All About Hydrocodone Oral Forms

If you have severe, ongoing pain, your doctor may prescribe hydrocodone for you. It’s a strong pain reliever used to help manage extreme pain in adults due to conditions such as cancer or serious injury.

Your doctor will prescribe this drug only if:

• your pain needs daily, around-the-clock, long-term treatment with an opioid
• other pain relievers don’t work well enough for you or cause troublesome side effects

Hydrocodone basics

Hydrocodone belongs to a group of pain-relieving drugs called opioids. It comes as an extended-release tablet and an extended-release capsule, both of which you swallow. (Extended release means the drug is released into your body slowly over time, not all at once.)

Hydrocodone brand-name versions

The brand-name version of the hydrocodone extended-release tablet is called Hysingla ER. The brand-name version of the extended-release capsule was Zohydro ER, but this is no longer available.

Hydrocodone is a generic drug, which means it contains an exact copy of the active ingredient in a brand-name medication. (An active ingredient is what makes a drug work.) The brand-name medication that hydrocodone extended-release tablet is based on is called Hysingla ER.

Generic drugs are considered as safe and effective as the brand-name drug they’re based on, but they usually cost less.

It’s not just health insurance premiums, but also deductibles, that keep on rising. In 2018, the average deductible was $3,000 for a gold-tier family plan, $8,000 for a silver-tier family plan and $12,000 for a bronze-tier family plan, according to USC Annenberg’s Center for Health Journalism.

If you’d like to know more about taking Hysingla ER instead of hydrocodone extended-release tablets, talk with your doctor. And check out this Austra Health article to learn more about the differences between generic and brand-name drugs.

Hydrocodone and oxycodone are both strong pain relievers called opioids. They’re prescribed to manage severe pain, such as that caused by cancer or serious injuries.

There’s little difference between the drugs in terms of their effectiveness and side effects. Both drugs can be taken for pain that needs daily, around-the-clock, long-term treatment. But oxycodone can be taken on an as-needed basis to relieve short-term pain as well.

For more information about how hydrocodone compares with oxycodone, see this article.

Like most drugs, hydrocodone can cause mild to serious side effects. Below are lists of some of the more common side effects this drug may cause. But these lists don’t include all possible side effects.

Keep in mind that side effects of a drug can depend on:

• your age
• other health conditions you have
• other medications you take

Your doctor or pharmacist can tell you more about the potential side effects of hydrocodone. They can also suggest ways to help manage them.

Mild side effects

Here’s a short list of some of the mild side effects that hydrocodone can cause. To learn about other mild side effects, talk with your doctor or pharmacist. You can also read the prescribing information for hydrocodone extended-release oral capsules and hydrocodone extended-release oral tablets.

Mild side effects of hydrocodone that have been reported include:

• sleepiness
• fatigue (low energy)
• dizziness
• headache
• dry mouth
• nausea and vomiting
• constipation
• abdominal pain
• itching
• swelling of the ankles, feet, legs, arms, or hands
• upper respiratory infection, such as the common cold or flu
• urinary tract infection (UTI)
• mild allergic reaction*

Mild side effects of many drugs may go away within a few days to a couple of weeks. But if they become bothersome, talk with your doctor or pharmacist.

* To learn more about this side effect, see the “Allergic reaction” section below.

Serious side effects

Serious side effects from hydrocodone aren’t common, but they can occur. If you experience serious side effects from this drug, call your doctor right away. But if you think you’re having a medical emergency, call 911 or your local emergency number.

Serious side effects of hydrocodone that have been reported include:

• reduced ability to drive safely
• very low blood pressure
• QT prolongation (a kind of abnormal heart rhythm) with high doses of hydrocodone
• adrenal gland problems
• choking when taking the extended-release tablet (to help prevent this side effect, see “How is hydrocodone taken” below)
• boxed warnings for the risks of:
  • misuse and addiction*
  • serious respiratory depression*
  • neonatal opioid withdrawal syndrome*
  • drug interactions that can result in fatal overdose*
  • use with benzodiazepines*
  • use with alcohol, especially with hydrocodone extended-release capsules*

  * For more information, see “What should be considered before taking hydrocodone?” below.
  † To learn more about this side effect, see the “Allergic reaction” section just below.

