High-Alert Medications - Hydrocodone with Acetaminophen

 

Extra care is needed because hydrocodone with acetaminophen is a high-alert medicine.

High-alert medicines have been proven to be safe and effective. But these medicines can cause serious injury if a mistake happens while taking them. This means that it is very important for you to know about this medicine and take it exactly as directed.

Top 10 List of Safety Tips for Hydrocodone with Acetaminophen

When filling your prescription
1. Check your medicine. If your doctor prescribes this medicine using one of its brand names, it could be confused with other medicines that have similar names. For example, a handwritten prescription for Lorcet may be mistaken as Fioricet. Lortab might be mistaken as Luride. Vicodin might be mistaken as Hycodan. When you pick up your prescription at the pharmacy, be sure you have the right medicine.
When taking your medicine
2. Do not take with other acetaminophen medicines. This pain reliever has two active ingredients: hydrocodone and acetaminophen (also known as Tylenol, and often abbreviated as APAP). Too much acetaminophen can damage the liver and cause death. While taking hydrocodone with acetaminophen, do not take nonprescription acetaminophen or medicines that contain acetaminophen, including cold medicines. Adults should not take more than 3,000 to 4,000 mg of acetaminophen each day. Depending on what your doctor prescribed, each tablet or liquid dose of this medicine contains between 300 mg and 750 mg of acetaminophen.
3. Report all medicines. Let your doctor and pharmacist know about all the prescription and nonprescription medicines you are taking, so other medicines that contain acetaminophen can be identified.
4. Read medicine labels. Always read the active ingredients on medicine labels (under Drug Facts on nonprescription medicine labels) to avoid taking other medicines that contain acetaminophen.
5. Take precautions. You may feel sleepy while taking this medicine. Avoid tasks that require mental alertness, such as driving or operating machinery. Avoid drinking alcohol while taking this medicine.
6. Prevent and treat constipation. Constipation is a common side effect when taking this medicine for more than a few days. Exercising, eating fiber, and drinking water can help, but you may need to ask your doctor or pharmacist to recommend a laxative. If your constipation seems severe or does not respond to laxatives, call your doctor. This can be a sign of a blockage in your bowels, a rare but serious side effect.
When discarding unused medicine
7. Dispose of medicine safely. Discard unused or expired medicine in a sealed container (coffee can with lid, sharps container from pharmacy) after mixing it with an undesirable substance such as cat litter or coffee grounds. This helps stop children and pets from getting into the medicine in the trash.
When you should call your doctor
8. Unrelieved pain. Call your doctor if the pain gets worse while taking the medicine, or if the medicine does not help control your pain. Do not take extra doses. Taking too much medicine can be fatal because it can slow or stop your breathing.
9. Signs of overdose. Call your doctor if you experience extreme fatigue, difficulty waking up, and/or shallow or very slow breathing.
10. Signs of withdrawal. Long-term use of hydrocodone can lead to dependence. Abruptly stopping the medicine after long-term use can lead to withdrawal symptoms (e.g., dilated pupils, runny nose, sweating, flushed face, flu-like symptoms, rapid breathing). Seek medical help if these symptoms occur.
 

 

 Topics Fast Facts
Generic name
  • hydrocodone and acetaminophen (pronounced hye droe KOE done and a seet a MIN oh fen) (generic available)
Common brand names
  • Vicodin, Vicodin ES, Vicodin HP, Lorcet 10/650, Lorcet Plus, Lortab, Maxidone, Norco, Zydone, Co-Gesic, Hycet, Margesic H, Stagesic, Xodol 10/300, Xodol 5/300, Xodol 7.5/300, Zamicet
Uses
  • Treats moderate to severe pain
Usual dose limits
  • Moderate pain: 2½ (2.5) to 5 mg of hydrocodone every 4 to 6 hours
  • Severe pain: 10 mg of hydrocodone every 4 to 6 hours
  • Do not exceed 3,000 to 4,000 mg each day of acetaminophen (depending on what your doctor prescribed, each tablet or liquid dose contains between 300 mg and 750 mg of acetaminophen)
Special instructions and precautions
  • Take exactly as prescribed
  • Call your doctor if your pain is not relieved; do not take an extra dose
  • Do not take regular acetaminophen (Tylenol) while taking this medicine
  • Do not take nonprescription cough and cold medicines or other medicines that contain acetaminophen while taking this medicine
  • Do not drive or operate machinery while taking this medicine because it may make you sleepy and impair your coordination; use caution when climbing stairs
  • Avoid drinking alcohol while taking this medicine
  • Do not start or stop any medicine, including nonprescription medicines, herbals, and vitamins, without letting your doctor or pharmacist know
Possible drug dependence with long-term use
  • Hydrocodone is an opioid that causes an exaggerated sense of well-being, which can lead to physical and psychological dependence with long-term use
  • Abruptly stopping the medicine after long-term use can lead to withdrawal symptoms (see safety tip #10)
  • Serious dependence rarely occurs when the medicine is taken as prescribed for short-term relief of pain
Safety during pregnancy/breastfeeding
  • Tell your doctor if you are pregnant or become pregnant
  • Use of this medicine during pregnancy may produce physical dependence in a newborn
  • Avoid taking this medicine for long periods or in high doses near your due date
  • Hydrocodone enters breast milk, so breastfeeding is not recommended
  • If taken while breastfeeding, let your baby's doctor know, take doses immediately after breastfeeding or 3 to 4 hours before the next feeding, and immediately report changes in your baby, such as increased sleepiness (beyond the usual), breathing difficulties, changes in the baby's feeding pattern, or limpness
Tell your doctor if you have:
  • Diseases: liver disease, lung disease, breathing problems, heart disease, a head injury, history of seizures, thyroid disorder, Addison's disease
  • Allergies to: acetaminophen, codeine, other powerful pain relievers
  • Been taking illicit drugs or drink 3 or more alcoholic beverages daily
Storage and disposal
  • Store at room temperature, protect from light and moisture
  • Dispose of tablets securely in the trash; do not flush down the toilet
Side effects to report to your doctor immediately
  • Difficulty breathing, very slow breathing, slow heart rate, persistent dizziness or headache, excessive sleepiness, confusion, weakness, trembling, blurred vision, vomiting, muscle spasms, difficulty urinating, hearing loss, allergic reaction
Other conditions to report to your doctor
  • Constipation, nausea, itchiness, skin rash
Nonprescription medicines/herbals that should not be taken with hydrocodone and acetaminophen
  • Acetaminophen (including Tylenol)
  • Cough and cold medicines that contain acetaminophen
  • Herbals such as valerian, St. John's wort, SAMe, kava kava
Prescription medicines that should not be taken with hydrocodone and acetaminophen
  • Other prescription medicine that contains acetaminophen
  • Sedatives, tranquilizers, antihistamines, other strong pain medicines
  • Alvimopan (Entereg), imatinib (Gleevec)

This information does not replace the need to follow your doctor's instructions and read the drug information leaflet provided with your prescription.

This project was supported by grant number R18HS017910 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not represent the official views of the Agency for Healthcare Research and Quality.

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