Medical News Today: What is acetaminophen-hydrocodone?

Highlights for acetaminophen-hydrocodone

  1. Acetaminophen-hydrocodone oral tablet is available as a generic drug and as brand-name drugs. Brand names: Norco, Vicodin.
  2. Acetaminophen-hydrocodone comes as an oral tablet and an oral solution.
  3. Acetaminophen-hydrocodone oral tablet is used to treat moderate to severe pain that other treatments have not been able to relieve.


Important warnings

FDA warnings

  • This drug has black box warnings. A black box warning is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients about drug effects that may be dangerous.
  • May cause addiction, abuse, and misuse. Taking this drug increases your risk of opioid (narcotic) addiction, abuse, and misuse. This could lead to overdose and death. Talk to your doctor if you are concerned about the habit-forming properties of this drug.
  • May slow or stop breathing. Hydrocodone in high doses may affect the parts of your brain that control your breathing. If you have trouble breathing, call your doctor or get emergency medical help right away.
  • Accidental ingestion by children. Swallowing even one dose of this medication could be fatal to a child. Keep away from children.
  • May cause withdrawal symptoms in newborn infants. If you use this medication during pregnancy, your baby may have life-threatening problems after it’s born. This is called neonatal opioid withdrawal syndrome. Problems in your newborn are more likely if you take this medication for a long period of time during pregnancy. Talk to your doctor if you are pregnant or planning to become pregnant.
  • Drug interactions. Hydrocodone and acetaminophen are broken down by your liver. If you take these drugs with another drug that can affect your liver, hydrocodone and acetaminophen could build up in your body and cause more breathing problems and other side effects. Your doctor may need to change or stop this medication or your other medications.
  • May cause liver failure. Taking too much acetaminophen can cause liver failure. Sometimes, this results in the need for liver transplant, or death. Most reported cases of liver injury have occurred when a person took more than 4,000 mg of acetaminophen per day, usually together with more than one product containing acetaminophen. The risk of liver failure is higher in people who already have liver disease, and people who drink alcohol while taking acetaminophen.
  • Use with central nervous system (CNS) depressants. Taking opioids with CNS depressants, such as benzodiazepines or alcohol, may result in excessive sedation, slow breathing, coma, and death.

Other warnings

  • Severe allergic reaction warning: This medication may cause a severe, potentially life-threatening allergic reaction. The reaction can occur very quickly. Symptoms may include:
    • trouble breathing
    • swelling of your face, throat, and mouth
    • rash
    • itching
    • vomiting

If this occurs, stop taking this medication and call your doctor right away or get emergency medical help.

  • Adrenal gland problems warning: This medication may cause your adrenal glands to not work as well. Symptoms may include:
    • nausea
    • vomiting
    • loss of appetite
    • tiredness
    • weakness
    • dizziness
    • lightheadedness

If you have these symptoms, talk to your doctor. You may need to stop taking this medication or have some tests done.

What is acetaminophen-hydrocodone?

Acetaminophen-hydrocodone is a prescription medication. As an opioid, it’s a controlled substance. It comes as an oral tablet and an oral solution.

Acetaminophen-hydrocodone oral tablet is available as the brand-name drugs Norco and Vicodin. It’s also available in its generic form. Generic drugs usually cost less than brand-name drugs. In some cases, they may not be available in every strength or form as the brand-name version.

This medication is a combination of two or more drugs in a single form. It’s important to know about all the drugs in the combination because each drug may affect you in a different way.

Why it’s used

Acetaminophen-hydrocodone oral tablet is used to treat moderate to severe pain that other treatments have not been able to relieve.

How it works

This medication is a combination of hydrocodone and acetaminophen. Hydrocodone is an opioid (narcotic), and acetaminophen is an analgesic (pain reliever). Both drugs are used to reduce pain.

These drugs work in your brain to block pain signals. They decrease your ability to feel pain.


Acetaminophen-hydrocodone side effects

Acetaminophen-hydrocodone oral tablet may make you feel sleepy, dizzy, or lightheaded. Avoid driving a car or using machinery until you know how your body reacts to this medication.

This drug can also cause other side effects.

More common side effects

The more common side effects that can occur with acetaminophen-hydrocodone include:

  • sleepiness or drowsiness
  • feeling dizzy or lightheaded

Serious side effects

Call your doctor 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:

  • Skin rash
  • Swelling of your face, throat, and mouth
  • Liver problems, including liver failure. Symptoms may include:
    • yellowing of your skin and the whites of your eyes
    • pain in the upper right part of your stomach area
    • swelling of your stomach area
    • itchiness
    • confusion
    • feeling tired
    • lack of appetite
  • Trouble breathing
  • Drug dependence

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

Acetaminophen-hydrocodone may interact with other medications

Acetaminophen-hydrocodone oral tablet can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Examples of drugs that can cause interactions with acetaminophen-hydrocodone are listed below.

