Hysingla ER (Hydrocodone) - Oral

Warning:

People who take Hysingla ER (hydrocodone) are at a higher risk of addiction, abuse, and misuse, which can lead to overdose and death. When misused, this medication can cause serious, life-threatening, or fatal respiratory depression. Accidental ingestion, especially in children, can lead to a deadly overdose. Using Hysingla ER with drugs known as CYP3A4 inhibitors can also result in an overdose of hydrocodone. 

Long-term use of Hysingla ER during pregnancy can cause neonatal opioid withdrawal syndrome. Tell your healthcare provider immediately if you are pregnant or become pregnant while using this medication. 

Using central nervous system depressants such as benzodiazepines with hydrocodone can cause profound sedation, respiratory depression, coma, and death.

What Is Hysingla ER?

Hysingla ER (hydrocodone) is a prescription opioid medication used to treat severe chronic pain. It comes as an extended-release (ER) oral tablet.

Hysingla ER is called a semisynthetic opioid agonist. It controls pain by binding to opioid receptors in the central nervous system (CNS), altering the body’s perception of and response to pain.

This medication is a controlled substance, meaning there is a high risk of opioid addiction, abuse, and misuse while taking it.

Drug Facts

Generic Name: Hydrocodone

Brand Name: Hysingla ER, Vantrela ER, Zohydro ER

Drug Availability: Prescription

Administration Route: Oral

Therapeutic Classification: Analgesic

Available Generically: Yes

Controlled Substance: Schedule II

Active Ingredient: Hydrocodone

Dosage Form: Extended-release tablet, extended-release capsule

What Is Hysingla ER Used For?

The Food and Drug Administration (FDA) approved Hysingla ER to treat severe chronic pain. It is typically used by people who require long-term and daily around-the-clock pain control therapy. This medication should not be used as an as-needed treatment.

Hysingla ER should only be used for people who have tried and failed previous treatment or have not had a positive response to treatment with other non-opioid or immediate-release opioid medications. 

Because of its potential for abuse, Hsyingla ER is categorized as a Schedule II controlled substance. Controlled substances are drugs that are regulated depending on how potentially dangerous they are. Hysingla ER carries the risk for abuse and misuse, which can lead to overdose and death.

Hysingla ER (Hydrocodone) Drug Information - Illustration by Zoe Hansen

Verywell / Zoe Hansen

How to Take Hysingla ER

Take Hysingla ER by mouth, exactly as your healthcare provider prescribes it.

When taking this medication, remember to:

  • Swallow your Hysingla ER tablet whole, rather than crushing, chewing, or dissolving it. Breaking the tablet can result in rapid release and absorption of a potentially fatal dose of hydrocodone. 
  • Take your dose at the same time(s) each day based on your prescription to control your pain adequately. After starting this medication, your dose may need to be adjusted by your healthcare provider to find out which dosage works best for you.
  • Avoid alcohol and other central nervous system (CNS) depressants. CNS depressants can include barbiturates, benzodiazepines, and sleeping medications.
  • Avoid driving and other activities that require mental alertness when taking this medication for the first time, until you know how this drug will affect you and your ability to function.

There is a high risk of abuse and misuse of this medication. Overdosing on an opioid can be very dangerous. Follow your healthcare provider’s directions very carefully, so you do not take too much medication at one time. 

You should not suddenly stop using Hysingla ER, as this can potentially cause opioid withdrawal symptoms. Your healthcare provider should gradually wean you off the medication to stop treatment.

Storage

Store this medication in a closed container at room temperature, away from heat, moisture, or direct light. Because this is an opioid medication, keep Hysingla ER in a safe and secure place away from children or anyone else who may be tempted to take your medication. 

Any unused or expired medication should be disposed of at a proper drug take-back location. 

Not all opioid medications can be flushed down the toilet. However, Hysingla ER is on the FDA flush list, so it is safe to do so.

Off-Label Uses

Healthcare providers sometimes prescribe medications to treat medical conditions not listed on the product label. This is known as off-label use. 

Hydrocodone can be prescribed off-label for pain associated with sickle cell anemia that cannot be controlled with other treatments.

How Long Does It Take Hysingla ER to Work?

After taking an initial dose, Hysingla ER can reach peak blood levels in about 14 to 16 hours. However, peak levels can occur anywhere from six to 30 hours.