  Allergic reaction

  Some people may have an allergic reaction to hydrocodone. Symptoms of a mild allergic reaction can include:

  • skin rash
  • itchiness
  • flushing (temporary warmth, redness, or deepening of skin color)

  A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include swelling under your skin, usually in your eyelids, lips, hands, or feet. They can also include swelling of your tongue, mouth, or throat, which can make it hard to breathe.

  Call your doctor right away if you have an allergic reaction to hydrocodone. But if you think you’re having a medical emergency, immediately call 911 or your local emergency number.

  Below are answers to some common questions about hydrocodone.

  Is hydrocodone an opioid?

  Yes, hydrocodone is an opioid, sometimes called a narcotic. Opioids are powerful pain-relieving drugs that reduce your perception of pain by acting on special sites in your brain called opioid receptors.

  How does hydrocodone compare with Percocet?

  Hydrocodone and Percocet are both powerful pain relievers prescribed for severe pain.

  Hydrocodone is a generic medication that contains only one active ingredient (hydrocodone). (An active ingredient is what makes a drug work.) Percocet is a brand-name drug. It contains two active ingredients: oxycodone (an opioid similar to hydrocodone) and acetaminophen (a mild, non-opioid pain reliever).

  Doctors prescribe hydrocodone only for pain that needs daily, around-the-clock, long-term treatment. They may prescribe Percocet to be taken on a regular basis or just when needed to relieve pain.

  These drugs can cause similar side effects. But unlike hydrocodone, Percocet might also cause liver damage in rare cases, due to its acetaminophen content.

  To find out more about how these drugs compare, talk with your doctor. They can help you determine your best treatment option, based on the nature of your pain.

  Can I take hydrocodone along with ibuprofen?

  Yes, you can usually take hydrocodone with ibuprofen. These drugs don’t interact with each other or cause similar side effects, so they’re usually safe to take together.

  In fact, this combination of drugs can be helpful if you have inflammation (swelling and damage) associated with your pain. Ibuprofen is a kind of pain reliever called a nonsteroidal anti-inflammatory drug (NSAID). It reduces inflammation as well as pain.

  If you want to take hydrocodone with ibuprofen, talk with your doctor about whether this combination is right for you.

  Does hydrocodone expire?

  Yes, like all drugs, hydrocodone expires. You can find the expiration date on the label on the bottle. If you have hydrocodone that’s gone past this date, talk with your pharmacist about whether it may still be safe to take.

  Your doctor will recommend the dosage of hydrocodone that’s right for you. Below are common dosages, but always take the dosage your doctor prescribes.

  Forms and strengths

  Hydrocodone comes in the following forms and 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

  (Extended release means the drug is released into your body slowly over time, rather than all at once.)

  Recommended dosages

  The dosage your doctor prescribes depends on various factors. These include the form of hydrocodone you take, how severe your pain is, and whether you’re switching to hydrocodone from another opioid.

  If you’re not switching from another opioid:

  • For hydrocodone extended-release capsule,the recommended starting dosage is 10 mg twice per day (every 12 hours).
  • For hydrocodone extended-release tablet, the recommended starting dosage is 20 mg once per day (every 24 hours).

  If you’re switching to either form of hydrocodone from another opioid: Your doctor will calculate your dosage based on the kind of opioid you currently take and its dosage.

  Questions about hydrocodone’s dosage

  Below are some common questions about hydrocodone’s dosage.

  • What if I miss a dose of hydrocodone? If you miss a dose, skip the missed dose and take your next dose as usual. Do not take two doses together or any extra doses to make up for a missed dose. This could cause overdose and death. If you miss a dose, your pain may return. Talk with your doctor about how to manage this.
  • Will I need to take hydrocodone long term? Hydrocodone is meant for pain that needs long-term treatment. If it works for you without causing troublesome side effects, you’ll likely take it as long as you continue to need it.
  • How long does hydrocodone take to work? Because hydrocodone is released into your body slowly instead of all at once, it may take several hours for it to start working. The tablets take longer to work than the capsules. With both dose forms, it takes 3 days for the medication to reach a steady level in your body that provides continuous relief from pain.