Drugs that cause drowsiness

Taking certain drugs with acetaminophen-hydrocodone increases your risk of drowsiness, dizziness, tiredness, and reduced physical and mental function. If you need to use one of these drugs with acetaminophen-hydrocodone, the dosage of one or both drugs should be reduced.

Examples of these drugs include:

  • other opioids (narcotics)
  • antihistamines, which are used for allergies
  • benzodiazepines, which are used for anxiety

Drugs that increase serotonin

Taking this medication with drugs that increase the amount of a chemical called serotonin in your body can cause a serious problem. This problem, called serotonin syndrome, can be fatal. Tell your doctor if you are taking any of these medications:

  • some antidepressants (selective serotonin reuptake inhibitors [SSRIs], selective serotonin and norepinephrine reuptake inhibitors [SNRIs], tricyclic antidepressants [TCAs], monoamine oxidase inhibitors [MAOIs], mirtazapine, trazodone)
  • certain drugs for nausea, such as ondansetron
  • tramadol, which is used for pain

Drugs that inhibit activity of certain enzymes in the liver

Taking this medication with drugs that can inhibit activity of certain liver enzymes can increase the amount of hydrocodone in your body and cause more side effects. You may have increased breathing problems or drowsiness. Examples of these drugs include:

  • erythromycin
  • ketoconazole
  • protease inhibitors used to treat HIV, such as ritonavir

Drugs that increase activity of certain enzymes in the liver

Taking this medication with drugs that can increase activity of certain liver enzymes can lower the amount of hydrocodone or acetaminophen in your body. You may need a higher dose of this medication to control your pain. Examples of these drugs include:

  • carbamazepine

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.


Acetaminophen-hydrocodone warnings

This drug comes with several warnings.

Allergy warning

This drug can cause a severe allergic reaction. Symptoms may include:

  • trouble breathing
  • swelling of your throat or tongue

If you develop these symptoms, call 911 or go to the nearest emergency room.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

Alcohol interaction warning

You shouldn’t drink alcohol while taking acetaminophen-hydrocodone. Drinking alcohol while taking this medication may cause:

  • slowed or stopped breathing
  • drowsiness
  • mental cloudiness
  • physical and mental slowing

Combining alcohol with this drug also increases your risk for liver problems and liver damage.

Warnings for people with certain health conditions

For people with head injury: If you have a head injury, hydrocodone may cause increased pressure in your brain and cause breathing problems.

For people with stomach problems: Use caution taking this drug if you have intestinal obstruction, ulcerative colitis, or constipation. This medication may worsen your symptoms.

For people with severe kidney disease: This drug may build up in your body, which can cause trouble breathing and other side effects.

For people with lung disease: If you have lung disease, you might have trouble breathing if you take this medication.

For people with severe liver disease: If you have severe liver disease, your risk of liver failure is increased. Also, this drug may build up in your body, which can cause trouble breathing and other side effects.

For people with prostate enlargement: If you have an enlarged prostate, taking acetaminophen-hydrocodone may cause increased difficulty in urination.

For people with asthma: If you have severe or uncontrolled asthma, do not use this medication without talking to your doctor. You may have to take the first few doses in a monitored setting.

For pregnant women: This drug is a category C pregnancy drug. That means two things:

  1. Research in animals has shown adverse effects to the fetus when the mother takes the drug.
  2. There haven’t been enough studies done in humans to be certain how the drug might affect the fetus.

Tell your doctor if you’re pregnant or plan to become pregnant. Babies born to mothers who regularly take opioids such as hydrocodone may be born physically dependent on this drug. This can cause symptoms of withdrawal, or neonatal opioid withdrawal syndrome. Symptoms can include:

  • excessive crying
  • rapid breathing
  • increased bowel movements

There’s also an increased chance that the baby may have trouble breathing if this medication is given to the mother shortly before giving birth.

For women who are breastfeeding: Acetaminophen is passed in small amounts in breast milk. Hydrocodone also passes into breast milk and may result in excessive tiredness and slowed breathing in a child who is breastfed.

Breastfeeding while taking this medication may come with risks. You and your doctor should decide whether you’ll take this medication or breastfeed.

