One of the most frequently prescribed medications for pain is a combination of hydrocodone bitartrate and acetaminophen, commonly known as Vicodin. Although it’s produced and dispensed as a generic formula and under various brand names such as Norco® and Lortab®, it’s casually referred to as Vicodin even though the brand name Vicodin (AbbVie) has been discontinued.
Vicodin is a combination opioid analgesic, which means one component of the drug is an opioid (in this case hydrocodone) and the other is an analgesic (pain-relieving) drug, such as acetaminophen. Hydrocodone is a semi-synthetic derivative of codeine, which is made from a substance in opium poppies. Related drugs include opium and morphine, as well as heroin, hydromorphone, and oxycodone (OxyContin®).
Because of the hydrocodone component, Vicodin is classified as a Schedule II drug by the Food and Drug Administration (FDA). It’s legal when prescribed by authorized medical personnel, and it has important medical benefits, but it also presents a high risk of abuse with potentially severe physical and psychological dependence.
You’re probably familiar with acetaminophen, the second component of Vicodin, by the brand name Tylenol® and its various formulas. It’s used as a pain reliever and fever reducer and can be found in many over-the-counter (OTC) preparations such as Nyquil, Excedrin, Midol, Sudafed, and Theraflu. It’s also used in prescription pain relievers, such as Percocet®, another combination opioid analgesic, which comprises oxycodone and acetaminophen.
What Is Vicodin Used For?
Vicodin is used to manage moderate to severe pain when relief is needed continuously for a period of time. Cancer, severe arthritis, and postoperative pain (including dental procedures) are just a few examples. The hydrocodone component has also been used historically as an effective cough suppressant, although today it’s not often used for that purpose.
Vicodin decreases the sensation or perception of pain by blocking specific nerve cell receptors in the brain. It is produced in tablet form and taken orally. In addition to pain relief, effects include sedation, relaxation, a decrease in anxiety, and a pleasurable sense of euphoria. Users may also experience nausea, constipation, dizziness, blurred vision, and drowsiness, among many other adverse effects.
Risks of Vicodin
No medication is without risks and adverse effects. Even when a drug is taken exactly as prescribed, individual tolerance varies. As a general rule of thumb, medications are prescribed for specific health issues when the benefits outweigh the risks.
One serious risk associated with Vicodin and other combination opioid analgesics is acetaminophen overdose, which can result in liver damage, failure, and even death due to hepatotoxicity. Prior to the Food and Drug Administration’s (FDA) request that drug manufacturers reduce the amount of acetaminophen in opioid analgesics, including Vicodin, to 325 milligrams per dose, some combination opioid analgesics contained as much as 1,000 milligrams per dosage. However, current research shows that healthy adults of average weight should take no more than 3,000 to 4,000 milligrams of acetaminophen during a 24-hour period to avoid hepatotoxicity. That’s a little more than 12 regular-strength Tylenol tablets (325 milligrams) or eight extra-strength Tylenol tablets (500 milligrams each).
Other health problems due to acetaminophen toxicity can occur, such as kidney and other organ damage, hypoglycemia (low blood sugar) and hypoglycemic coma, and thrombocytopenia (low blood platelets, which can result in severe internal bleeding). Concurrent to this problem is that evidence of damage may not be apparent for two to three days.
Part of the risk is that the maximum daily dosage means acetaminophen from all sources, not just Vicodin. Since many OTC drugs contain acetaminophen, individuals taking Vicodin for legitimate pain under a physician’s guidance may inadvertently exceed the maximum dose by taking OTC drugs, such as cold or allergy preparations, that contain acetaminophen.
Acetaminophen overdose results in approximately 500 deaths annually plus 56,000 emergency room visits and 2,600 cases of hospitalization. Half of these overdoses are accidental.
Between 1991 and 2019, 500,000 people — half a million — died from opioid overdoses. Many of these deaths were attributed to illicitly produced fentanyl and are not necessarily representative of prescribed opioids.
Between 2010 and 2014, drug overdose deaths in the U.S. increased by 23%, with 47,055 overdose deaths in 2014. Hydrocodone was among the top six drugs involved, along with heroin, oxycodone, methadone, morphine, and fentanyl.
