Hydrocodone-acetaminophen, Hydrocodone Bitartrate Acetaminophen

Written by Helen Marshall BPharm MRPharmS
Medically reviewed by Elizabeth Scheffel, PharmD
Updated on June 27, 2023

This article describes hydrocodone/acetaminophen’s uses, side effects, and more. You’ll also find some coupon options to help save on the cost of hydrocodone/acetaminophen.

Boxed warnings

Hydrocodone/acetaminophen has boxed warnings about the following risks:

• misuse and addiction
• respiratory depression (serious breathing problems)
• someone accidentally taking the drug
• neonatal withdrawal syndrome (side effects in newborn babies), if the drug is taken during pregnancy
• liver damage
• drug interactions

Boxed warnings are the most serious warnings from the Food and Drug Administration (FDA). For details, see the “Interactions and warnings for hydrocodone/acetaminophen” section.

Below you’ll find answers to a few commonly asked questions about hydrocodone/acetaminophen.

What brand names are available for hydrocodone/acetaminophen?

Hydrocodone/acetaminophen is a generic drug that’s available as the brand name oral liquid solution Lortab Elixir. If you’re interested in taking this form of hydrocodone/acetaminophen, talk with your doctor. They can tell you whether Lortab Elixir is right for you.

How does hydrocodone/acetaminophen work? And how long does it take to start working?

Hydrocodone/acetaminophen contains two active drugs. Hydrocodone is a powerful pain reliever called an opioid, while acetaminophen is a non-opioid pain reliever.

Hydrocodone and acetaminophen work in different ways to stop your brain from receiving pain messages from your body. This helps reduce your awareness of pain.

Hydrocodone/acetaminophen usually starts working about 1 hour after you take a dose.

If you’d like to know more about what to expect with your treatment, talk with your doctor or pharmacist.

The Food and Drug Administration (FDA) approves prescription drugs such as hydrocodone/acetaminophen for certain conditions. The approved use for hydrocodone/acetaminophen is described below.

Use for pain

Doctors may prescribe hydrocodone/acetaminophen for pain that’s severe enough to need treatment with an opioid. It’s used for this purpose in adults. It may be prescribed as a long-term or short-term treatment.

Opioids are powerful pain relievers that can relieve moderate to severe pain. Pain that’s severe enough to need opioid treatment may occur after a serious injury or surgery. It may also occur with cancer or other serious medical conditions.

Doctors may only prescribe hydrocodone/acetaminophen if weaker pain relievers can’t relieve your pain or if they cause bothersome side effects.

Hydrocodone/acetaminophen may cause mild or serious side effects. More common mild side effects of hydrocodone/acetaminophen and its serious side effects are listed below. This article doesn’t include all possible side effects of the drug. Side effects can vary based on your age, overall health, and any other medications you take.

To learn more about hydrocodone/acetaminophen’s side effects, ask your doctor or pharmacist. You can also read the prescribing information for hydrocodone/acetaminophen listed in the “Article resources” section.

Mild side effects

More common mild side effects reported with some forms of hydrocodone/acetaminophen are listed below.

This article doesn’t include all possible mild side effects of the drug. To learn more about hydrocodone/acetaminophen’s side effects, refer to the prescribing information for the drug, listed in the “Article resources” section.

With many drugs, mild side effects may go away within a few days or a couple of weeks. If the side effects are bothersome, tell your doctor or pharmacist. They may be able to suggest ways to manage them.

Mild side effects of hydrocodone/acetaminophen oral tablet and oral solution include:

• drowsiness
• lightheadedness or dizziness
• nausea and vomiting
• constipation
• mild allergic reaction*

* For details about this side effect, see the “Interactions and warnings for hydrocodone/acetaminophen” section.

Serious side effects

Serious side effects of hydrocodone/acetaminophen are listed below.

This article doesn’t include all possible serious side effects of the drug. To learn more about hydrocodone/acetaminophen’s side effects, refer to the prescribing information for the drug, listed in the “Article resources” section.

With many drugs, serious side effects are possible but not common. If you have serious side effects from this drug, call your doctor right away. If you’re having severe symptoms or a medical emergency, call 911 or a local emergency number.

Hydrocodone/acetaminophen’s serious side effects include:

• low blood pressure
• problems with adrenal glands (glands that make certain hormones)
• boxed warnings: risks of misuse and addiction, serious breathing problems, accidentally taking the drug, neonatal withdrawal syndrome (side effects in newborns) if taken during pregnancy, liver damage, and drug interactions*
• severe allergic reaction*

* For details about this, see the “Interactions and warnings for hydrocodone/acetaminophen” section.

