Hydrocodone and acetaminophen overdose
Definition
Hydrocodone is a painkiller in the opioid family (related to morphine). Acetaminophen is an over-the-counter medicine used to treat pain and inflammation. They may be combined in one prescription medicine to treat moderate to severe pain. An overdose occurs when someone takes more than the recommended amount of this medicine. The treatment of this overdose must consider both the opioid and acetaminophen components.
This article is for information only. DO NOT use it to treat or manage an actual overdose. If you or someone you are with overdoses, call the local emergency number (such as 911), or the local poison control center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States.
Alternative Names
Lorcet overdose; Lortab overdose; Vicodin overdose; Norco overdose
Poisonous Ingredient
Both acetaminophen and hydrocodone can be harmful in large amounts.
Where Found
Acetaminophen with hydrocodone is the main ingredient in many prescription painkillers, some of which have been discontinued, including:
- Anexsia
- Anolor DH
- Norco
- Vicodin
Medicines with other names may also contain hydrocodone and acetaminophen.
Symptoms
Symptoms of a hydrocodone and acetaminophen overdose include:
- Bluish-colored fingernails and lips (cyanosis)
- Breathing problems, including slow and labored breathing, shallow breathing, or no breathing
- Cold, clammy skin
- Decreased level of consciousness and lack of responsiveness
- Loss of consciousness, coma
- Confusion
- Dizziness
- Drowsiness
- Fatigue
- Lightheadedness
- Liver failure (from acetaminophen overdose), causing yellow skin and eyes (jaundice)
- Low blood pressure
- Muscle twitches
- Nausea and vomiting
- Tiny pupils
- Seizures
- Spasms of the stomach and intestines
- Weakness
- Weak pulse
Home Care
Seek medical help right away. DO NOT make the person throw up unless poison control or a health care provider tells you to.
Before Calling Emergency
Have this information ready:
- Person's age, weight, and condition
- Name of the product (ingredients and strength, if known)
- Time it was swallowed
- Amount swallowed
- If the medicine was prescribed for the person
Poison Control
The local poison control center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. This national hotline will let you talk to experts in poisoning. They will give you further instructions.
This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.
You can also get online poison help now at Poisonhelp.org. Just enter the product, poison, or medicine to get expert help.
For more information about America's Poison Centers, go to poisoncenters.org.
What to Expect at the Emergency Room
If you go to the emergency room, take the container for the poison with you, if possible.
The provider will measure and monitor the person's vital signs, including temperature, pulse, breathing rate, and blood pressure.
Tests that may done include:
- Blood and urine tests including the blood level of acetaminophen
- CT scan of the head
- Chest x-ray
- ECG (electrocardiogram or heart tracing)
Treatment may include:
- Activated charcoal
- Breathing support, including oxygen, tube through the mouth and breathing machine (ventilator)
- Fluids through a vein (by IV)
- Laxative
- Medicine to lower acetaminophen level in the blood or to counteract its effects (n-acetylcysteine)
- Medicine to reverse the effects of the hydrocodone
- Tube through the mouth into the stomach to wash out the stomach (gastric lavage), if unable to swallow medicines
Outlook (Prognosis)
How well you do depends on how much hydrocodone and acetaminophen you swallowed and how quickly you receive treatment. The faster medical help is given, the better the chance for recovery.
You may need to stay in the hospital to receive more doses of the medicine that reverses the effects of the hydrocodone and acetaminophen. Complications may cause permanent disability. These possible complications are:
- Pneumonia
- Muscle damage from lying on a hard surface for a prolonged period of time
- Brain damage from lack of oxygen
- Kidney injury or failure
- Liver damage or failure
If there are no complications, long-term effects and death are rare.
If you receive medical attention before serious breathing problems occur, you should have few long-term health problems, and will probably be back to normal within several days.
A person may survive the hydrocodone overdose and still have serious injury from the acetaminophen, including liver failure. This, might require a liver transplant.
References
Aronson JK. Paracetamol (acetaminophen) and combinations. In: Aronson JK, ed. Meyler's Side Effects of Drugs. 16th ed. Waltham, MA: Elsevier; 2016:474-493.
Bluth MH, Pincus MR, Abraham NZ. Toxicology and therapeutic drug monitoring. In: McPherson RA, Pincus MR, eds. Henry's Clinical Diagnosis and Management by Laboratory Methods. 24th ed. Philadelphia, PA: Elsevier; 2022:chap 24.
Ganetsky M. Acetaminophen. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 138.
Nelson LS, Calello DP. Acute poisoning. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 96.
Nikolaides, JK, Thompson TM. Opioids. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 151.
Theobald JL, Corcoran JN. Poisoning. In: Kliegman RM, St. Geme JW, Blum NJ, et al, eds. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia, PA: Elsevier; 2025:chap 94.
Reviewed By: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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