  There are several factors to consider before starting treatment with hydrocodone. This drug may interact with other conditions you have and other drugs you take. Be sure to talk with your doctor about your health history and other treatments before taking hydrocodone. Some things to consider are discussed below.

  Interactions

  Taking a medication with certain other drugs, foods, and other things can affect how the medication works. These effects are called interactions.

  Before taking hydrocodone, be sure to tell your doctor about all drugs you take (including prescription and over-the-counter kinds). Also describe any vitamins, herbs, or supplements you take. Your doctor or pharmacist can tell you about any interactions these items may cause with hydrocodone.

  For information about drug-condition interactions with hydrocodone, see the “Other warnings” section below.

  Interactions with drugs or supplements

  Hydrocodone can interact with many kinds of drugs. These include:

  • other opioid drugs (hydrocodone is an opioid), such as:
    • codeine
    • morphine (Kadian, MS Contin, others)*
    • alprazolam (Xanax)
    • lorazepam (Ativan)*
    • zolpidem (Ambien)
    • eszopiclone (Lunesta)*
    • amitriptyline
    • fluoxetine (Prozac)
    • venlafaxine (Effexor XR)*
    • haloperidol (Haldol)
    • risperidone (Risperdal)*
    • cyclobenzaprine
    • baclofen (Lyvispah, Lioresal, others)*
    • phenytoin (Dilantin)
    • carbamazepine (Tegretol, Carbatrol, others)*
    • ketoconazole
    • itraconazole (Sporanox, Tolsura)*
    • clarithromycin
    • rifampicin (Rifadin, Rimactane)*
    • atazanavir (Reyataz, Evotaz)
    • ritonavir (Norvir)*
    • sumatriptan (Imigran)
    • oxybutynin (Oxytrol, Ditropan XL, others)
    • trihexyphenidyl
    • glycopyrrolate
    • lactulose

    This list does not contain all kinds of drugs that may interact with hydrocodone. Your doctor or pharmacist can tell you more about these interactions and any others that may occur while taking hydrocodone.

    * Hydrocodone has boxed warnings about interactions with these drugs. A boxed warning is a serious warning from the Food and Drug Administration (FDA). To learn more, see the “Boxed warnings” section below.

    Other interactions

    You should not consume grapefruit or grapefruit juice while taking hydrocodone, as they can interact with this drug.

    Boxed warnings

    Hydrocodone has boxed warnings . Boxed warnings are the most serious warnings from the Food and Drug Administration (FDA). They alert doctors and patients about drug effects that may be dangerous. Hydrocodone’s boxed warnings include:

    Risks of misuse or addiction. Hydrocodone has a risk of misuse. This is when a drug is taken in a way or for a reason other than how it’s prescribed. It also has a risk of addiction, which is when a drug is taken even if it’s causing harmful effects. It’s possible to develop an addiction to hydrocodone even if you take it as prescribed. Hydrocodone misuse and addiction can lead to overdose and death.

    Due to these risks, hydrocodone is a controlled substance in the United States. This means the drug has an approved medical use, but it may be misused for other purposes. It also means government agencies, doctors, and pharmacists pay close attention to how it’s prescribed and taken.

    Your doctor will assess your risk of misuse and addiction before prescribing this drug for you. You’re more likely to experience misuse or addiction if you have a mental health condition or have experienced drug or alcohol misuse in the past.

    Risk of serious respiratory depression. Hydrocodone can cause a serious breathing problem called respiratory depression, where your breathing becomes dangerously slow. This can be fatal.

    Respiratory depression can happen even if you take hydrocodone as prescribed. It’s more likely when starting treatment or if your doctor increases your dosage. It can also happen with hydrocodone overdose. If hydrocodone is taken accidentally, especially by children, this can cause fatal respiratory depression even with just one dose.