In 2017, hydrocodone was among the top 10 drugs involved in fatal drug overdoses and most frequently included on death certificates. Alcohol is frequently involved.
Some signs of hydrocodone overdose are slow or shallow breathing with longer than normal pauses in between each breath. Other signs include slurred speech, small (pinpoint) pupils, pale or blueish skin in White people, gray or ash-colored skin in Black people, choking, gurgling, and loss of consciousness. Even if you’re not sure an overdose has occurred, it’s always best to treat the signs as a possible emergency and call 911.
Addiction to Vicodin Is Another Serious Risk
Psychological and physical addiction to Vicodin can happen even to the most well-intentioned person suffering from pain, especially when it’s severe, long-term pain. Although psychological addiction does not always occur, physical addiction can begin in as little as a few days or weeks.
Physical addiction refers to the body’s adaptation to a drug. In the case of narcotic pain relievers such as Vicodin, brain functions are altered while taking the drug. When the drug is suddenly stopped, the brain continues to function as if the drug is still present — but it’s not. The brain needs time to adjust and go back to its previous state. It’s during this process of adjustment that withdrawal symptoms occur if the drug is discontinued suddenly.
How long it takes to become physically addicted to Vicodin or any other prescription narcotic depends partly on the individual and their condition and overall health. The length of time that Vicodin is used is the main determinant, since physical addiction is inevitable with continued usage due to the drug’s mechanism of action and the body’s response. However, with appropriate medical supervision, the lowest effective dose is used to relieve pain. When the individual no longer needs strong pain relief, the dosage is reduced gradually to avoid or minimize withdrawal symptoms.
Psychological addiction, however, is different from physical addiction. It’s similar to dependence on coffee or other caffeinated beverages: it feels good, therefore we drink it. Coffee, by the way, is also physically addictive, as any habitual coffee drinker knows; a bad headache is the main withdrawal symptom.
Even if an individual has never before taken Vicodin or other narcotics, prescription or otherwise, the feel-good effect may be quite positive from the start. Whether continued pain relief is needed or not, the person may develop tolerance and crave more of the drug or higher dosages.
When psychological and physical addiction are combined, discontinuing the drug can be extremely difficult, both mentally and physically.
Stages in the Metabolization of Vicodin
From the moment a dose of Vicodin enters your system, your body begins to metabolize it.
Metabolism is usually thought of in relation to food and turning it into energy or various nutrients that the body utilizes. Carbohydrates turn into energy, for example, and protein is used in many ways including growth and muscle building or repair. Nutrients like magnesium are altered into a form the heart needs and waste products are excreted, mainly via bile and urine. The adrenal, thyroid, and pituitary glands, along with body fat and muscle, play major roles in metabolism, but the liver is the captain of the ship.
As with food, most drugs are also metabolized, primarily by the liver. Certain enzymes called P-450 enzymes are responsible for the rate at which drug metabolism takes place, and their capacity is limited. That means if the liver is busy metabolizing other substances such as alcohol (which is also a drug), the metabolization of drugs like Vicodin may be slowed. But certain foods and other drugs can also increase or decrease metabolic rates.
In general, variations in metabolism can be attributed to age, gender, overall body size, weight, muscle mass, the ratio of fat to muscle, physical activity, hormones, and genetics. Health conditions and drug interactions are additional factors.
Metabolism and Elimination of Vicodin
Part of the metabolic process for drugs is the elimination of the drug, its metabolites, and its waste products from the body. This is also known as detoxification, but metabolism and elimination are processes that take place naturally.
In between the time that the body begins to metabolize Vicodin and the time the drug is gone (assuming, for this example, that only one dose has been taken), a point on the timeline known as elimination half-life can be calculated.
Elimination half-life is the time required for drug concentration in blood plasma to decrease by half the amount of the original dose. Knowing the elimination half-life of a drug is useful in calculating dosages and dosage time intervals as well as understanding toxicity, especially in overdoses.
Metabolic rates in general and excretion rates specifically vary among drug types as well as individuals. Moreover, health factors such as liver disease and damage can affect the elimination half-life, which can mean higher or lower peak concentrations and slower or faster excretion rates.
Even though metabolism and excretion rates for Vicodin vary among individuals and circumstances, averages for the hydrocodone component in Vicodin have been established.
