Hydrocodone/acetaminophen dosage, forms, and strengths

Hydrocodone/acetaminophen (generic Vicodin) is an opioid analgesic. Opioid or opiate drugs are medications that act on the opioid receptors in the central nervous system to produce morphine-like effects. Healthcare providers prescribe opiates for pain relief of moderate to severe pain, such as experienced after surgery, in certain chronic conditions, and cancer.

Although brand-name Vicodin, Vicodin ES, and Vicodin HP are discontinued, the U.S. Food and Drug Administration (FDA) has approved a variety of generic drugs containing the active ingredients hydrocodone and acetaminophen. Hydrocodone combination products are all prescription drugs that are not available over the counter. These medications should only be taken when prescribed by a healthcare provider with an active DEA license.

Take these pain relievers only as they are prescribed. Prescription medications made with hydrocodone are associated with drug abuse, physical dependence, and overdose. Misuse can be life-threatening and cause death. Although acetaminophen is not habit-forming, it can cause liver damage when taken in large doses or over long periods of time. 

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Hydrocodone/acetaminophen forms and strengths

Hydrocodone/acetaminophen combination tablets are available generically and under the brand name Norco, which is taken by mouth in the following strengths:

• 2.5 mg of hydrocodone/325 mg of acetaminophen

• 5 mg of hydrocodone/300 mg of acetaminophen

• 5 mg of hydrocodone/325 mg of acetaminophen 

• 7.5 mg of hydrocodone/300 mg of acetaminophen

• 7.5 mg of hydrocodone/325 mg of acetaminophen 

• 10 mg of hydrocodone/300 mg of acetaminophen

• 10 mg of hydrocodone/325 mg of acetaminophen 

Hydrocodone/acetaminophen is also available as a generic combination solution or under the brand name Lortab, which is taken by mouth in the following strengths:

• 7.5 mg of hydrocodone/325 mg of acetaminophen per 15 mL of solution

• 10 mg of hydrocodone/325 mg of acetaminophen per 15 ML of solution

• 10 mg of hydrocodone/300 mg of acetaminophen per 15 mL of solution 

Hydrocodone/acetaminophen dosage for adults

Hydrocodone/acetaminophen is used to treat moderate to severe pain that cannot be relieved by non-opioid pain medications. The lowest effective dose of hydrocodone/acetaminophen should be used. People with kidney disease and liver disease should start at a lower dose. If this medication has been taken for a long time and needs to be stopped, doses should be tapered every two to four days until it is safe to discontinue use. Acetaminophen should be limited to 4 gm per day from all medications a person is taking.

Hydrocodone/acetaminophen dosage for children

Hydrocodone/acetaminophen is used to treat moderate to moderately severe pain in children older than 2 years of age, including postoperative pain. For pediatric use, this medication is dosed by weight, although there is emerging data that it may be better to dose by body surface area. In children with severe kidney disease, dosing should be spread out over a longer period of time. In children with liver disease, a lower dose should be used. Dosages should not exceed:

• 75/mg/kg of acetaminophen per day in children less than 50 kg 

• 4 gm of acetaminophen per day in children more than 50 kg

* Drug information from Epocrates.

* Drug information from Epocrates.

Hydrocodone/acetaminophen dosage restrictions

The daily hydrocodone/acetaminophen dose is limited by the amount of acetaminophen that is safe to take. Hydrocodone, the opioid part of the medication, should be limited to the lowest dose that will relieve pain. This medication should be not be used in individuals with: 

• With hypersensitivity to drugs in this class or to components of this medication

• Taking MAO inhibitors within 14 days

• With severe respiratory depression

• With acute or severe asthma

• Suffering a known or suspected GI obstruction

• With paralytic ileus (a condition where the motor activity of the bowel is impaired)

• With circulatory shock

• In a coma, with a recent head injury, or with impaired consciousness

In addition to the list above, there are several other medical conditions that require caution before taking hydrocodone/acetaminophen.

