8 Hydrocodone/​Acetaminophen Side Effects: Managing Constipation, Drowsiness, and More

Hydrocodone / acetaminophen — previously sold under the brand names Norco and Vicodin — is a prescription-only, opioid medication. It contains hydrocodone, an opioid, and acetaminophen (Tylenol), a common over-the-counter (OTC) pain reliever.

Hydrocodone / acetaminophen works well to treat moderate-to-severe pain when other pain medications haven’t been effective. But it also has several potential side effects and risks to consider.

Hydrocodone / acetaminophen side effects at a glance

Mild hydrocodone / acetaminophen side effects can often be managed at home. And in some cases, they subside as a person’s body gets used to the medication. While less common, serious side effects are also possible and may require medical care.

Common, typically mild hydrocodone / acetaminophen side effects include:

• Drowsiness

• Dizziness

• Nausea

• Vomiting

• Constipation

• Headaches

• Itching

• Weakness or lack of energy

• Trouble sleeping

• Mood changes

Less common but potentially serious hydrocodone / acetaminophen side effects include:

• Misuse and dependence

• Overdose

• Withdrawal symptoms (if stopped abruptly)

• Liver damage

• Falls

• Adrenal insufficiency (low levels of cortisol)

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Here, we’ll cover eight hydrocodone / acetaminophen side effects you should be aware of if you or someone you know is taking the medication.

1. Drowsiness

Drowsiness is a common hydrocodone / acetaminophen side effect. This is because hydrocodone has sedative effects on the brain. 

Since hydrocodone / acetaminophen is typically taken every 4 to 6 hours as needed, drowsiness during the day may be unavoidable. But there are a few tips that can help you manage drowsiness from the medication:

• Avoid driving. Avoid activities that require alertness until you know how the medication affects you. This includes driving.

• Steer clear of other sedating substances. Avoid combining hydrocodone / acetaminophen with sleep medications, benzodiazepines, and alcohol. These substances can worsen drowsiness and slow breathing. Your healthcare team can review your current medication list for other potential culprits.

• Get enough sleep. Try to get adequate sleep at night to reduce daytime drowsiness. If you’re not getting enough rest, there are things you can do to help improve your sleep hygiene.

• Follow your prescriber’s instructions. Take hydrocodone / acetaminophen as directed by your prescriber. Taking a higher dose or taking it more often than prescribed can worsen drowsiness.

If you experience drowsiness that feels excessive or interferes with your daily activities, talk to your prescriber. They may adjust your dosage or suggest an alternative pain medication. Seek emergency care if you have severe drowsiness, trouble staying awake, or difficulty with coordination.

2. Dizziness

Dizziness is another known side effect of hydrocodone / acetaminophen. The medication’s effects on brain activity and blood pressure can contribute to dizziness. Older adults and people taking certain other medications may be more likely to feel dizzy while taking hydrocodone / acetaminophen.

Tips for managing dizziness from hydrocodone / acetaminophen include:

• Move slowly when standing up or changing positions. This can help prevent sudden drops in blood pressure that can worsen dizziness. It’s also a good idea to sit or lie down if you feel lightheaded to prevent falls or injuries.

• Stay hydrated. Be sure to drink enough fluids throughout the day, since dehydration can make dizziness worse.

• Avoid alcohol and other sedating medications. These substances can amplify dizziness and increase the risk of falls. Your healthcare team can give you more information about specific things to avoid.

• Use caution when performing activities that require balance or coordination. This is especially important when first starting the medication and after any dosage changes. Once you know more about how the medication affects you, you’ll have a better idea of which activities are safe to do.

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• Finding relief: Are your medications making you constipated? Here are the best laxatives for constipation caused by medications.

• Opioid alternatives: There are several nonopioid pain relievers that help with mild-to-moderate pain.

• Checking for opioid interactions: The best way to check for potential opioid interactions is to give your healthcare team a list of all of your medications, including any over-the-counter products.

Tell your prescriber if you have dizziness that persists or worsens. They may adjust your dosage or suggest an alternative pain medication.

3. Nausea and vomiting

Opioids, including hydrocodone / acetaminophen, activate areas in the brain that trigger nausea and vomiting, making these common side effects. Studies show that up to 40% of people taking opioids experience nausea and about 25% experience vomiting.

Nausea from opioids tends to get better over time. But in the meantime, here are a few ways to lessen nausea from hydrocodone / acetaminophen:

• Take it with food. If you’ve been experiencing nausea after taking your doses on an empty stomach, try taking the medication with a light meal or snack.

• Stay hydrated. Drink plenty of water to help prevent dehydration, which can worsen nausea.

• Try home remedies. You can try an at-home, anti-nausea remedy like ginger if you’re feeling queasy.

• Ask about OTC or prescription options. Your healthcare team can recommend an OTC or prescription medication to help with nausea, if needed. But check with them before trying a new medication.

If your nausea is still bothersome after trying the above tips, let your prescriber know. They may recommend reducing your dosage or trying another type of pain medication or an opioid that’s less likely to cause nausea.