What Are Side Effects of Hysingla ER?

Like other medications, Hysingla ER can cause side effects. Tell your healthcare provider about any side effects you experience while taking it. 

This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 1-800-FDA-1088.

Common Side Effects

Common side effects of Hysingla ER include:

  • Swelling of your lower legs or hands (peripheral edema)
  • Itching
  • Abdominal pain
  • Constipation
  • Diarrhea
  • Nausea and vomiting
  • Dry mouth
  • Muscle spasms
  • Dizziness
  • Headache
  • Drowsiness
  • Tremors
  • Anxiety
  • Urinary tract infections
  • Upper respiratory infections
  • Fatigue

Severe Side Effects

Call a healthcare provider right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. 

Serious side effects and their symptoms can include the following:

  • High risk of overdose, which can lead to death
  • Low blood pressure, which can cause dizziness upon standing and fainting
  • Heart rhythm problems (prolonged QT interval)
  • Adrenal gland problems (adrenal insufficiency)
  • Bowel obstruction, which can cause severe constipation, difficulty swallowing, and inflammation of the pancreas (pancreatitis)
  • Increased intracranial pressure, which can lead to seizures
  • Difficulty breathing (respiratory depression)
  • Opioid withdrawal symptoms  
  • Serotonin syndrome when used with certain medications

Report Side Effects

Hysingla HR may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your provider may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Hysingla ER Should I Take?

Drug Content Provided and Reviewed by IBM Micromedex®

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For severe pain:
    • For oral dosage form (extended-release capsules):
      • Patients who are not taking narcotic medicines:
        • Adults—At first, 10 milligrams (mg) every 12 hours. Your doctor may adjust your dose as needed.
        • Children—Use and dose must be determined by your doctor.
      • Patients switching from other narcotic medicines:
        • Adults—The capsule is given every 12 hours. Your doctor will determine your dose and adjust the dose as needed.
        • Children—Use and dose must be determined by your doctor.
    • For oral dosage form (extended-release tablets):
      • Patients who are not taking narcotic medicines:
        • Adults—
          • Hysingla® ER: At first, 20 milligrams (mg) every 24 hours. Your doctor may adjust your dose as needed.
          • Vantrela™: At first, 15 mg every 12 hours. Your doctor may adjust your dose as needed.
        • Children—Use and dose must be determined by your doctor.
      • Patients switching from other narcotic medicines:
        • Adults—
          • Hysingla® ER: The tablet is given every 24 hours. Your doctor will determine your dose and adjust the dose as needed.
          • Vantrela™: The tablet is given every 12 hours. Your doctor will determine your dose and adjust the dose as needed.
        • Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose, skip the missed dose and take your next dose as usual. Do not take extra doses to make up for a missed dose.

Overdose: What Happens If I Take Too Much Hysingla ER?

Because Hysingla ER is an opioid medication with a high risk of addiction, abuse, and misuse, knowing how to recognize the signs and symptoms of overdose is very important. 

Mild to moderate toxicity includes:

  • Sudden feeling or state of intense excitement and happiness (euphoria)
  • Drowsiness
  • Severe constipation
  • Nausea
  • Vomiting 
  • Pinpoint pupils
  • Slow heart rate (bradycardia) and low blood pressure (hypotension)

Severe toxicity includes:

  • Difficulty/delayed breathing (life-threatening respiratory depression)
  • Low oxygen levels in your tissues or organs (hypoxia)
  • Coma
  • Low heart rate (bradycardia) or acute lung injury 
  • Rarely, seizures may develop from hypoxia
  • Death may result from any of these

Your healthcare provider may also prescribe Narcan (naloxone), an opioid overdose antidote, along with Hysingla ER  to help treat an emergency overdose.

What Happens If I Overdose on Hysingla HE?

If you think you or someone else may have overdosed on Hysingla HR, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses, has a seizure, has trouble breathing, or can’t wake up after taking too much Hysingla HR, call 911 immediately.

Precautions

Drug Content Provided and Reviewed by IBM Micromedex®

It is very important that your doctor check your progress while you are using this medicine, especially within the first 24 to 72 hours of treatment. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to take it. Blood and urine tests may be needed to check for unwanted effects.