Hydrocodone/acetaminophen dosage for pets

Hydrocodone preparations are routinely used off-label for effective pain management and cough control in dogs. This medication should not be administered to cats. Cats are very sensitive to acetaminophen and can be up to seven to 10 times more sensitive to the toxic effects of acetaminophen than dogs. 

Hydrocodone is a controlled substance and should only be prescribed by a veterinarian with an active DEA license. Similarly to humans, hydrocodone acts as a CNS depressant in dogs and can cause a variety of unwanted side effects including sedation, nausea, vomiting, and constipation.

In dogs, this medication is usually dosed at 0.5 mg/kg of hydrocodone every 12 hours.

How to take hydrocodone/acetaminophen

Vicodin tablets should be taken by mouth, every four to six hours, as needed for pain relief. This medication may be taken with or without food. If you are experiencing nausea or an upset stomach, it may be helpful to take this medication with a small meal or snack. 

• Take this medication only in the amount, frequency, and length of time that is prescribed by your healthcare provider. The dose of this medication may be changed as needed for pain control.

• This medication may be taken with food. In tablet form, this medication should be swallowed whole. Do not crush or chew the tablet.

• In liquid form, this medication should be taken by mouth with a marked measuring spoon, oral syringe, or medicine cup. Shake the bottle well before dispensing.

• This medication should be stored in a closed container, away from heat, moisture, and direct light.

• Missed dose: Take the next dose as soon as you remember if it is needed for pain. If it is almost time for your next dose, wait until then and take a regular dose. Do not take extra medication to make up for a missed dose.

• This medication may cause unwanted sleepiness. Certain activities like driving and operating heavy machinery may not be safe when taking this medication. Only take this medication when it is safe to do so and speak with your healthcare provider if you have any questions. 

RELATED: The dangers of using opioids for sleep

Hydrocodone/acetaminophen dosage FAQs

How do I stop taking hydrocodone/acetaminophen?

Opioid medications like hydrocodone/acetaminophen are highly addictive. With prolonged use, it may take higher and higher doses to achieve adequate pain relief and pain can actually worsen. In these conditions, individuals could develop dependence on the drug in order to function “normally.” 

If opioid medications have been taken for a long period of time, stopping them suddenly can cause painful withdrawal symptoms. Withdrawal symptoms can be severe and life-threatening, usually beginning within 12 to 30 hours after the last dose and increasing in severity for the first few days after the last dose of medication. Withdrawal symptoms may last seven to 10 days. The length and severity of symptoms depend in part on how much medication was being taken and for how long. If you experience any of the withdrawal symptoms below, it is important to seek emergency medical care as opiate withdrawal can be life-threatening. Discontinuation of these medications should be done with medical help. 

Treatment for withdrawal usually includes medications, counseling, and other support as needed. Withdrawal can be treated at home under the supervision of a healthcare provider, in dedicated facilities, or in a hospital setting. Several different types of medications can be used which include methadone, buprenorphine, and clonidine to help with withdrawal symptoms, and other medications to help with sleep and nausea or vomiting.

Can you overdose on hydrocodone/acetaminophen?

Opiate overdose usually occurs in a non-clinical setting. Individuals at the highest risk for overdose are those already taking high doses, those with a history of substance abuse, or individuals taking other sedative medications or alcohol. The maximum dose used for pain management in a clinical setting is based on the acetaminophen component and is generally 4 gm of acetaminophen per day. Higher doses may cause severe damage to the liver.

According to the NIH National Institute on Drug Abuse, approximately 21% to 29% of patients prescribed opioids for chronic pain misuse them. Most of the research studies available do not include information about illicitly-manufactured opioids, but they are widely considered to be responsible for many overdose deaths seen in the U.S. in the last five years.

Opioid overdose is an emergency and is treated with a medication called Narcan (naloxone). This medication may be prescribed together with hydrocodone/acetaminophen if a person may be at risk of an overdose.

