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Hydrocodone/paracetamol, also known as hydrocodone/acetaminophen, is the combination of the pain medications hydrocodone and paracetamol (acetaminophen).[2] It is used to treat moderate to severe pain.[2][3] It is taken by mouth.[2] Recreational use is common in the United States.[4][5]

Common side effects include dizziness, sleepiness, constipation, and vomiting.[2][3] Serious side effects include addictiondecreased rate of breathinglow blood pressureserotonin syndromesevere allergic reactions, and liver failure.[2] When used during pregnancy may harm the baby.[2] Use with alcohol is not recommended.[3] Hydrocodone works by binding to the mu-opioid receptor.[2] How paracetamol works is unclear but may involve blocking the creation of prostaglandins.[2][6]

Hydrocodone/paracetamol was approved for medical use in the United States in 1982.[2] In the United States, it is a schedule II controlled substance.[2] In 2018, it was the twelfth most commonly prescribed medication in the United States, with more than 42 million prescriptions.[7][8] It is not available in the United Kingdom,[9] though the combination codeine/paracetamol is.[10] It is sold under the brand names Vicodin and Norco among others

How To Use


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Hydrocodone/paracetamol is a fixed-dose combination consisting of the opioid hydrocodone and the non-opioid analgesic paracetamol. It is indicated for relief of moderate to severe pain of acute, chronic, or postoperative types.[11] Hydrocodone/paracetamol comes in oral solution and tablet formulations; however strength of each component may vary.[12] In October 2014, the Drug Enforcement Administration rescheduled hydrocodone combination drugs from schedule III to schedule II due to its risk for misuse, abuse, and diversions.[13]


Hydrocodone diversion and recreational use has escalated in recent years due to its opioid effects.[14] In 2009 and 2010, hydrocodone was the second most frequently encountered opioid pharmaceutical in drug evidence submitted to U.S. federal, state, and local forensic laboratories as reported by DEA‘s National Forensic Laboratory Information System (NFLIS) and System to Retrieve Information from Drug Evidence (STRIDE).

Pregnancy and breastfeeding

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Pregnancy category C: Risk in pregnancy cannot be ruled out. Animal controlled studies have not been conducted with this medication.

Low concentrations of paracetamol is excreted through breast milk, however, hydrocodone’s excretion is unknown.

Kidney and liver impairment

Use with caution due to possible risk of toxicity.

Side effects

Most common

  • Lightheadedness
  • Dizziness
  • Euphoria
  • Sedation
  • Nausea and vomiting
  • Headaches

Less common

  • Central nervous system: drowsiness, confusion, lethargy, anxiety, fear, unease, dependence, mood changes, impairment of mental and physical performance
  • Gastrointestinal system: constipation
  • Genitourinary system: inability to urinate, bladder spasms
  • Respiratory depression: decreased rate and effort of breathing
  • Hearing impairment, permanent hearing loss
  • Dermatological: rash, itching

Black box warning

“Paracetamol has been associated with cases of acute liver failure, at times resulting in liver transplant or death. Most of the cases of liver injury are associated with the use of paracetamol at doses that exceed 4000 milligrams per day, and often involve more than one paracetamol-containing product.”

Allergy warning

“Do not take hydrocodone bitartrate and paracetamol tablets if you are allergic to any of its ingredients. If you develop signs of allergy such as a rash or difficulty breathing stop taking hydrocodone bitartrate and paracetamol tablets and contact your healthcare provider immediately.

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