Hydrocodone/Acetaminophen for Treating Pain


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Hydrocodone/acetaminophen (generic for Vicodin, Lortab, Norco) is a narcotic analgesic used to treat pain. The drug received renewed attention after Darvon and Darvocet were removed from the market on November 19, 2010. As pain medications are removed from the market, fewer options remain for the treatment of chronic pain.

Vicodin, which was discontinued in the U.S. market, was a popular alternative for some Darvocet-users. Vicodin, which was available in tablet form, to be taken orally (by mouth) contained 5 milligrams (mg) hydrocodone bitartrate and 500 mg acetaminophen. There were also Vicodin-ES (7.5 mg hydrocodone bitartrate/750 mg acetaminophen) and Vicodin-HP (10 mg hydrocodone bitartrate/660 mg acetaminophen).

In 2014, the Food & Drug Administration (FDA) applied stricter restrictions on hydrocodone-containing products to improve safety and combat prescription pain medication abuse.

The FDA has limited the amount of acetaminophen to 325 mg per tablet in hydrocodone-containing products and other prescription combination drugs containing acetaminophen in order to prevent overdoses of acetaminophen. The FDA has also changed hydrocodone-containing products from schedule III to II, which affects how the drugs can be prescribed and obtained.


Hydrocodone/acetaminophen is prescribed to relieve moderate to moderately severe pain. Researchers believe that the ingredient hydrocodone relieves pain by changing how the brain and nervous system respond to painful stimuli.


The dosage of hydrocodone/acetaminophen should be adjusted under the close supervision of your prescribing provider, without exceeding the total allowable daily dosage. With continued use, tolerance to hydrocodone can develop, and with increased dosage, there may be increased side effects.

Common Side Effects

Some of the common side effects that may be associated with hydrocodone/acetaminophen include:

  • Lightheadedness
  • Dizziness
  • Sedation
  • Nausea
  • Vomiting

There are also adverse events related to the central nervous system, gastrointestinal system, genitourinary system, respiratory system, the senses, and dermatology:

  • Central nervous system: Drowsiness, lethargy, cloudy thinking, impairment of mental and physical performance, anxiety, fear, dysphoria, mood changes, and psychic dependence
  • Gastrointestinal: Constipation with prolonged use
  • Genitourinary: Ureteral spasm, bladder sphincter spasm, urinary retention
  • Respiratory: Respiratory depression and death (dose-related)
  • Special senses: Hearing impairment or hearing loss related to chronic overdose
  • Dermatology: Skin rash, pruritis

Precautions and Contraindications

People who previously exhibited hypersensitivity to hydrocodone or acetaminophen should not take medications with these active ingredients.

Hydrocodone/acetaminophen should be used with caution in the elderly population and with debilitated patients, and in patients with severe liver or kidney impairment, hypothyroidism, Addison's disease, prostatic hypertrophy, or urethral stricture. It should always be remembered that there is the potential for respiratory depression and that the drug suppresses the cough mechanism.

Patients should use caution when driving and operating machinery while taking hydrocodone/acetaminophen.

The drug can be habit-forming. If you require increasingly more medicine to achieve the same therapeutic benefit, talk to your healthcare provider.

Special Instructions for Pregnant Women

Hydrocodone/acetaminophen should be used with caution by pregnant women. Its use during pregnancy may lead to physical dependence or breathing problems in the newborn. Mothers who are breastfeeding should not use hydrocodone/acetaminophen since it is excreted in breast milk.

Drug Interactions

There may be drug interactions with narcotic analgesics and antihistamines, antipsychotics, anti-anxiety medications, or other central nervous system depressants, including alcohol and sedatives. Your healthcare provider may need to adjust your dose of hydrocodone/acetaminophen if you take any of these drugs.

Signs of Overdose

Signs and symptoms of overdose include respiratory depression, extreme sleepiness that progresses to coma, skeletal muscle flaccidity (limpness), cold or clammy skin, bradycardia (slow heartbeat), and hypotension (low blood pressure). With very severe overdose, there can be apnea, circulatory collapse, cardiac arrest, and death. The acetaminophen portion can result in fatal hepatic necrosis, renal tubular necrosis, hypoglycemic coma, and thrombocytopenia (low platelets).

4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. U.S. Food and Drug Administration. FDA drug safety communication: Prescription acetaminophen products to be limited to 325 mg per dosage unit; boxed warning will highlight potential for severe liver failure.

  2. DailyMed U.S. National Library of Medicine. Label: Hydrocodone bitartrate and acetaminophen tablet.

  3. MedlinePlus. Hydrocodone combination products.

  4. MedlinePlus. Hydrocodone and acetaminophen overdose.

By Carol Eustice
Carol Eustice is a writer covering arthritis and chronic illness, who herself has been diagnosed with both rheumatoid arthritis and osteoarthritis.