This medicine may cause a serious type of allergic reaction called anaphylaxis, which can be life-threatening and requires immediate medical attention. Call your doctor right away if you have a rash, itching, hoarseness, trouble breathing, trouble swallowing, or any swelling of your hands, face, or mouth while you are using this medicine.

Do not use this medicine if you have used an MAO inhibitor (MAOI) (eg, isocarboxazid [Marplan®], linezolid [Zyvox®], phenelzine [Nardil®], selegiline [Eldepryl®], tranylcypromine [Parnate®]) within the past 14 days.

This medicine may be habit-forming. If you feel that the medicine is not working as well, do not use more than your prescribed dose. Call your doctor for instructions.

This medicine will add to the effects of alcohol and other CNS depressants. CNS depressants are medicines that slow down the nervous system, which may cause drowsiness or make you less alert. Some examples of CNS depressants are antihistamines or medicine for allergies or colds, sedatives, tranquilizers, or sleeping medicine, other prescription pain medicine or narcotics, medicine for seizures or barbiturates, muscle relaxants, or anesthetics, including some dental anesthetics. This effect may last for a few days after you stop using this medicine. Check with your doctor before taking any of these medicines while you are using this medicine.

This medicine may make you dizzy, drowsy, or lightheaded. Do not drive or do anything else that could be dangerous until you know how this medicine affects you.

Using too much hydrocodone may cause an overdose, which can be life-threatening. Signs of an overdose include: change in consciousness, cold, clammy skin, dark urine, difficult or trouble breathing, irregular, fast or slow, or shallow breathing, loss of consciousness, nausea or vomiting, pain in the upper stomach, pale or blue lips, fingernails, or skin, pinpoint pupils of the eyes, sleepiness or unusual drowsiness, or yellow eyes or skin. In case of an overdose, call your doctor right away. Your doctor may also give naloxone to treat an overdose.

This medicine may cause adrenal gland problems. Check with your doctor right away if you have darkening of the skin, diarrhea, dizziness, fainting, loss of appetite, mental depression, nausea, skin rash, unusual tiredness or weakness, or vomiting.

Dizziness, lightheadedness, or fainting may occur when you get up suddenly from a lying or sitting position. Getting up slowly may help lessen this problem. Also, lying down for a while may relieve dizziness or lightheadedness.

Using narcotics for a long time can cause severe constipation. To prevent this, your doctor may direct you to take laxatives, drink a lot of fluids, or increase the amount of fiber in your diet. Be sure to follow the directions carefully, because continuing constipation can lead to more serious problems.

Contact your doctor right away if you have any changes to your heart rhythm. You might feel dizzy or faint, or you might have a fast, pounding, or uneven heartbeat. Make sure your doctor knows if you or anyone in your family has ever had a heart rhythm problem including QT prolongation.

Do not suddenly stop or change your dose without first checking with your doctor. You may be directed to gradually reduce the amount you are using before stopping treatment completely, or to take another narcotic for a while, to lessen the chance of withdrawal side effects (eg, anxiety, fever, nausea, runny nose, stomach cramps, sweating, tremors, or trouble with sleeping.

Check with your doctor right away if you have anxiety, restlessness, a fast heartbeat, fever, sweating, muscle spasms, twitching, nausea, vomiting, diarrhea, or see or hear things that are not there. These may be symptoms of a serious condition called serotonin syndrome. Your risk may be higher if you also take certain other medicines that affect serotonin levels in your body.

Using this medicine while you are pregnant may cause neonatal withdrawal syndrome in your newborn babies. Tell your doctor right away if your baby has an abnormal sleep pattern, diarrhea, a high-pitched cry, irritability, shakiness or tremors, weight loss, vomiting, or fails to gain weight.

For nursing mothers:

  • Talk to your doctor if you have any questions about taking hydrocodone or about how this medicine may affect your baby.
  • Call your doctor if you become extremely tired and have difficulty caring for your baby.
  • Your baby should generally nurse every 2 to 3 hours and should not sleep for more than 4 hours at a time.
  • Check with your doctor or hospital emergency room immediately if your baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, difficulty breathing, or limpness. These may be symptoms of an overdose and need immediate medical attention.

Using too much of this medicine may cause infertility (unable to have children). Talk with your doctor before using this medicine if you plan to have children.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn't Take Hysingla ER?