4. Constipation

Constipation is a common side effect of opioids, including hydrocodone / acetaminophen. This is because opioids slow down the movement of food through the gastrointestinal tract, in addition to having other effects. Up to 80% of people taking opioids report constipation. And unlike some opioid side effects, constipation generally doesn’t improve over time.

A few ways to prevent or manage constipation from hydrocodone / acetaminophen include:

• Stay active. Regular movement can help keep your digestive tract working properly.

• Drink plenty of water. Staying hydrated can soften stools and make them easier to pass.

• Eat a fiber-rich diet. Try introducing more fiber into your diet with fruits, vegetables, and whole grains.

• Try OTC laxatives. Your prescriber or pharmacist may recommend trying one or more OTC laxatives. They might suggest a stool softener, such as docusate (Colace), a stimulant laxative, such as sennosides (Senokot, Ex-Lax) or bisacodyl (Dulcolax), or a combination of these.

• Ask about prescription options. There are also prescription medications available for constipation from opioids. If needed, your prescriber can recommend one for you.

If you have severe constipation, you may need medical attention. Serious symptoms include severe stomach pain, trouble eating, and vomiting. 

If you’re experiencing constipation, talk to a healthcare professional. They can help you figure out what to do next. It’s possible that you may need further evaluation and/or a change in medications.

5. Mood changes

In some cases, hydrocodone / acetaminophen can cause mood changes, which can be unpredictable and vary from person to person. Examples of these mood changes include:

• Feelings of uneasiness, fear, or anxiety

• Depression, which is more likely with long-term use

• Manic or hypomanic episodes in people with bipolar disorder

Contact your healthcare team if you experience significant mood changes, such as heightened anxiety, mood swings, or unusual bursts of energy. (This is also the case if you have depression or are feeling depressed while taking the medication.) They can evaluate your symptoms and determine if adjustments to your medication regimen are needed.

For additional resources or to connect with mental health services in your area, call SAMHSA’s National Helpline at 1-800-662-4357. For immediate assistance, call the National Suicide Prevention Lifeline at 988, or text “HOME” to 741-741 to reach the Crisis Text Line.

Good to know: Restlessness, anxiety, and depression can also occur if you stop taking an opioid or reduce your dosage too quickly. If you’re planning to stop taking hydrocodone / acetaminophen, talk to your healthcare team about how to taper off safely.

6. Liver damage

Acetaminophen can cause serious liver damage if taken in high doses. And the pain reliever is found in many OTC and prescription medications. So it’s best to track your total daily intake to stay within safe limits if you’re taking hydrocodone / acetaminophen.

For most adults, the maximum daily dose of acetaminophen is 4,000 mg. But this may be lower for people who have liver damage or who drink a lot of alcohol. Your healthcare team can tell you how much acetaminophen is OK for you to take in a 24-hour period.

If you think you’ve taken too much acetaminophen, call Poison Control at 1-800-222-1222. Go to the ER if your symptoms feel severe or life-threatening. Symptoms to watch for include:

• Stomach pain

• Nausea and vomiting

• Confusion

• Jaundice (yellowing of the skin or eyes)

Before taking hydrocodone / acetaminophen, create a list of all your medications, including OTC products. Give this to your prescriber and pharmacist. They can help you check whether any of your other medications contain acetaminophen.

7. Dependence and misuse

Hydrocodone / acetaminophen is a Schedule 2 controlled substance. This means it carries a high risk of dependence and misuse. 

In general, the longer you take opioids, the higher your risk is of developing opioid use disorder (OUD). Taking an opioid differently than how it’s prescribed, such as taking a higher dose, can also increase this risk. Signs of OUD include taking opioids despite negative consequences, taking higher doses of opioids than intended, and experiencing cravings for opioids. 

If you or someone you know struggles with substance use, call SAMHSA’s National Helpline at 1-800-662-4357 to learn about resources in your area.

8. Opioid overdose

Taking too much hydrocodone / acetaminophen can lead to a life-threatening opioid overdose. Key warning signs of an overdose include:

• Slowed or stopped breathing

• Unresponsiveness or unconsciousness

• Bluish skin, lips, or fingernails

• Pinpoint (very small) pupils

• Limp body or weak pulse

Certain people may be more likely to experience an opioid overdose, including those who:

• Have OUD or a history of opioid misuse

• Take higher doses than prescribed or take opioids that weren’t prescribed for them

• Combine opioids with other substances that slow breathing, such as benzodiazepines or alcohol

A hydrocodone / acetaminophen overdose can be fatal. If you think you've witnessed an overdose, administer an opioid reversal medication, such as naloxone (Narcan, Zimhi) or nalmefene (Opvee), if possible. Call 911 immediately, even if the person starts breathing again. Stay with them until help arrives. And since naloxone only lasts for a short amount of time, be prepared to administer another dose if necessary.

If you or a loved one takes hydrocodone / acetaminophen, it’s safest to keep naloxone or nalmefene with you at all times. For information on how to access naloxone, and even get it for free, check out our GoodRx Health article on this topic.

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Written by:

Austin Ulrich, PharmD, BCACP

​​Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. Ulrich’s experience includes direct patient care in hospital and community pharmacies.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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