    You should watch for signs of respiratory depression while taking this drug. It’s a good idea to have people you live with or are close to watch for signs as well. If your breathing becomes slow, shallow, or stops, you or another person should call 911 or your local emergency number immediately.

    Your doctor may prescribe naloxone (Narcan) to keep on hand while you’re taking hydrocodone. Narcan is a nasal (nose) spray that can be administered in an emergency to treat respiratory depression. It reverses the effects of hydrocodone. Talk with your doctor about this.

    Risk of neonatal opioid withdrawal syndrome. If you take hydrocodone while pregnant, your baby may be born with neonatal opioid withdrawal syndrome (NOWS). For more information, see the “Pregnancy and breastfeeding” section below.

    Risk of drug interactions that can result in fatal overdose. Certain drugs can stop your body from breaking down hydrocodone properly. Examples include certain drugs for bacterial or fungal infections and certain HIV drugs. Taking hydrocodone with these drugs can cause hydrocodone to build up in your system. This can lead to overdose and death.

    Be sure to tell your doctor about all drugs, herbs, or supplements you take before taking hydrocodone.

    Risk of use with benzodiazepines. It can be dangerous to take hydrocodone with benzodiazepines or other drugs that slow activity in your brain and nervous system. The combination could cause extreme sleepiness, respiratory depression (see above), coma, and death. Due to these risks, doctors usually will not prescribe hydrocodone with a benzodiazepine.

    Benzodiazepines are drugs taken for anxiety and insomnia (trouble sleeping). Examples include alprazolam (Xanax) and lorazepam (Ativan). Other drugs that slow activity in your brain and nervous system include seizure medications, certain antidepressants, antipsychotics, and muscle relaxers.

    Be sure to tell your doctor about all drugs, herbs, or supplements you take before taking hydrocodone.

    Risk of use with alcohol. You should not drink alcohol with hydrocodone, especially with the extended-release capsules. For more information, see the “Hydrocodone and alcohol” section below.

    Other warnings

    Hydrocodone can sometimes cause harmful effects in people who have certain conditions. This is known as a drug-condition interaction. Other factors may also affect whether hydrocodone is a good treatment option for you. Talk with your doctor about your health history before starting hydrocodone. Factors to consider include those described below.

    Allergic reaction. If you’ve had an allergic reaction to hydrocodone or any of its ingredients, your doctor will likely not prescribe it for you. Ask them about other medications that might be better options.

    Trouble swallowing. Hydrocodone must be swallowed whole. If you have trouble swallowing, your doctor will likely not prescribe this drug for you. Ask them what other medications are better options for you. (You can also check out this article for tips on how to make it easier to take tablets and capsules.)

    Blockage in your digestive system. Your doctor will likely not prescribe hydrocodone for you if you have a blockage or narrowing in your digestive system. Examples include a blockage due to esophageal cancer or colon cancer. Ask your doctor about other treatments that might be better options.

    Breathing problems. Hydrocodone may affect your breathing. If you have breathing problems, such as chronic obstructive pulmonary disease (COPD) or sleep apnea, this drug could worsen your condition. Ask your doctor whether hydrocodone is safe for you.

    Heart problems. While it’s rare, hydrocodone may cause abnormal heart rhythms. If you have certain heart problems, such as slow heart rate, heart failure, or long QT syndrome, you may have an increased risk of this side effect. Ask your doctor whether hydrocodone is safe for you.

    Seizure disorders. If you have a seizure disorder such as epilepsy, hydrocodone could worsen your seizures. Talk with your doctor about whether hydrocodone is right for you.

    Low blood pressure. If you have low blood pressure, hydrocodone could make it worse. Ask your doctor whether hydrocodone is safe for you.

    Liver or kidney problems. Your liver and kidneys are responsible for removing hydrocodone from your body. If you have liver or kidney problems, the drug could build up in your body. This could increase your risk of serious side effects. Your doctor will likely prescribe a lower hydrocodone dose than usual for you.

