Hydrocodone
in VICODIN / NORCO
What it isFull mu opioid agonist, dispensed with acetaminophen; moderate to severe pain.
Why this oneOral, familiar, and effective for short courses.
What limits itThe acetaminophen ceiling limits the dose, not the opioid. CYP2D6 activation to hydromorphone means variable effect. Constipation never abates.
FDA-approved for
- pain (~1943)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Pain (severe enough to require opioid) | 5 mg/325 mg strength | 1-2 tab q4-6h PRN | 8 tab/day | |
| Pain (severe enough to require opioid) | 7.5 or 10 mg/325 mg strength | 1 tab q4-6h PRN | 6 tab/day |
Renal Undefined
Hepatic Undefined
Total daily dose capped by acetaminophen content (<=4,000 mg/day)
Instructions
- Use lowest effective dose for shortest duration
- Do not exceed acetaminophen 4,000 mg/day
- Do not stop abruptly in physically dependent patients; taper ~10-25% of daily dose every 2-4 weeks
- Ensure access to an opioid overdose reversal agent (naloxone/nalmefene)
Contraindications
- Significant respiratory depression
- Acute or severe bronchial asthma (unmonitored / no resuscitative equipment)
- Known or suspected GI obstruction, including paralytic ileus
Cautions
- Serotonin syndrome with concomitant serotonergic drugs
- Adrenal insufficiency
- Severe hypotension
- CYP3A4 inhibitors/inducers alter hydrocodone levels
- Acetaminophen hepatotoxicity / acute liver failure
Adverse reactions
- Light-headedness, dizziness
- Sedation
- Nausea, vomiting
- Constipation
Pregnancy Prolonged use may cause neonatal opioid withdrawal syndrome
Lactation Undefined
⚠ BOXED WARNINGS
- Addiction, abuse and misuse
- Life-threatening respiratory depression
- Risk from concomitant use with benzodiazepines
Cost, est. cash$10–$300/month
Generic entry2020
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityRespiratory depression, dependence and overdose; risk rises sharply with sedatives or impaired clearance.
Mechanism of action: Hydrocodone ballicule
Open Hydrocodone in the interactive console ↗
Memory aids: mascots and interaction avatars
Viking for Vicodin (combo with acetaminophen)