Individuals who are worried about misusing opioids and need help can call a local or national hotline to receive addiction assistance. There is effective treatment available at low- to no cost.

RELATED: Which naloxone formulation should you get?

What interacts with hydrocodone/acetaminophen?

There are drug interactions that individuals taking hydrocodone/acetaminophen should be aware of. Several medications are absolutely contraindicated for use with hydrocodone/acetaminophen and a few other classes of medications should be used with extreme caution. 

Medications contraindicated for use with hydrocodone/acetaminophen:

• Some topical analgesics including topical benzocaine and topical lidocaine 

• Naltrexone 

• Pimozide 

• Thioridazine

Medications that should be used with extreme caution include:

• Mixing opioids can cause severe adverse effects including extreme drowsiness and severe respiratory depression.

• Individuals taking selective serotonin reuptake inhibitor (SSRI) antidepressants may require dose adjustments or may even be prescribed an alternate class of medication. SSRIs may reduce the effectiveness of hydrocodone.

• Certain antihistamines such as Benadryl (diphenhydramine) are CNS depressants. When taken together with opiods the combination can cause excessive sedation, dizziness, lightheadedness, confusion, impaired judgment and thinking, and slowed motor function.

• Both benzodiazepines and narcotics are highly addictive with lethal side effects. Using these classes of medications together increases the risks for addiction potential and death from overdose, sedation, or withdrawal symptoms.

• Skeletal muscle relaxants and opioids may result in an overdose if taken together. Recent research also shows reduced brain function with the combination. This effect is generally not seen in short-term use but when these medications are used together over long periods of time.

• Some high blood pressure and heart medications may put the heart at risk of abnormal heart rhythms when taken together with opiates.

• Other medications also require caution. Talk to your healthcare provider about all prescription and over-the-counter medications you are taking.

What happens when you mix opioids and alcohol?

Opioids should not be used with alcohol. Alcohol is a CNS depressant. Serious, life-threatening or even fatal respiratory depression, sedation, and coma can occur if this medication is taken with alcohol. 

Acetaminophen can exacerbate liver disease, which can progress to liver failure in certain individuals. Alcohol is extremely toxic to the liver, and using alcohol with acetaminophen can precipitate or exaggerate these effects. It is important to follow medical advice when taking this medication. Notify your healthcare provider if you are concerned about taking this medication or any other medication you may be using. 

Is it safe to take hydrocodone/acetaminophen during pregnancy and breastfeeding?

There are no adequate or well-controlled studies of this medication in pregnant women. This medication should only be taken in pregnancy if the potential benefit to the mother outweighs the potential risk to the fetus. Babies born to mothers who have been taking opioids for a period of time prior to delivery will be physically dependent (addicted) to the medication and will experience withdrawal symptoms after delivery. Breastfeeding mothers should be prescribed the lowest dose that controls pain.

Withdrawal signs in infants include irritability and excessive crying, tremors, hyperactive reflexes, increased respiratory rate, increased stools, sneezing, yawning, vomiting, and fever. There is no general consensus on the best way to manage withdrawal in infants. Extreme care should be taken when starting or stopping this medication in pregnant women. 

Related resources for hydrocodone/acetaminophen dosages:

• Adult dosing for hydrocodone/acetaminophen, Epocrates

• Norco dosage for children, Epocrates

• Lortab dosage for children, Epocrates

• Pharmacokinetics of hydrocodone/acetaminophen in children, The Journal of Clinical Pharmacology

• Acetaminophen toxicity in cats and dogs, Vetstreet

• Opioid overdose crisis, National Institute on Drug Abuse

• Non-fatal opioid overdose and associated health outcomes, U.S. Department of Health and Human Services

• Risk of opioid overdose associated with concomitant use of opioids and skeletal muscle relaxants, Clinical Pharmacology & Therapeutics