    Adrenal gland problems. While it’s rare, hydrocodone may stop your adrenal glands from producing enough hormones. If you already have adrenal gland problems, this drug could make them worse. Talk with your doctor about whether hydrocodone is right for you.

    Being weak or easily injured. If your body is very weak or easily injured, you may be especially sensitive to hydrocodone’s side effects. Your doctor may prescribe a dose for you that’s lower than usual and will monitor you closely.

    Head injury or brain tumor. If you have a head injury or brain tumor, hydrocodone could worsen your condition. It could cause excessive sleepiness and breathing problems. It could also make it harder for your doctor to monitor your condition. Ask them whether this drug is safe for you to take.

    Gallbladder or pancreas problems. If you have a problem with your gallbladder or pancreas, taking hydrocodone could make the problem worse. Talk with your doctor about whether hydrocodone is right for you.

    Hydrocodone and alcohol

    You should not drink alcohol while taking hydrocodone extended-release capsules. The capsules release the drug into your body slowly over time, not all at once. But drinking alcohol can cause all the hydrocodone 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 hydrocodone is released from the tablets. But the combination can cause extreme sleepiness, respiratory depression (see above), coma, and even death.

    Talk with your doctor if you drink alcohol and think you may have trouble avoiding it while taking hydrocodone.

    Pregnancy and breastfeeding

    If you’re pregnant or breastfeeding or thinking about becoming pregnant or breastfeeding, it’s important to talk with your doctor before taking hydrocodone.

    Pregnancy

    If you take hydrocodone for long periods of time while you’re pregnant, your baby could be born with neonatal opioid withdrawal syndrome (NOWS). Symptoms of NOWS can include:

    • high-pitched crying
    • crying for long periods
    • being easily upset
    • sleep problems
    • shaking
    • diarrhea
    • vomiting
    • lack of weight gain

    If you take hydrocodone during labor or delivery, your newborn baby may have breathing problems and be excessively sleepy.

    If you’re pregnant or plan to become pregnant, talk with your doctor about the risks and benefits of taking hydrocodone. They can advise you on the best way to manage your pain.

    Breastfeeding

    Hydrocodone gets into breast milk and could cause serious side effects in a child who’s breastfed. Your doctor will likely recommend that you do not breastfeed while taking this drug. Talk with them about other healthy ways to feed your child or other pain relievers that may be safer to take while breastfeeding.

    Hydrocodone and codeine are both opioid pain relievers. Hydrocodone is a strong opioid that’s prescribed by doctors for severe pain. Codeine is a weaker opioid that’s prescribed for mild to moderate pain.

    Codeine can be taken regularly or on an as-needed basis. But hydrocodone is only prescribed for pain that needs daily, around-the-clock treatment.

    These drugs can cause similar side effects. To learn more about how they compare, see this article.

    Hydrocodone and tramadol are both opioid pain relievers, but tramadol works in a slightly different way than hydrocodone. Both drugs reduce your perception of pain by acting on opioid receptors in your brain. But tramadol is also thought to reduce pain signals by increasing the effect of serotonin and norepinephrine in your nervous system.

    These drugs have some similar and some different side effects. Tramadol is less likely than hydrocodone to cause constipation, breathing problems, and addiction.* But tramadol is more likely to cause seizures.

    For more details about how hydrocodone compares with tramadol, see this article.

    * With addiction, a drug is taken even if it’s causing harmful effects.

    Yes, it can. If you take hydrocodone for a long time, you can become dependent on the drug. With dependence, your body gets used to a drug and needs it for you to function as usual.

    If you become dependent on hydrocodone, you may have withdrawal symptoms. (Withdrawal symptoms are side effects that can happen when you stop taking a drug that your body has become dependent on.)

    Do not suddenly stop taking hydrocodone without talking with your doctor first. To help you avoid withdrawal symptoms, they’ll likely recommend that you slowly reduce your dose before you stop treatment. They’ll explain how to do this.