You should not take Hysingla ER if you have:

  • Allergies to hydrocodone bitartrate or any of its ingredients
  • Acute or severe bronchial asthma, unless monitoring and resuscitative equipment are available
  • Known or suspected paralytic ileus (stopping of intestinal movements without blockage) and gastrointestinal obstruction 
  • Significant history of difficulty breathing (respiratory depression)

Talk to your healthcare provider if you are pregnant or breastfeeding, and let them know if you have a history of:

  • Kidney disease
  • Liver disease
  • Breathing or lung problems (including apnea)
  • Heart failure
  • Heart rhythm problems (including congenital long QT syndrome, slow heartbeat)
  • Adrenal problems
  • Digestion problems
  • Pancreas problems
  • Depression
  • Head injury
  • Seizures
  • Substance use disorder 

If you have any of these conditions, your healthcare provider may reconsider if Hysingla ER is the best treatment option.

What Other Medications Interact With Hysingla ER?

Some medicines can affect how Hysingla works or increase your chances of developing side effects. 

Hysingla ER should not be used with serotonergic drugs, or drugs that affect serotonin, as it may result in serotonin syndrome. Serotonergic drugs are drugs that affect the serotonin neurotransmitter system and can include:

  • Antidepressants, such as Remeron (mirtazapine) and trazodone
  • Tramadol
  • Certain muscle relaxants, such as cyclobenzaprine and metaxalone
  • Triptan medications to treat migraine 
  • Monoamine oxidase inhibitors (MAOIs)

Specifically, you should not use Hysingla ER if you have taken an MAOI in the past 14 days. 

 Other medications that interact with Hysingla ER include:

  • CYP3A4 inhibitors, such as macrolide antibiotics, antifungal agents, and protease inhibitors
  • CYP3A4 inducers, such as Tegretol (carbamazepine), Dilantin (phenytoin), and Rifadin or Rimactane (rifampin)
  • Benzodiazepines or other CNS depressants
  • Diuretics (water pills)
  • Strong laxatives, such as lactulose

Do not drink alcohol or take any medicine that contains alcohol while you are using this medicine. Tell your provider if you use anything else that makes you sleepy, such as allergy medications or narcotics.

Consult with your provider before taking any other medicine with Hysingla ER, including over-the-counter medicines, vitamins, and herbal products to avoid unwanted interactions.

Frequently Asked Questions

  • What is Hysingla ER used for?

    Hysingla ER is used to treat severe chronic pain. It is usually used in people who need daily, around-the-clock, long-term pain control and for whom alternative treatment options are not effective.

  • What should I do if I miss a dose?

    If you miss a dose, skip the missed dose and take your next dose as usual. Do not take an extra dose to make up for a missed dose.

  • How can I safely stop taking Hysingla ER?

    Do not abruptly stop using Hysingla, as this can increase the potential risk of developing opioid withdrawal symptoms. Your healthcare provider should gradually taper your dose before taking you off this medication.

  • What are signs and symptoms of an accidental overdose?

    An overdose can cause a feeling of euphoria, severe drowsiness or weakness, cold and clammy skin, nausea or vomiting, severe constipation, pinpoint pupils, a slow heart rate, low blood pressure, difficulty breathing, and low oxygen levels.

    Your healthcare provider may also prescribe Narcan (naloxone), an opioid overdose antidote, to help treat an emergency overdose.

How Can I Stay Healthy While Taking Hysingla ER?

This medication is typically used in people with severe, chronic pain who have not had success with other non-opioid treatments. Living with chronic pain can be difficult. Long-term opioid treatment can help provide some relief and improve quality of life. You can also join support groups, which can offer a safe environment for emotional support and to learn about coping strategies.

Hysingla ER is a habit-forming medication, so it is important only to take it as prescribed. Tell your healthcare provider if you don’t think this medication is working for you. They will help you find the right treatment regimen. 

This drug can also cause constipation, especially when used long-term. If you experience constipation, ask your provider if you should use a laxative.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and not intended as a replacement for medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

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.
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  2. Food and Drug Administration. Drug disposal: FDA’s flush list for certain medications.

  3. Han J, Santosh SL, Gowhari M, et al. Patterns of opioid use in sickle cell disease. American Journal of Hematology. 2016. doi:10.1002/ajh.24498

  4. MedlinePlus. Hydrocodone.