Short answer: Hydrocodone is a prescription opioid for severe pain, most often combined with acetaminophen in products such as Norco and Vicodin. It has been a Schedule II controlled substance since 2014. It can cause addiction, overdose, and withdrawal, and the acetaminophen in combination products can damage the liver at high doses.
Key takeaways
- What it is: Hydrocodone is an opioid agonist and a Schedule II controlled substance in the US.
- Main uses: Severe pain.
- Timing: effects start in 20 to 60 minutes and last 4 to 6 hours (immediate release).
- Most dangerous mix: Benzodiazepines (alprazolam, diazepam, clonazepam), which can cause profound sedation, slowed breathing, coma, death.
- Naloxone: it reverses an overdose.
- Dependence risk: High.
- Legal route: only with a prescription from a DEA-registered clinician, filled by a licensed pharmacy.
What is hydrocodone?
Hydrocodone combined with acetaminophen is approved for pain severe enough to require an opioid when other treatments are inadequate. Extended-release hydrocodone alone (Hysingla ER, Zohydro ER) is only for severe, long-lasting pain that needs daily, around-the-clock treatment.
In 2014 the DEA moved all hydrocodone combination products from Schedule III to Schedule II, which ended refills and tightened prescribing. At the time, hydrocodone combinations were the most prescribed medicines in the US.
Quick facts
| Fact | Hydrocodone |
|---|---|
| Generic name | Hydrocodone bitartrate |
| Brand names | Norco, Vicodin, Lortab (with acetaminophen); Hysingla ER, Zohydro ER |
| Drug class | Opioid agonist |
| US legal status | Schedule II, prescription only (since October 2014) |
| Approved uses | Severe pain needing an opioid; some combination products for cough |
| Forms | Tablets and oral solution with acetaminophen or ibuprofen; extended-release tablets and capsules |
| Onset | 20 to 60 minutes |
| Half-life | About 4 hours (immediate release) |
| Broken down by | CYP3A4 (to norhydrocodone) and CYP2D6 (to hydromorphone) |
How long does hydrocodone last?
- Starts working: 20 to 60 minutes
- Effects last: 4 to 6 hours (immediate release)
- Half-life: About 4 hours (immediate release)
Its half-life is about 4 hours. Urine tests usually detect it for 2 to 4 days after the last dose.
Timing varies with the dose, the form, how it is taken, liver and kidney function, age, and other drugs taken at the same time.
What are the biggest risks of hydrocodone?
The FDA requires boxed warnings, its strongest, on hydrocodone products, including:
- Hydrocodone exposes users to risks of addiction, misuse, and abuse, which can lead to overdose and death.
- Life-threatening slowed breathing can occur, especially when starting treatment or after a dose increase.
- Accidental ingestion, especially by children, can cause a fatal overdose.
- Use with benzodiazepines or other central nervous system depressants, including alcohol, can cause profound sedation, slowed breathing, coma, and death.
Common side effects include constipation, nausea, vomiting, drowsiness, dizziness, and itching.
Serious risks include slowed breathing, low blood pressure, adrenal insufficiency, and hearing loss reported with heavy, long-term use of hydrocodone-acetaminophen.
What should you never mix with hydrocodone?
| Combined with | What happens | Label guidance |
|---|---|---|
| Benzodiazepines (alprazolam, diazepam, clonazepam) | Profound sedation, slowed breathing, coma, death | Boxed warning; avoid unless no alternative |
| Alcohol | Stronger sedation and slowed breathing | Avoid |
| Gabapentin, pregabalin, sleep medicines, muscle relaxants | Additive sedation and breathing problems | Use caution; lower doses |
| Acetaminophen from other products (Tylenol, cold medicines) | Liver damage from too much acetaminophen | Keep total under 4,000 mg a day |
| Clarithromycin, ketoconazole, ritonavir | Raise hydrocodone levels | Monitor closely |
| SSRIs, SNRIs, MAOIs | Serotonin syndrome | MAOIs: avoid within 14 days |
Check any combination with the DoseUses combination checker or ask a pharmacist.
What are the signs of a hydrocodone overdose, and what should you do?
A hydrocodone overdose causes pinpoint pupils, severe drowsiness, slow or stopped breathing, limpness, and blue lips. With combination products, an acetaminophen overdose can also occur. It may cause few symptoms for the first day, then liver failure, so anyone who took too many tablets needs medical care even if they feel well.
