How Much Hydrocodone Can I Take?
Medically reviewed by Femi Aremu, PharmD
Hydrocodone is an orally administered, generic prescription opioid that is categorized as a Schedule II medication according to the Controlled Substance Act.
The Food and Drug Administration (FDA) has approved hydrocodone for the management of chronic pain that other analgesics (painkillers) cannot effectively manage. It is available via prescription only in extended-release (ER, long-acting) tablets and capsule forms.
Hydrocodone can be combined with other active ingredients for pain management, such as acetaminophen (the active ingredient in Tylenol).
It should only be used when prescribed and closely monitored by a healthcare provider. Even at recommended doses, it can cause an overdose if not taken as recommended.
Generally, however, hydrocodone is dosed at 10-20 milligrams (mg) to be taken every 12 or 24 hours, based on the administrative form being used.
This article will provide an in-depth review of hydrocodone, emphasizing safe dosing procedures.
Getty Images / Smith Collection/Gado
Understanding Opioids
Opioids, also known as narcotics, are a type of drug made from the opium plant, and others are synthetic (artificial).
Opioids are used for managing moderate to severe chronic pain in people who are not treatable by other analgesics, such as acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs).
They are also used to reduce pain after a significant injury or surgery, severe pain from health conditions like cancer, and chronic pain.
How They Work
Opioids work by attaching to proteins called opioid receptors in the brain, spinal cord, gastrointestinal tract, and other body parts.
They block pain messages from the body through the spinal cord to the brain.
Although opioids can effectively relieve pain, they carry some risks and can be highly addictive. The risk of addiction is exceptionally high when opioids are used to manage chronic pain over a long period.
Commonly Administered Opioids
Some commonly used opioids include fentanyl, OxyContin (oxycodone), codeine, and morphine, among others.
What Is Hydrocodone?
Hydrocodone is the most commonly used drug for acute and chronic pain in the United States, which consumes nearly 99% of the global supply of hydrocodone.
With its easy availability and abuse patterns, hydrocodone is a primary driver of opioid-related abuse and misuse.
Hydrocodone is a semi-synthetic opioid drug classified as a Schedule II drug. It is in a class of medications called opiate (narcotic) analgesics.
The FDA approves hydrocodone for pain management. It is primarily used to treat severe chronic pain that is not effectively treated by non-opioid alternatives.
Hydrocodone comes with a boxed warning as designated by the FDA that describes the potential risk of tolerance, dependence, and addiction.
Similarly, the safety and effectiveness of hydrocodone in children and adolescents have not been established.
Forms of Administration
Hydrocodone is available in ER dosage forms, including capsules and tablets.
Hydrocodone ER capsules or ER tablets should not be used to treat pain that other medications can control.
Common brand name forms of hydrocodone include Hysingla.
Use In Other Products
Hydrocodone is also available in combination with other ingredients prescribed for different uses. Hydrocodone combination products are used to relieve moderate-to-severe pain.
Some others are also used to relieve cough.
Some combinational products include:
Anexsia (acetaminophen; hydrocodone)
Hycodan (homatropine methylbromide; hydrocodone)
How Does Hydrocodone Work?
Hydrocodone is an opioid receptor agonist which works on the mu-opioid receptors in the body.
It relieves pain by changing the response of the brain and nervous system to pain.
When used in combination products, it relieves cough by decreasing brain activity in the specific part that causes coughing.
Boxed Warning
Boxed warnings are safety-related warnings related to a medication causing severe adverse effects or even death.
It is the strongest warning the Food and Drug Administration assigned to bring attention to the significant risks of the drug.
Hydrocodone also comes with black-box warnings.
These include:
Hydrocodone has a risk of opioid addiction, abuse, and misuse, which may lead to overdose and even death.
Hydrocodone may cause severe, life-threatening respiratory depression.
Accidental intake of even one dose of hydrocodone ER can result in a fatal overdose of hydrocodone, especially in children.