How Long Does Vicodin Stay in Your System?
Within one hour, concentrations of hydrocodone in the immediate-release (IR) form of the drug, regardless of strength, reach a peak and the elimination half-life is four to six hours. These are averages, however, and both measurements exist on a scale. For example, poor metabolizers and ultra-rapid metabolizers may have dramatic differences in their rates of elimination. Some individuals, in fact, are unable to metabolize hydrocodone and experience little or no pain-relieving effects.
The kidneys take on the primary responsibility for the excretion of hydrocodone and associated waste products via urine. Typically, hydrocodone can be detected in urine for two to four days and in hair or air follicles for 90 days or more.
Vicodin can also be detected in saliva for up to three days (though typically less than 24 hours), but the test is prone to error.
Blood tests provide greater accuracy with the ability to detect hydrocodone in blood for up to 24 hours. All tests count the time after the last dose.
Although the opioid effects of Vicodin last for about four hours, traces of the drug can be found for as long as five days. However, the exact amount of time it takes for Vicodin to be flushed out of the system depends on a number of factors, including body fat content, body mass, age, liver condition, and the amount of the last dose. A higher dose means the concentration in the body will also be higher, and that means Vicodin will stay in your system longer.
Withdrawal From Vicodin
With appropriate medical supervision, withdrawal from Vicodin even after a long period of use doesn’t need to be extremely uncomfortable or painful. A trained medical provider will evaluate factors such as length of time on the drug and dosage levels. They will also take into account the person’s age, weight, general health, and any health-related conditions that may affect the withdrawal process.
A tapering schedule that takes place over a period of time with increasingly lower doses is developed. Strict adherence is required to minimize physical and psychological discomfort. With sufficient motivation and low psychological dependence, an individual may successfully discontinue Vicodin at home along with medical supervision in person, by videoconference, or by phone.
Withdrawal from Vicodin and any other opioid medication is a physical process that isn’t easy, however, and psychological addiction often plays a part. Methadone and buprenorphine are two drugs that can be used, especially in long-term addiction, to aid in the withdrawal process and alleviate distressful symptoms.
If Vicodin is stopped suddenly, withdrawal symptoms can begin within a few hours depending on the dosage level and frequency. Symptoms include:
- Runny nose and/or watery eyes
- Chills and “goosebumps” on the skin
- Muscle pain
- Nausea and vomiting
- Pupil dilation
- Rapid heart rate
Death from opiate withdrawal, no matter the type of opioid drug, isn’t common, but it can and does occur.
Two withdrawal symptoms are a major cause of death. Vomiting and diarrhea can cause severe dehydration and, with that, elevated sodium in the blood which can cause heart failure. This can also result in low oxygen levels in the brain and subsequent brain damage.
Vicodin is one of the most commonly prescribed medications for moderate to severe pain relief. The combination of acetaminophen and hydrocodone is effective in reducing the subjective experience of pain because it blocks nerve receptors that communicate pain from the source to the brain. It’s typically used postoperatively for both medical and dental procedures, for cancer patients experiencing pain, and for other painful conditions, such as severe arthritis and back pain. Moreover, the acetaminophen component of Vicodin can reduce fever while the hydrocodone component can suppress coughing, although this is not a common use of the drug.
Risks of Vicodin include potential overdose of acetaminophen, which can cause severe liver damage and even death. Overdose of hydrocodone can also occur.
Hydrocodone can be detected in urine for up to two to four days. It can be found in hair and hair follicles for up to 90 days. Blood tests, which are considered largely accurate, show evidence of hydrocodone for as long as 24 hours. Saliva tests, although prone to errors, reveal hydrocodone for up to three days, although a 12-hour limit is more common.
Addiction to Vicodin, both physical and psychological, is a risk and may result in death. Medical supervision and gradual tapering from the drug are advised to prevent uncomfortable withdrawal symptoms. Drugs such as methadone or buprenorphine can be used to assist in the withdrawal process, whether on an inpatient or outpatient basis.
Are you or a loved one struggling with addiction? Remember, you’re not alone. Many people have fought the good fight and won! We’re here for you and we’re here to help. Chat with us or call (855) 430-9439.