For seniors: Older adults may have decreased kidney, liver, and heart function. If you’re a senior, your doctor may start you at a low dose of this medication.

How to take acetaminophen-hydrocodone

All possible dosages and drug forms may not be included here. Your dosage, drug form, and how often you take the drug will depend on:

  • the condition being treated
  • the severity of your condition
  • other medical conditions you have
  • how you react to the first dose

Forms and strengths

Generic: Acetaminophen-hydrocodone

  • Form: oral tablet
  • Strengths:

    • hydrocodone 5 mg/acetaminophen 300 mg
    • hydrocodone 7.5 mg/acetaminophen 300 mg
    • hydrocodone 10 mg/acetaminophen 300 mg
    • hydrocodone 2.5 mg/acetaminophen 325 mg
    • hydrocodone 5 mg/acetaminophen 325 mg
    • hydrocodone 7.5 mg/acetaminophen 325 mg
    • hydrocodone 10 mg/acetaminophen 325 mg

Brand: Norco

  • Form: oral tablet
  • Strengths:

    • 2.5 mg hydrocodone/325 mg acetaminophen
    • 5 mg hydrocodone/325 mg acetaminophen
    • 7.5 mg hydrocodone/325 mg acetaminophen
    • 10 mg hydrocodone/325 mg acetaminophen

Brand: Vicodin

  • Form: oral tablet
  • Strength: 5 mg hydrocodone/300 mg acetaminophen

Brand: Vicodin ES

  • Form: oral tablet
  • Strength: 7.5 mg hydrocodone/300 mg acetaminophen

Brand: Vicodin HP

  • Form: oral tablet
  • Strength: 10 mg hydrocodone/300 mg acetaminophen

Dosage for moderate to severe pain

Adult dosage (ages 18 years and older and weighing at least 101 pounds [46 kg])

  • 5 mg or 2.5 mg hydrocodone / 300 mg or 325 mg acetaminophen: The typical dosage is 1–2 tablets taken every 4–6 hours as needed. The maximum dosage is 8 tablets per day.
  • 7.5 mg or 10 mg hydrocodone / 300 mg or 325 mg acetaminophen: The typical dosage is 1 tablet taken 4–6 hours as needed. The maximum dosage is 6 tablets per day.

Child dosage (ages 0–17 years)

  • Dosage for people younger than 18 years hasn’t been established.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always speak with your doctor or pharmacist about dosages that are right for you.


Take as directed

Acetaminophen-hydrocodone is used for short- or long-term treatment. It comes with risks if you don’t take it exactly as prescribed by your doctor.

If you stop taking the drug or don’t take it at all: Your pain will continue and might get worse.

If you miss doses or don’t take the drug on schedule: Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

What to do if you miss a dose: If you’re taking the medication regularly, take the missed dose as soon as you remember. Skip the missed dose if it’s almost time for your next scheduled dose.

Don’t use extra medication to make up the missed dose. This could result in dangerous side effects.

If you take too much: If you take too much, you can overdose on this medication. You may experience:

  • nausea and vomiting
  • an overall feeling of fatigue
  • slowed or stopped breathing
  • slowed heart rate
  • liver damage or failure

If you think you’ve taken too much of this drug, call your doctor or seek guidance from the American Association of Poison Control Centers at 1-800-222-1222 or through their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.

How to tell if the drug is working: Your pain should decrease.

Important considerations for taking this drug

Keep these considerations in mind if your doctor prescribes acetaminophen-hydrocodone for you.

General

  • You can cut or crush the oral tablet.

Storage

  • Store this drug at temperatures ranging from 68°F to 77°F (20°C to 25°C).
  • Keep this in a container with a child-resistant closure.
  • Keep this drug away from light.

Refills

A prescription for this medication is not refillable. You or your pharmacy will have to contact your doctor for a new prescription if you need this medication refilled.

Travel

When traveling with your medication:

  • Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
  • Don’t worry about airport X-ray machines. They can’t hurt your medication.
  • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled container with you.
  • Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Clinical monitoring

Your doctor may do certain tests to check whether you have severe liver or kidney disease. These tests will check your:

  • Kidney function. Your doctor may do kidney tests if you have kidney problems to make sure that this medication is safe for you and won’t cause breathing problems.
  • Liver function. Your doctor may do liver tests if you have liver problems to make sure that this medication is safe for you and won’t cause breathing problems.

Prior authorization

Most insurance companies do not require a prior authorization for this drug.


Are there any alternatives?

There are other drugs available to treat your condition. Some may be more suitable for you than others. Talk to your doctor about other drug options that may work for you.

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 other 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.

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