The extended use of ER hydrocodone during pregnancy can result in opioid withdrawal syndrome in newborns, which may be life-threatening.
Using ER hydrocodone with all cytochrome P450 3A4 inhibitor drugs can increase or prolong adverse reactions and may cause potentially fatal respiratory depression.
Using other opioids, including hydrocodone, with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in sedation, respiratory depression, coma, and death if alternative treatment options are inadequate.
Dosing Guidelines
Hydrocodone is recommended for use in adults only.
Always follow the guidelines of your healthcare provider. Your healthcare provider may prescribe a specific dose depending on your needs.
Furthermore, a healthcare provider will gradually increase the dose if required until the therapeutic effect is achieved.
Hydrocodone ER tablets are generally safe and well tolerated at 15–90 milligrams (mg) doses administered every 12 hours.
Standard dosing guidelines include the following:
Dosage form: | Dose in non-opioid dependent individuals: | Dose in opioid-dependent individuals: |
• ER capsules | • 10 mg every 12 hours | • Your healthcare provider will determine the dose given every 12 hours |
• ER tablets | • 20 mg every 24 hours | • Your healthcare provider will determine the dose given every 24 hours |
Safe Using Guidelines
The following provides guidelines for the safe consumption of hydrocodone:
Take ER capsules every 12 hours. Conversely, take the ER tablets once daily.
Swallow the ER capsules or ER tablets with plenty of water. Swallow the medication as soon as you put it in your mouth.
Do not break, open, wet, or lick the ER tablets and capsules. It can result in an overdose, which can be fatal.
Take hydrocodone at around the same time(s) every day. Furthermore, hydrocodone can be used "around the clock" for long-term treatment.
Your healthcare provider may start you on a lower dose of hydrocodone and will gradually increase the dose once every three to seven days if needed.
Do not stop taking hydrocodone without talking to your healthcare provider.
Sudden discontinuation of hydrocodone may cause withdrawal symptoms. Your healthcare provider will gradually decrease the dose before stopping the medication.
Additionally, do not drink alcohol or use prescription or over-the-counter (OTC) medicines that contain alcohol. Using alcohol or products containing alcohol during treatment with hydrocodone ER tablets or capsules may cause you to overdose.
Potential for Interaction
Hydrocodone may cause drug-drug interactions when used with a few other medications.
These include:
Antihistamines (found in cough and cold medications), such as Zyrtec (cetirizine)
Monoamine oxidase inhibitors (MAOIs), such as Marplan (isocarboxazid)
Strong laxatives, such as Cholac (lactulose)
Muscle relaxants, such as Amrix (cyclobenzaprine)
Opioid analgesics, such as Talwin (pentazocine) and Buprenex (buprenorphine)
Selective serotonin-reuptake inhibitors (SSRIs), such as Celexa (citalopram), Lexapro (escitalopram), and Prozac (paroxetine)
Serotonin and norepinephrine reuptake inhibitors (SNRIs), such as Cymbalta (duloxetine) and Effexor (venlafaxine)
Benzodiazepines and CNS depressants, such as Valium (diazepam), Xanax (alprazolam), and Klonopin (clonazepam)
Protease inhibitors, such as Norvir (ritonavir)
Natural remedies for depression, such as Saint-John's-wort
This may not be a complete list of drugs that interact with hydrocodone.
Always talk to your healthcare provider before taking any drug when using hydrocodone.
How Quickly Will Hydrocodone Work?
After a single oral intake, hydrocodone reaches maximum serum concentrations within one hour.
The ER formulations of hydrocodone reach peak blood concentration within 14-16 hours.
How Long Does Hydrocodone Stay in Your System?
Hydrocodone and its metabolites (by-products of the drug) are cleared primarily by renal (kidney) excretion. As such, 99% of the administered dose is eliminated within 72 hours.
The average half-life (time taken to eliminate half of the drug from the body) was similar for all hydrocodone ER dosage forms, ranging from approximately 7 to 9 hours across the range of doses.
