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hydrocodone ER

Generic Hysingla
Used for Pain

Hydrocodone extended-release (ER) is a long-acting opioid medication. It's used for severe chronic pain that non-opioid options can't relieve. Once-daily tablets are available as brand name Hysingla ER and generics. Capsules are only available as generics and are taken every 12 hours. The dosage depends on the severity of your pain and your previous pain medications. Side effects include constipation, nausea, and sleepiness. Hydrocodone ER (Hysingla ER) is a controlled substance because it has a high risk for misuse and dependence.

Reviewed by:
reviewerRobert Chad Hakim, PharmD, BCCCP
reviewerCydnee Ng, PharmD
Last reviewed on March 13, 2025
basics-icon

What is Hydrocodone ER (Hysingla ER)?

What is Hydrocodone ER (Hysingla ER) used for?

How Hydrocodone ER (Hysingla ER) works

Hydrocodone ER (Hysingla ER) is an opioid. It attaches to certain opioid receptors (signaling proteins) in the brain. This changes how you react to pain and helps lower how much pain you feel.

When does Hydrocodone ER (Hysingla ER) start working?Time passed since treatment started:
HOURS
DAYS
WEEKS
Full effect
MONTHS

Drug facts

Common BrandsHysingla ER
Drug ClassOpioid
Controlled Substance ClassificationSchedule II
Generic StatusLower-cost generic available
AvailabilityPrescription only
warnings-icon

Risks and warnings for Hydrocodone ER (Hysingla ER)

Hydrocodone ER (Hysingla ER) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

Potential for addiction and misuse

  • Risk factors: Personal or family history of alcohol or substance use disorder | Personal or family history of depression or other mental health condition

Black Box WarningHydrocodone ER (Hysingla ER) is a controlled substance with a risk of addiction and misuse. Misusing the medication can lead to serious, life-threatening side effects, like dangerously slow breathing and overdose.

blank warning iconTo stay safe, take hydrocodone ER (Hysingla ER) exactly as prescribed. You'll get prescribed the lowest dose for the shortest amount of time needed to manage your pain. Don't change how much or how often you take it without talking to your pain specialist first.

blank warning iconBecause of the risk of addiction and misuse, hydrocodone ER (Hysingla ER) is only available through a special Risk Evaluation and Mitigation Strategy (REMS) program. This program is called the Opioid Analgesic REMS program. Your prescriber and pharmacy must register with the program and get trained on safe medication use. They'll talk to you about how to safely take hydrocodone ER (Hysingla ER).

Dangerously slow breathing (respiratory depression)

  • Risk factors: Conditions that cause breathing problems (e.g., COPD, asthma, head injury) | Older age | Being frail | Taking medications that can cause slow breathing or slow the body down | Drinking alcohol | Taking too much hydrocodone ER (Hysingla ER)

Black Box WarningHydrocodone ER (Hysingla ER) can cause dangerously slow breathing, which can be life-threatening. This can happen to anyone and at recommended doses of the medication. But the risk is highest when you first start the medication and when your dose goes up.

blank warning iconDon't drink alcohol while you're taking hydrocodone ER (Hysingla ER). Also, don't take it with medications that slow your body down, like benzodiazepines, other opioids, and muscle relaxants. This can raise the risk of dangerously slow breathing.

blank warning iconYour pain specialist will recommend keeping naloxone (Narcan) with you at all times. Naloxone can quickly reverse slowed breathing from opioids. Make sure you and your loved ones know how to use naloxone (Narcan) in case of an emergency. Give naloxone (Narcan) and call 911 right away if you have trouble breathing or notice bluish-colored lips, fingers, or toes.

Risk for opioid overdose

  • Risk factors: History of opioid use disorder | Previous opioid overdose | Taking high doses of hydrocodone ER (Hysingla ER) | Taking more opioids than prescribed | Alcohol use

Black Box WarningTake hydrocodone ER (Hysingla ER) exactly as prescribed. Taking too much or taking it more often than prescribed can lead to an overdose. Keep it out of reach from children, visitors, and pets to prevent an accidental exposure or overdose.

blank warning iconSymptoms of an opioid overdose include not responding to sound or touch, very slowed breathing, slow heartbeat, extreme sleepiness, and cold or clammy skin. Be sure you and your loved ones know how to spot an overdose. Your pain specialist will recommend getting naloxone (Narcan), which can quickly treat an opioid overdose. Always carry naloxone and use it right away if an overdose happens. Call 911 right away after giving naloxone (Narcan).

Difficulty concentrating and extreme sleepiness

  • Risk factors: Taking high doses of hydrocodone ER (Hysingla ER) | Drinking alcohol | Taking other medications that can cause sleepiness

Black Box WarningHydrocodone ER (Hysingla ER) can cause extreme sleepiness. It can also make it hard to think, react, and focus. Don't mix alcohol with hydrocodone ER (Hysingla ER). Also don't take it with other medications that can cause sleepiness or "brain fog." These include benzodiazepines, muscle relaxants, and sleep aids. Taking these medications together can make you even sleepier and slow your thinking.

blank warning iconMake sure you know how hydrocodone ER (Hysingla ER) affects you before driving a car or doing activities that need your full attention. Talk to your prescriber right away if the medication makes you too sleepy.

