Hydrocodone with Acetaminophen

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Also indexed as:

Acetaminophen with Hydrocodone, Vicodin

This drug combines two primary active ingredients: acetaminophen and hydrocodone.

Acetaminophen is used to reduce pain and fever. Unlike NSAIDs (nonsteroidal anti-inflammatory drugs), it lacks anti-inflammatory activity. Acetaminophen is available by itself or in nonprescription and prescription-only combination products used to relieve pain and the symptoms associated with colds and flu.

Hydrocodone is a narcotic analgesic used in combination products to relieve mild to moderate pain and an antitussive agent to relieve cough and upper respiratory symptoms associated with allergy or cold.

Herbs

Summary of Interactions for Hydrocodone with Acetominophen

Depletion or interference	None known
Adverse interaction	None known
Side effect reduction/prevention	Milk thistle* N-acetyl cysteine
Supportive interaction	Vitamin C*
Reduced drug absorption/bioavailability	Hibiscus
Other (see text)	Schisandra
The interactions listed in this table may apply to one or more ingredient of this medication.

An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

Interactions with Supplements

N-acetyl cysteine (NAC)

Hospitals use oral and intravenous N-acetyl cysteine (NAC) to treat liver damage induced by acetaminophen overdose poisoning.¹ NAC is often administered intravenously by emergency room doctors. Oral NAC appears to be effective for acetaminophen toxicity.

An uncontrolled trial compared intravenous NAC with oral NAC in children with acetaminophen poisoning and found that both methods were equally effective in reversing acetaminophen-induced liver toxicity.² However, acetaminophen toxicity is a potential medical emergency, and should only be managed by qualified healthcare professionals.

Vitamin C

Taking 3 grams vitamin C with acetaminophen has been shown to prolong the amount of time acetaminophen stays in the body.³ This theoretically might allow people to use less acetaminophen, thereby reducing the risk of side effects. Consult with a doctor about this potential before reducing the amount of acetaminophen.

Interactions with Herbs

Hibiscus

One small study found that hibiscus could decrease levels of acetaminophen if the drug was taken after the tea was consumed though it was not entirely clear if the decreases were clinically significant.⁴

Milk thistle(Silybum marianum)

Silymarin is a collection of complex flavonoids found in milk thistle that has been shown to elevate liver glutathione levels in rats.⁵Acetaminophen can cause liver damage, which is believed to involve glutathione depletion.⁶ In one study involving rats, silymarin protected against acetaminophen-induced glutathione depletion.⁷ While studies to confirm this action in humans have not been conducted, some doctors recommend silymarin supplementation with 200 mg milk thistle extract, containing 70-80% silymarin, three times per day for people taking acetaminophen in large amounts for more than one year and/or with other risk factors for liver problems.

Schisandra(Schisandra chinensis)

Gomisin A is a constituent found in the Chinese herb schisandra. In a study of rats given liver-damaging amounts of acetaminophen, gomisin A appeared to protect against some liver damage but did not prevent glutathione depletion⁸ (unlike milk thistle, as reported above). Studies have not yet confirmed this action in humans.

Other Interactions

Alcohol

Moderate to high amounts of acetaminophen have caused liver damage in people with alcoholism.⁹ To prevent problems, people taking acetaminophen should avoid alcohol.

Hydrocodone may cause drowsiness, dizziness, or blurred vision. Alcohol may intensify these effects and increase the risk of accidental injury.¹⁰ To prevent problems, people taking hydrocodone should avoid alcohol.

Food

Food, especially foods high in pectin (including jellies), carbohydrates, and large amounts of cruciferous vegetables (broccoli, Brussels sprouts, cabbage, and others) can interfere with acetaminophen absorption.¹¹ However, this interference is probably not of great significance, and it is generally accepted that acetaminophen can be taken with or without food.

Hydrocodone may cause gastrointestinal (GI) upset. Hydrocodone-containing products may be taken with food to reduce or prevent GI upset.¹² A common side effect of narcotic analgesics is constipation.¹³ Increasing dietary fiber (especially vegetables and whole-grain foods) and water intake can ease constipation.

References

1. Vale JA, Proudfoot AT. Paracetamol (acetaminophen) poisoning. Lancet 1995;346:547-52.
2. Perry HE, Shannon MW. J Pediatr 1998;132:149-52.
3. Houston JB, Levy G. Drug biotransformation interactions in man. VI: Acetaminophen and ascorbic acid. J Pharm Sci 1976;65:1218-21.
4. Kolawole JA, Maduenyi A. Effect of zobo drink (Hibiscus sabdariffa water extract) on the pharmacokinetics of acetaminophen in human volunteers. Eur J Drug Metab Pharmacokinet 2004;29:25-9.
5. Valenzuela A, Aspillaga M, Vial S, Guerra R. Selectivity of silymarin on the increase of the glutathione content in different tissues of the rat. Planta Med 1989;55:420-2.
6. Threlkeld DS, ed. Central Nervous System Drugs, Acetaminophen. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Mar 1997, 247-f.
7. Campos R, Garrido A, Guerra R, Valenzuela A. Silybin dihemisuccinate protects against glutathione depletion and lipid peroxidation induced by acetaminophen on rat liver. Planta Med 1989;55:417-9.
8. Yamada S, Murawaki Y, Kawasaki H. Preventive effect of gomisin A, a lignan component of schizandra fruits, on acetaminophen-induced hepatotoxicity in rats. Biochem Pharmacol 1993;46:1081-5.
9. Threlkeld DS, ed. Central Nervous System Drugs, Acetaminophen. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Mar 1997, 247-f.
10. Threlkeld DS, ed. Central Nervous System Drugs, Narcotic Agonist Analgesics. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Feb 1990, 242-3v.
11. Holt GA. Food & Drug Interactions. Chicago: Precept Press, 1998, 2.
12. Threlkeld DS, ed. Central Nervous System Drugs, Narcotic Agonist Analgesics. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Feb 1990, 242-3v.
13. Threlkeld DS, ed. Central Nervous System Drugs, Narcotic Agonist Analgesics. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Feb 1990, 242-3v.

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Last Review: 09-01-2007

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