Vicodin: 7 things you should know

Medically reviewed by Carmen Pope, BPharm. Last updated on Aug 29, 2023.

1. How it works

• Vicodin is a brand (trade) name for a combination tablet containing acetaminophen and hydrocodone.
• Acetaminophen and hydrocodone are two different pain-relieving medicines with two different mechanisms of action. Experts aren't sure exactly how acetaminophen works but suspect it blocks a specific type of cyclo-oxygenase (COX) enzyme, located mainly in the brain, which inhibits prostaglandin synthesis. Hydrocodone binds to specific receptors known as mu-opioid receptors that block pain signals on their way to the brain.
• Hydrocodone belongs to the group of drugs known as opioids or opioid analgesics. Hydrocodone may also be called a narcotic analgesic. Therefore, Vicodin belongs to the group of medicines known as combination narcotic analgesics.
• The Vicodin brand has been discontinued in the United States.

2. Upsides

• May be used to treat moderate-to-moderately severe pain that is unrelieved by nonopioid analgesics.
• Vicodin can also help stop a dry cough (hydrocodone component).
• The combination of acetaminophen and hydrocodone is more effective than either drug alone.
• Generic Vicodin is available under the name acetaminophen/hydrocodone.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

• Stomach upsets including nausea, vomiting, and constipation; shortness of breath; dizziness; low blood pressure; and headache (hydrocodone component).
• Drowsiness that may impair reaction skills and affect a person's ability to drive or operate machinery (hydrocodone component). Alcohol should be avoided.
• Rarely, serious, life-threatening, breathing problems (hydrocodone component).
• Vicodin is habit-forming and potentially abusable (attributable to the hydrocodone component). Vicodin should only be used short-term at the lowest effective dose when other nonopioid analgesics are not effective. Legitimate supplies of Vicodin may be sought out by drug seekers.
• Tolerance may develop if taken for long periods (hydrocodone component); which means that Vicodin may no longer work at the prescribed dosage. Talk to your doctor if this happens.
• Rarely, liver failure especially at dosages greater than 4000mg/day (acetaminophen component).
• The hydrocodone component of Vicodin may interact with several other drugs, including those that affect hepatic enzymes CYP 2D6, and those that also cause respiratory depression (such as other opioids, benzodiazepines, and alcohol).
• Interaction or overdosage may also cause serotonin syndrome. Symptoms include mental status changes such as agitation, hallucinations, coma, or delirium; a fast heart rate; dizziness; flushing; muscle tremor or rigidity; and stomach symptoms (including nausea, vomiting, and diarrhea).
• May not be suitable for some people including those who have exhibited previous cross-sensitivity to other opioid analgesics, with head injury or raised intracranial pressure, with lung disease, with acute abdominal conditions, or postoperatively.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

4. Bottom Line

Vicodin is a combination narcotic analgesic that may be used short-term for the relief of moderate-to-moderately severe pain that is unrelieved by nonopioid analgesics, and also for the relief of a cough that remains unrelieved by other less potent medications. Vicodin is habit-forming and potentially abusable. The Vicodin brand has been discontinued in the United States.

5. Tips

• May be taken with or without food.
• Intended for short-term use only. Long-term use may lead to addiction and dependence. Vicodin may need to be discontinued slowly depending on the duration of use. Talk to your doctor about a tapering schedule.
• May cause drowsiness which may impair your reaction skills and affect your ability to drive or operate machinery (hydrocodone component). Avoid alcohol.
• Avoid alcohol while taking Vicodin. Alcohol can contribute to the sedative effects of hydrocodone and also increase the risk of respiratory depression.
• Different strengths of Vicodin are available. Make sure you take the correct tablet and do not exceed the recommended dosage.
• Vicodin may make you feel dizzy when getting up from a lying down or sitting position to standing. Always get up slowly, but talk with your doctor if this dizziness results in a fall.
• Vicodin may cause constipation which can be relieved with laxatives. Talk to your doctor if you experience any troublesome side effects.
• Seek urgent medical advice if you experience any excessive sedation, breathing difficulties, wheezing, rash, itching, or facial swelling. Call emergency services if you suspect somebody has overdosed on Vicodin (pinpoint pupils may be indicative of overdosage).
• Tell your doctor if you think you have become addicted to this combination drug or if the usual dosage does not appear to be working.
• Avoid taking extra acetaminophen while taking Vicodin. Be especially cautious when taking cough and cold remedies in addition to Vicodin. Some of these may also contain acetaminophen. Always check with your doctor or pharmacist that products you buy over-the-counter are compatible with Vicodin
• Do not use during pregnancy and breastfeeding unless specifically recommended by your doctor.
• Keep this medicine in a safe place and out of the reach of children and pets. Accidental ingestion can result in a fatal overdose of Vicodin, especially in children, and acetaminophen is toxic to dogs and cats. Never give Vicodin to children without a doctor's advice.

6. Response and effectiveness

• It takes approximately 1.3 hours for the hydrocodone component of Vicodin to reach peak concentrations. Hydrocodone is metabolized entirely by the CYP2D6 hepatic enzymes to hydromorphone. The pain and cough-relieving effects of hydrocodone last for three to four hours; however it may take a day or two for hydrocodone and its metabolite hydromorphone to be completely cleared by the body.
• The peak analgesic effects of acetaminophen are reached within 30 to 60 minutes of oral administration and last for three to four hours.
• Note that up to 10% of Caucasians, 6% of Mexican-Americans, and 5% of African-Americans are poor metabolizers at CYP2D6 and are unlikely to metabolize hydrocodone into hydromorphone, which may limit its effect. 30% of Ethiopians, 20% of Saudis, 10% of Portuguese and Greeks, and 4% of North Americans are ultra-rapid metabolizers at CYP 2D6 and may experience excessive side effects, such as extreme sleepiness, confusion, and shallow breathing, even with normal dosages of Vicodin.

7. Interactions

Medicines that interact with Vicodin may either decrease its effect, affect how long it works, increase side effects, or have less of an effect when taken with Vicodin. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with Vicodin include:

• antibiotics, such as erythromycin
• antidepressants, such as tricyclic antidepressants (eg, amitriptyline), monoamine oxidase inhibitors (eg, isocarboxazid, phenelzine, and tranylcypromine), or SSRIs (eg, fluoxetine, sertraline)
• antifungal agents, such as itraconazole and ketoconazole
• anticonvulsants, such as carbamazepine, lamotrigine, phenytoin, phenobarbital, or primidone
• antimigraine agents such as sumatriptan
• antipsychotics (such as butyrophenones, phenothiazines, or thioxanthenes) and atypical antipsychotics (eg, olanzapine, quetiapine, ziprasidone)
• any medication that may cause drowsiness, such as amphetamines, benzodiazepines (eg, diazepam, lorazepam), first-generation antihistamines (such as doxylamine or promethazine), metoclopramide, or opioids (such as codeine, morphine)
• buprenorphine
• HIV medications such as ritonavir
• muscle relaxants, such as cyclobenzaprine
• naltrexone
• other medications that are CYP3A4 or CYP2D6 inhibitors or inducers
• pentazocine
• rifampin.

Avoid drinking alcohol or taking illegal or recreational drugs while taking Vicodin.

Note that this list is not all-inclusive and includes only common medications that may interact with Vicodin. You should refer to the prescribing information for Vicodin for a complete list of interactions.

References

• Vicodin (hydrocodone bitartrate and acetaminophen) [Package Insert]. Revised 07/2023. AbbVie Inc. https://www.drugs.com/pro/vicodin.html

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Vicodin only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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