Like all opioid analgesics, hydrocodone is a CNS depressant. The risk for CNS depression is especially prominent in non-opiate-tolerant users. An overdose of hydrocodone can lead to respiratory depression or failure, the latter of which can cause death in minutes. Hydrocodone should not be mixed with other CNS depressants
such as benzodiazepines or alcohol
(or any others), as the additive effects of these drug combinations can cause far greater CNS depression than any one of them alone.
In addition, hydrocodone is only available in the US in combination with APAP (acetaminophen) or an NSAID as of this time, although in the EU and elsewhere it can be proscribed by itself.
The most common form of Hydrocodone in the US is Vicodin, a combination with APAP which is toxic to the liver, especially in high doses, and especially when combined with alcohol. APAP should not be taken in amounts greater than 1,000mg in one dose or greater than 3,000mg in a 24-hour period, and single doses should be separated by 4-6 hours. Hydrocodone can be extracted from combination pills containing APAP via a cold water extraction. While it is relatively simple to extract the APAP, if it is done incorrectly it can lead to a massive overdose of acetaminophen, and so needs to be done carefully and with caution no matter how experienced a user is. Hydrocodone cannot be extracted from liquid solutions, or effervescent pills containing APAP.
The extreme toxicity of APAP has not been ignored by the American Medical Association, who are lobbying to have the maximum allowable APAP content of any combination drug decreased to 325mg, which is directly aimed at making Hydrocodone and Oxycodone
formulations safer for proscribed users, although this is unlikely to effect recreational users.
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There are also formulations of hydrocodone which include NSAIDs instead of APAP, typically using Ibuprofen or Aspirin. It is much more difficult to extract hydrocodone from pills containing NSAIDs, and while it is unlikely that taking hydrocodone pills that contain it would lead to an overdose (needing between fifty and a hundred 200mg doses of Ibuprofen for example) high doses of NSAIDs can have negative side effects
. High-dose ibuprofen can cause gastro-intestinal distress and high blood pressure
, while high or frequent doses of aspirin can cause intestinal bleeding and anemia. While none of these side effects are anything like as dangerous as high doses of APAP, users of such Hydrocodone/NSAID compounds such as Lortab ASA or Vicoprofen should be aware of additional risks they pose. The absence of APAP certainly does not imply that users will avoid side effects entirely.
If users have a sensitivity to APAP, Ibuprofen, Asprin or NSAIDs in general then it is extremely important to know what compound illicitly obtained pills (which may not come in their original packaging) contain. While there is no global resource, for those in the US where most of these issues are likely to occur, you can use The Drugs.Com Pill Imprint Identifier