
  • if you have trouble swallowing
  • if you have a blockage or narrowing in your digestive system, for example due to esophageal or colon cancer
  • if you have a problem with your gallbladder or pancreas

Note: For more information about the potential negative effects of hydrocodone, see the “Hydrocodone oral forms side effects” section above.

Using more than the recommended dosage of hydrocodone can lead to serious side effects and death. Do not use more hydrocodone than your doctor recommends. (For information on the recommended dosages of hydrocodone, see the “Hydrocodone oral forms dosage” section above.)

Overdose symptoms

Symptoms of an overdose can include:

  • respiratory depression (slow, shallow breathing)
  • extreme sleepiness
  • weak, limp muscles
  • clammy skin
  • pinpoint pupils
  • unresponsiveness
  • coma

Hydrocodone overdose can be fatal, especially if it’s taken with a benzodiazepine, alcohol, or another CNS depressant. Certain drug interactions can also raise your risk for fatal overdose from hydrocodone. See the “Hydrocodone oral forms precautions” section above to learn more.

What to do in case of overdose

If you think you’ve taken too much of this drug, call your doctor. You can also call the American Association of Poison Control Centers at 800-222-1222 or use its online tool. However, if your symptoms are severe, call 911 or your local emergency number, or go to the nearest emergency room right away.

Your doctor may prescribe naloxone (Narcan) for you to keep on hand while you’re taking hydrocodone. Narcan is a nasal spray that can be used in an emergency to treat hydrocodone overdose. Talk with your doctor about this.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.