An opioid painkiller and cough suppressant, often combined with paracetamol
Hydrocodone
An opioid painkiller (also used for cough) that is usually combined with paracetamol and is mainly a US medicine.
What is Hydrocodone?
Hydrocodone is an opioid painkiller that is also used to suppress cough. It is usually combined with paracetamol and is largely a United States product, used much less in the UK than other opioids. Like all opioids, its dominant risks are slowed or dangerous breathing (respiratory depression), the potential for dependence and addiction, drowsiness, and constipation. It is a controlled drug. Because it is often combined with paracetamol, there is also a risk of taking too much paracetamol if doses are exceeded, which can harm the liver.
Education and reference only. This is a plain-language guide to Hydrocodone — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Hydrocodone is an opioid medicine used to relieve pain and to suppress coughing. It is most often supplied combined with paracetamol in a single tablet, and it is mainly a United States product; in the UK other opioids are usually chosen instead. As an opioid, it is a controlled drug, meaning its supply is tightly regulated because of the risks of misuse and dependence. It is taken by mouth and is intended for short-term or carefully supervised use rather than casual or long-term self-management.
How it works
Hydrocodone acts on opioid receptors in the brain and spinal cord, the body's natural pain-control system, changing the way pain signals are felt and reducing the sense of pain. Acting on similar pathways in the brainstem also dampens the cough reflex, which is why it can be used as a cough suppressant. These same actions on the brain, however, slow the drive to breathe and produce drowsiness and a sense of calm or pleasure, which underlies both the sedation it causes and its potential to lead to dependence. When combined with paracetamol, the paracetamol adds a separate, non-opioid pain-relieving effect.
Company & origin
Originated / developed by: Generic (mainly a US product).
An opioid painkiller and cough suppressant, largely a US product, usually combined with paracetamol; rarely used in the UK.
Practical use
How to take Hydrocodone
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Take it exactly as prescribed, at the lowest dose that controls your pain and for as short a time as possible.
- Do not drink alcohol or take other sedating medicines with it, as this can dangerously slow your breathing.
- Because it usually contains paracetamol, do not exceed the dose or take other paracetamol-containing products.
- Expect constipation and drowsiness; ask about a laxative and do not drive if you feel sleepy.
- Do not stop suddenly after regular use; ask your prescriber how to reduce it gradually to avoid withdrawal.
Weighing it up
Advantages & disadvantages of Hydrocodone
Advantages
- An effective opioid painkiller for moderate to more severe pain.
- Also useful for suppressing a troublesome cough.
- When combined with paracetamol, the two work together for added pain relief.
Disadvantages
- Can cause slowed, dangerous breathing, especially with alcohol or other sedatives.
- Carries a risk of dependence and addiction, and is a controlled drug.
- Commonly causes drowsiness and constipation, and the paracetamol component can harm the liver if overused.
Practical use
Good to know
The most important things to understand about hydrocodone are the standard opioid risks. The most dangerous is respiratory depression, where breathing becomes slow and shallow; this is more likely with higher doses, in older or frail people, and especially when combined with alcohol, sleeping tablets, or other sedating medicines. Opioids can also cause dependence and addiction, so they are used at the lowest effective dose for the shortest time, and stopping after regular use should be done gradually to avoid withdrawal. Drowsiness and constipation are very common; the constipation often needs a laxative. Because hydrocodone is usually combined with paracetamol, never exceed the dose and avoid other paracetamol-containing products, as too much paracetamol can seriously harm the liver. It is a controlled drug and is rarely used in the UK.
Who should not take it / use with caution
- People with serious breathing problems, such as severe asthma or respiratory depression, should not take it.
- People who have had a serious allergic reaction to it should not take it.
- It is used with great care, or avoided, alongside alcohol, sleeping tablets and other sedating medicines.
- It is used cautiously in older or frail people and those with liver or kidney problems, under medical guidance.
Monitoring
- Reviewing how well pain is controlled and whether the medicine is still needed.
- Watching for drowsiness, slowed breathing and signs of dependence.
- Checking for constipation and ensuring paracetamol limits are not exceeded.
Side effects
- Drowsiness, dizziness and feeling sick.
- Constipation, which is very common and often needs treatment.
- Slowed breathing, which is the most serious risk, especially with sedatives or high doses.
- With regular use, dependence and withdrawal if stopped suddenly; the paracetamol part can harm the liver if overused.
Key interactions
- Alcohol, sleeping tablets, benzodiazepines and other sedatives add to the risk of dangerously slowed breathing.
- Other paracetamol-containing products risk paracetamol overdose and liver harm.
- Some medicines change how the body handles hydrocodone, so tell your prescriber everything you take.
Available as: Tablets and liquids taken by mouth, usually combined with paracetamol.
Answers
Hydrocodone: frequently asked questions
What is hydrocodone used for?
It is an opioid used to relieve moderate to more severe pain and to suppress cough, usually combined with paracetamol.
Is it used in the UK?
It is largely a United States product and is rarely used in the UK, where other opioids are usually chosen instead.
What is the most serious risk?
Slowed, shallow breathing (respiratory depression), which is more likely at higher doses and with alcohol or other sedating medicines.
Why does the paracetamol matter?
Because it is usually combined with paracetamol, taking too much, or adding other paracetamol products, can seriously harm the liver.
Can I become dependent on it?
Yes, opioids can cause dependence and addiction, so it is used at the lowest effective dose for the shortest time and reduced gradually when stopping.
The wider class
About Opioid painkiller (and cough suppressant)
Hydrocodone belongs to the opioid painkiller (and cough suppressant) class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
Browse by body system
Authoritative sources
- BNF
- NICE CKS
Building a medicines information resource?
We create evidence-led, dose-free drug and formulary references for teams.