    Hydrocodone is prescribed by doctors to help manage severe pain in adults. This includes pain caused by cancer, serious injury, or conditions such as arthritis. Hydrocodone belongs to a group of powerful pain-relieving drugs called opioids. Your doctor will only prescribe hydrocodone if other pain relievers don’t work well enough for your condition or cause bothersome side effects.

    Hydrocodone comes as extended-release tablets and capsules. These release the drug into your body slowly over time, not all at once. They’re taken on a regular basis to provide continuous pain relief. Your doctor will prescribe hydrocodone only if your pain needs daily, around-the-clock, long-term treatment with an opioid.

    Your doctor will explain how you should take hydrocodone, including how much to take and how often. Be sure to follow your doctor’s instructions.

    Hydrocodone comes as extended-release tablets and capsules. These release hydrocodone into your body slowly over time, not all at once.

    Hydrocodone must be swallowed whole. Taking it any other way can cause the drug to be released all at once. This can cause overdose and death.

    Taking hydrocodone

    Hydrocodone extended-release tablets: Take the tablets once per day at the same time each day. Swallow each tablet whole with enough water to make sure it goes down easily. Do not dissolve, crush, 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: The capsules are taken twice per day (every 12 hours). Swallow each capsule whole with water. Do not crush, chew, suck, or dissolve the capsule or its contents.

    Accessible medication containers and labels

    Certain pharmacies provide medication labels that:

    • have large print
    • use braille
    • contain a code you can scan with a smartphone to change the text to audio

    Your doctor or pharmacist may be able to recommend a pharmacy that offers these options if your current pharmacy doesn’t.

    Also, if you’re having trouble opening your medication bottles, let your pharmacist know. They may be able to put hydrocodone in an easy-open container. Or they may be able to recommend tools to help make it simpler to open the drug’s container.

    Questions about taking hydrocodone

    Below are some common questions about taking hydrocodone.

    • Can hydrocodone be chewed, crushed, or split? No, hydrocodone must be swallowed whole. (See “Taking hydrocodone” above.) If you have trouble swallowing this medication, check out this article or talk with your doctor or pharmacist.
    • Should I take hydrocodone with food? You can take hydrocodone with or without food.
    • Is there a best time of day to take hydrocodone? No, but the tablets must be taken every 24 hours and the capsules must be taken every 12 hours. Taking this drug around the same time each day helps to keep a steady level of the drug in your body. This helps hydrocodone work effectively.

    Costs of prescription drugs can vary depending on many factors, including what your insurance plan covers (if you have insurance) and which pharmacy you use.

    Financial assistance may be available to help you pay for hydrocodone. Medicine Assistance Tool and NeedyMeds are two websites that provide resources to help reduce the cost of this drug. They also offer tools to help you find low cost healthcare and certain educational resources.

    Do not take more hydrocodone than your doctor prescribes, as this can lead to serious side effects.

    Symptoms of overdose

    Symptoms caused by an overdose can include:

    • extreme sleepiness
    • muscle weakness
    • respiratory depression (slow, shallow breathing)
    • clammy skin
    • pinpoint pupils
    • loss of consciousness (fainting)
    • coma

    What to do in case you take too much hydrocodone

    Call your doctor if you think you’ve taken too much hydrocodone. You can also call 800-222-1222 to reach America’s Poison Centers or use its online resource. But if you have severe symptoms, immediately call 911 or your local emergency number, or go to the nearest emergency room.

    If you have questions about taking hydrocodone, talk with your doctor or pharmacist. Here are some examples of questions to help get you started:

    • Is hydrocodone a good option for managing my pain?
    • What should I do if my pain comes back while I’m taking hydrocodone?
    • Is hydrocodone safe to take with my other medications?
    • How quickly can addiction happen with hydrocodone?

    To get information on different conditions and tips for improving your health, subscribe to any of Austra Health’s newsletters. You may also want to check out the online communities at Bezzy. It’s a place where people with certain conditions can find support and connect with others.

    Disclaimer: Austra Health 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.