Finally, hydrocodone may be present in your urine for two to four days, in saliva for 12-36 hours, and in your hair for 90 days.
Side Effects and Precautions
Hydrocodone is a Schedule II drug that must be taken as prescribed and has the potential for habit forming with prolonged use.
When taken as prescribed, hydrocodone is safe and effective.
However, it may cause some side effects and must be taken only as prescribed.
Common Side Effects
Common side effects associated with the use of hydrocodone include:
Difficulty falling asleep or staying asleep
Problems with urination
Foot, leg, or ankle swelling
Severe Side Effects
Seek emergency medical help or call 911 right away if you have any of these severe side effects after using hydrocodone:
Swelling of your face, tongue or throat
Severe drowsiness
Lightheadedness when changing positions, such as standing up
Feeling faint
Trouble walking
Stiff muscles
Mental changes, such as confusion
Long-Term Side Effects
Taking hydrocodone for a more extended period, such as months or years, is likely to develop tolerance.
As a result, people may require higher doses to get the desired effect, and the drug may stay in their system longer.
Precautions and Warnings
Before taking hydrocodone, tell your healthcare provider if you have a history of:
Problems with urination
Addiction to any street or prescription drugs, alcohol addiction, opioid overdose, or mental health problems
Difficulty swallowing
Esophageal cancer (cancer in the tube that connects the mouth and stomach)
Heart failure (HF, inability of the heart to pump enough blood to other parts of the body)
Cardiac arrhythmia (heart rhythm problems), such as long QT syndrome (a condition causing irregular heartbeat that may cause fainting or sudden death)
Prolonged use of hydrocodone during pregnancy can cause life-threatening withdrawal symptoms in the infant if not treated.
Do not take hydrocodone while breastfeeding. It may harm the baby.
Do not drive or operate heavy machinery until you know how hydrocodone affects you. It can make you sleepy, dizzy, or lightheaded.
Alternative Treatment Options
There are options for pain management beyond the use of prescription opioids.
Some options include:
Non-opioid drugs, such as Tylenol (acetaminophen) and Advil (ibuprofen)
Topical ointments, such as lidocaine
Exercise therapy, such as physical therapy
General exercise
Cognitive behavioral therapy (CBT, a psychological approach to alter the physical, behavioral, and emotional responses to pain and stress)
Other therapies, such as acupuncture and massage
Summary
Primary care physicians in the United States write 10s of millions of opioid prescriptions annually for pain management.
Hydrocodone is also an opioid drug used for pain management, available on prescription in ER dosage forms. It is an effective pain reliever, but it also has the risk of tolerance, dependence, and addiction.
Hydrocodone should only be used when prescribed and closely monitored by a healthcare provider. Even at standard doses, this drug can cause a potentially deadly overdose if not consumed as instructed.
Hydrocodone is traditionally dosed at 10-20 milligrams (mg) every 12 or 24 hours, based on the administrative form used.
Your healthcare provider will determine the dose you require, depending on your needs, and should closely monitor it.
When stopping hydrocodone, your healthcare provider will gradually decrease the dose. This helps to avoid withdrawal symptoms. Don't suddenly stop taking hydrocodone, even if you feel well.
Frequently Asked Questions
How can I safely store hydrocodone?
Store hydrocodone at room temperature (68-77 degrees F) and away from heat and moisture (not in the bathroom).
Store the tablets or capsules securely, out of sight, and out of reach of children.
Keep in a location inaccessible by others, including visitors to the home, due to the risks associated with accidental ingestion, misuse, and abuse.
Are there any studies that reviewed the efficacy of hydrocodone?
Studies support that hydrocodone ER tablets are generally safe and well tolerated. It was associated with a significant improvement in pain.
The results, combined with the established efficacy of hydrocodone as an analgesic, generally support the effectiveness of the hydrocodone ER formulation for treating chronic pain.
Read the original article on Verywell Health.