Suicide prevention

If you or someone you know is in crisis and considering suicide or self-harm, please seek support:

• Call the 988 Suicide and Crisis Lifeline at 988.
• Text HOME to the Crisis Textline at 741741.
• Not in the United States? Find a helpline in your country with Befrienders Worldwide.
• Call 911 or your local emergency services number if you feel safe to do so.

If you’re calling on behalf of someone else, stay with them until help arrives. You may remove weapons or substances that can cause harm if you can do so safely.

If you are not in the same household, stay on the phone with them until help arrives.

Below, you’ll find information about hydrocodone/acetaminophen’s possible interactions and warnings.

Interactions of hydrocodone/acetaminophen

Certain things may affect how a drug works. These include getting vaccines, consuming alcohol* or certain foods,* or taking the drug with other medications. This effect is called a drug interaction.

Before you take hydrocodone/acetaminophen, ask your doctor to check for possible interactions. Be sure to tell them about any of the following you take or use:

• prescription or over-the-counter drugs
• vitamins, herbs, or supplements

To learn about drug-condition interactions, see the “Warnings for hydrocodone/acetaminophen” section below.

* It’s recommended that you do not consume alcohol, grapefruit, or grapefruit juice while taking hydrocodone/acetaminophen. Talk with your doctor if you have concerns about avoiding alcohol or grapefruit during your treatment.

Warnings for hydrocodone/acetaminophen

Some people should not take hydrocodone/acetaminophen and others should take it cautiously.

Boxed warnings

Hydrocodone/acetaminophen has boxed warnings about the risks of:

• misuse and addiction
• respiratory depression (slow, shallow breathing)
• accidentally taking the drug
• neonatal withdrawal syndrome (side effects in newborns), if taken during pregnancy
• liver damage
• drug interactions

Boxed warnings are the most serious warnings from the Food and Drug Administration (FDA).

Due to these risks, hydrocodone/acetaminophen is a controlled substance. A controlled substance is a drug the government regulates due to the risk of dependence or misuse.

To learn more about these warnings, read below. You can also talk with your doctor or pharmacist.

Risk of misuse and addiction. Hydrocodone/acetaminophen is an opioid drug that has a risk of misuse (taking a drug in a way that’s not prescribed, sometimes called “abuse”). Misuse of this drug can lead to addiction (feeling unable to stop taking the drug, even if it’s causing harm). Misuse and addiction can lead to overdose and death in some cases.

You should only take hydrocodone/acetaminophen as prescribed by your doctor. If you have concerns about the risk of misuse and addiction with this drug, talk with your doctor.

Risk of respiratory depression. Hydrocodone/acetaminophen may cause a serious breathing problem called respiratory depression. Symptoms of this side effect include slow or shallow breathing, or your breathing stopping. Respiratory depression can lead to death. If you have symptoms of respiratory depression, you or another person should call 911 or your local emergency number right away.

Respiratory depression is most likely to occur when starting treatment and after dosage increases. It can also occur with accidental ingestion or overdose (see below).

If you have concerns about the risk of respiratory depression, tell your doctor. They may prescribe a medication called Narcan. Narcan nasal spray can be used in an emergency to reverse the effects of hydrocodone/acetaminophen. Your doctor can tell you more about this.

Risk of accidental ingestion. If someone takes hydrocodone/acetaminophen by accident, such as a child, this can cause fatal overdose and respiratory depression.

You should keep hydrocodone/acetaminophen in a safe place, out of sight and reach of children. Do not share your medication with anyone.

If you have concerns about the risk of accidental ingestion, tell your doctor.

Risk of neonatal withdrawal syndrome. If you take hydrocodone/acetaminophen for a long time while pregnant, your baby could be born with neonatal opioid withdrawal syndrome (NOWS). This condition is sometimes also called neonatal abstinence syndrome. With NOWS, a newborn baby may have symptoms such as:

• crying for long periods
• being easily upset
• shaking
• diarrhea
• vomiting
• sleep problems
• lack of weight gain

If you’re pregnant or planning a pregnancy, tell your doctor. They’ll recommend the safest way to manage your pain during pregnancy.

Risk of liver damage. Taking too much acetaminophen could cause liver damage and liver failure, which may lead to death. You should not take more hydrocodone/acetaminophen than your doctor prescribes. And you should not take it with other medications that contain acetaminophen, such as Tylenol.

If you’re taking hydrocodone/acetaminophen and you also take more than 4,000 milligrams (mg) of acetaminophen in a day, call your doctor right away, even if you feel well. They can check for potential liver problems or liver damage caused by this high dose of pain medications.

