Hydrocodone and acetaminophen overdose

Both acetaminophen and hydrocodone can be harmful in large amounts.

Acetaminophen with hydrocodone is the main ingredient in many prescription painkillers, including:

• Anexsia
• Anolor DH
• Norco
• Vicodin

Medicines with other names may also contain hydrocodone and acetaminophen.

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

Seek medical help right away. DO NOT make the person throw up unless poison control or a health care provider tells you to.

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

Your 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.

Take the container to the hospital 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 (computerized axial tomography) 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

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 drug. 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.

Lorcet overdose; Lortab overdose; Vicodin overdose; Norco overdose

Aronson JK. Opioid receptor agonists. In: Aronson JK, ed. Meyler's Side Effects of Drugs. 16th ed. Waltham, MA: Elsevier; 2016:348-380.

Aronson JK. Paracetamol (acetaminophen) and combinations. In: Aronson JK, ed. Meyler's Side Effects of Drugs. 16th ed. Waltham, MA: Elsevier; 2016:474-493.

Ganetsky M. Acetaminophen. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 138.

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.

Updated 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.