If someone may have overdosed
- Call 911 if the person is unresponsive, cannot be woken, has blue or gray lips, or is breathing slowly or not at all.
- Give naloxone (Narcan or a generic nasal spray, sold without a prescription) into one nostril. If there is no response after 2 to 3 minutes, give another dose.
- If you are trained, give rescue breaths. Otherwise place the person on their side so they do not choke.
- Stay with them. Naloxone can wear off before hydrocodone does, so the overdose can return even after the person wakes up.
- Most states have Good Samaritan laws that protect people who call 911 for an overdose from some drug charges.
What is hydrocodone withdrawal like, and how long does it last?
People who take hydrocodone regularly for more than a few weeks become physically dependent, even when they take it exactly as prescribed. Dependence is not the same as addiction, but it means stopping suddenly causes withdrawal.
- 6 to 12 hoursEarly symptomsAnxiety, restlessness, yawning, sweating, runny nose, watery eyes, and muscle aches.
- Days 1 to 3Peak withdrawalDiarrhea, stomach cramps, nausea and vomiting, goosebumps, dilated pupils, fast heartbeat, and strong cravings. Rarely dangerous in healthy adults, but dehydration can be serious.
- Days 5 to 10, then weeksLingering symptomsPoor sleep, low mood, low energy, and cravings can continue for weeks. Tolerance falls quickly, which raises the risk of overdose if use restarts.
See the withdrawal timelines and the full hydrocodone withdrawal guide.
Is hydrocodone legal?
In the United States, hydrocodone is a Schedule II controlled substance. The only legal way to get it is with a prescription from a clinician registered with the Drug Enforcement Administration (DEA), filled by a licensed pharmacy. Depending on state law, that can be a physician, nurse practitioner, or physician assistant.
- Refills: Schedule II prescriptions cannot be refilled. A prescriber can write several prescriptions at once, with dates when each may be filled, for up to a 90-day supply in total.
- Telehealth: federal flexibilities let DEA-registered clinicians prescribe Schedule II to V medicines after a telemedicine visit, without a prior in-person exam, through December 31, 2026. A permanent DEA rule was under final review in late 2026. State rules can be stricter.
- Monitoring: prescribers and pharmacists in most states check a prescription drug monitoring program, a database of controlled-substance prescriptions, before prescribing or dispensing.
Outside the United States
| Country | Status |
|---|---|
| United Kingdom | Class A; prescription only |
| Canada | Schedule I of the Controlled Drugs and Substances Act; prescription only |
| Australia | Schedule 8 controlled drug; limited availability |
| International | Schedule I of the 1961 Single Convention on Narcotic Drugs |
Frequently asked questions about hydrocodone
Is hydrocodone the same as Vicodin?
Vicodin was a brand of hydrocodone combined with acetaminophen. Norco and generic hydrocodone-acetaminophen tablets contain the same two ingredients in different strengths.
How long does hydrocodone stay in your system?
Its half-life is about 4 hours. Urine tests usually detect it for 2 to 4 days after the last dose.
Can you get refills on hydrocodone?
No. Since 2014 hydrocodone has been Schedule II, which does not allow refills. A prescriber can issue up to a 90-day supply as several dated prescriptions.
How much acetaminophen is too much?
Adults should not take more than 4,000 mg a day from all sources, and many clinicians advise 3,000 mg or less, especially for people who drink alcohol or have liver disease.
Can you drink alcohol with hydrocodone?
No. Alcohol adds to the sedation and breathing effects and also raises the risk of liver damage from acetaminophen.
Sources
- Norco (hydrocodone) prescribing information, DailyMed, US National Library of Medicine.
- Controlled Substance Schedules, DEA Diversion Control Division.
- Information about naloxone and nalmefene, US Food and Drug Administration.
- CDC Clinical Practice Guideline for Prescribing Opioids for Pain, 2022, Centers for Disease Control and Prevention, MMWR.
- 21 CFR 1306.12, Refilling prescriptions; issuance of multiple prescriptions (Schedule II), Electronic Code of Federal Regulations.
- Prescribing controlled substances via telehealth, US Department of Health and Human Services.
- BeSafeRx: Your Source for Online Pharmacy Information, US Food and Drug Administration.
- Safe Pharmacy, National Association of Boards of Pharmacy.
This guide summarizes the sourced DoseUses Hydrocodone profile, written from FDA labels, DEA rules, and federal health agencies. It is educational and is not medical advice. Last updated October 5, 2026.