Risk of drug interactions. Taking hydrocodone/acetaminophen with certain drugs can make hydrocodone build up in your body. This can raise your risk of interactions, side effects, overdose, and death. Examples of these other drugs include certain antifungals, antibiotics, and HIV drugs.

Taking hydrocodone/acetaminophen with benzodiazepines or other drugs that slow activity in your nervous system can raise your risk of respiratory depression. This can be fatal. Examples of these drugs include:

• alprazolam (Xanax)
• diazepam (Valium)
• muscle relaxants
• sleep medications
• seizure medications

Tell your doctor about all the medications you take before starting treatment with hydrocodone/acetaminophen. And be sure to check with your doctor before starting any new medications with this pain reliever.

Other warnings

Hydrocodone/acetaminophen could cause harm to people with certain health conditions. This effect is called a drug-condition interaction. Other factors can also affect whether hydrocodone/acetaminophen is a safe option for you.

Ask your doctor about specific warnings for hydrocodone/acetaminophen, and be sure to tell your doctor about your:

• current health, including any allergies to medications
• past health conditions or surgeries

Allergic reaction

Hydrocodone/acetaminophen can cause an allergic reaction in some people. Severe allergic reactions are rare but possible.

If you’ve had an allergic reaction to hydrocodone/acetaminophen or any of its ingredients, your doctor will likely not prescribe hydrocodone/acetaminophen. They can tell you about medications that are safer options for you.

A mild allergic reaction may cause the following symptoms:

• skin rash
• itchiness
• flushing (temporary warmth, redness, or deepening of skin color)

A severe allergic reaction may cause the following symptoms:

• swelling under your skin, usually in your hands, feet, eyelids, or lips
• swelling of your mouth, throat, or tongue, which can cause breathing problems

If you have an allergic reaction to hydrocodone/acetaminophen, call your doctor right away. If you have severe symptoms, call 911 or a local emergency number.

Overdose of hydrocodone/acetaminophen

You should not take more hydrocodone/acetaminophen than your doctor prescribes. For some drugs, doing so may lead to harmful effects or overdose.

If you think you’ve taken too much hydrocodone/acetaminophen, call your doctor or pharmacist right away. Or you could call 800-222-1222 to speak with someone at America’s Poison Centers. You can also use its online resource. If you have concerning symptoms, call 911 or a local emergency number immediately. You can also go to the closest emergency room.

Pregnancy or breastfeeding and hydrocodone/acetaminophen

Information about hydrocodone/acetaminophen and pregnancy and breastfeeding is described below.

Hydrocodone/acetaminophen and pregnancy

There are risks to taking hydrocodone/acetaminophen during pregnancy. The drug has a boxed warning about the risk of neonatal withdrawal syndrome if it’s taken during pregnancy (see “Boxed warnings” just above). But there are also risks with having unmanaged pain while pregnant. (Keep in mind that hydrocodone/acetaminophen is used for treating severe pain.)

If you’re planning a pregnancy or can become pregnant, talk with your doctor about pain treatment options during pregnancy. Together, you can discuss the risks and benefits of your treatment options and decide whether or not you should take hydrocodone/acetaminophen during pregnancy.

Hydrocodone/acetaminophen and breastfeeding

Hydrocodone/acetaminophen should not be taken while breastfeeding. If you’re currently breastfeeding or planning to do so, talk with your doctor before taking this medication. Your doctor may recommend other ways to feed your child during treatment with hydrocodone/acetaminophen.

This article describes hydrocodone/acetaminophen’s uses, side effects, and more. Let your doctor know if you have questions about hydrocodone/acetaminophen or would like more details about it.

Here’s a list of some possible questions you may want to ask your doctor:

• How quickly can you get addicted to hydrocodone/acetaminophen?
• When stopping treatment with hydrocodone/acetaminophen, will you slowly lower my dosage of the drug?
• Can I take other pain relievers with hydrocodone/acetaminophen?
• Should I keep a supply of Narcan while taking hydrocodone/acetaminophen?

• Food and Drug Administration. (2023). Orange Book: Approved drug products with therapeutic equivalence evaluations. https://www.accessdata.fda.gov/scripts/cder/ob/index.cfm
• Hydrocodone bitartrate and acetaminophen- hydrocodone bitartrate and acetaminophen solution. (2023).  https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/f45f5daa-1b76-738f-e053-2995a90a692f/spl-doc
• Hydrocodone bitartrate and acetaminophen- hydrocodone bitartrate and acetaminophen tablet. (2023). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/90a1f7e4-b645-1118-e053-2a95a90ae912/spl-doc

Disclaimer: Optum Perks has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.