Drug interactions

Black Box WarningHydrocodone ER (Hysingla ER) interacts with many medications. Tell your care team about all the medications you take to make sure they're safe together. Also, talk to them before making any changes to your medications because sudden adjustments can be harmful.

blank iconSome interactions can raise hydrocodone levels in the body. This can raise your risk of serious side effects, like dangerously slowed breathing and overdose. Examples include taking the opioid with erythromycin, ketoconazole, or ritonavir (Norvir).

blank iconOther interactions can lower hydrocodone levels in the body. This can make the opioid work less well for pain and possibly cause withdrawal symptoms. Examples include taking the opioid with rifampin (Rifadin) or carbamazepine (Tegretol).

Harm to newborns when taken during pregnancy

Black Box WarningLong-term use of hydrocodone ER (Hysingla ER) during pregnancy can make your unborn baby dependent on the medication. This happens because the opioid can pass through the placenta to your baby. Your baby can have withdrawal symptoms after they're born.

blank iconSigns of withdrawal in newborns include high-pitched crying, poor feeding, poor sucking, and trembling. In severe cases, it can lead to seizures.

blank iconWithdrawal can be life-threatening if not recognized and treated in time. Tell your care team if you've taken hydrocodone ER (Hysingla ER) during pregnancy. Specialized healthcare professionals will make sure your baby gets the care they need.

Physical dependence and withdrawal symptoms

  • Risk factors: Long-term use of hydrocodone ER (Hysingla ER)

Taking hydrocodone ER (Hysingla ER) regularly for a long time can cause physical dependence. This means that your body relies on the medication to function. You might have withdrawal if you lower your dose or stop taking the medication too suddenly.

Withdrawal can make your pain come back. It can also cause unpleasant symptoms like anxiety, irritability, body aches, stomach upset, and chills.

Don't lower your dose or stop taking hydrocodone ER (Hysingla ER) suddenly without talking to your prescriber. If needed, they'll slowly lower your dose over time to prevent withdrawal. Talk to your prescriber if you're worried about dependence and withdrawal with hydrocodone ER (Hysingla ER).

Low blood pressure

  • Risk factors: Medical conditions that make it hard to have a stable blood pressure | Taking medications that can drop blood pressure

Hydrocodone ER (Hysingla ER) can sometimes cause extremely low blood pressure. This can include a drop in blood pressure when you stand from a sitting or lying down position. Low blood pressure can lead to dizziness and fainting.

To avoid falling, get up slowly if you've been sitting or lying down. Talk to your prescriber if dizziness or lightheadedness doesn't go away.

Low adrenal hormone levels

  • Risk factors: Taking hydrocodone ER (Hysingla ER) for longer than 1 month

Some people taking opioids like hydrocodone ER (Hysingla ER) have had low adrenal hormone levels. This is more likely if you've taken opioids for a month or longer. Tell your prescriber if you have symptoms of low adrenal hormone levels. These can include long-lasting tiredness, muscle weakness, low appetite, and nausea. If your adrenal hormone levels are too low, you might need to stop hydrocodone ER (Hysingla ER) and take corticosteroids for treatment.

Life-threatening abnormal heart rhythm (QT prolongation)

  • Risk factors: Taking other medications that cause QT prolongation | Personal or family history of long QT syndrome | History of heart failure | History of abnormal heart rhythms (arrhythmias) | Slow heart rate | Abnormal electrolyte levels

Although rare, hydrocodone ER (Hysingla ER) can cause QT prolongation. This is when your heart takes longer to recharge between beats. It can affect your heart rhythm, which can be serious and life-threatening.

Before starting hydrocodone ER (Hysingla ER), tell your prescriber about your full medical history. Also let them know about all your medications. Your risk for QT prolongation is higher if you already have heart rhythm problems or abnormal electrolyte levels. The risk is also higher if you take medications that can affect heart rhythm, like amiodarone (Pacerone) or ciprofloxacin (Cipro).

Call your prescriber if you have a pounding heartbeat, trouble breathing, chest pain, or lightheadedness while taking hydrocodone ER (Hysingla ER). These could be signs of heart rhythm problems. Your prescriber might lower your dose or switch you to a different pain medication if needed.

Seizures

  • Risk factors: History of seizures | Taking other medications or having health conditions that raise your risk of seizures

If you've had a seizure before, opioids like hydrocodone ER (Hysingla ER) can raise the risk of having seizures more often. Opioids can also put you at risk of seizures in some situations. Get medical help right away if you have a seizure while you're taking hydrocodone ER (Hysingla ER).

side-effects-icon

Side effects of Hydrocodone ER (Hysingla ER)

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

Extended-release tablet:

  • Nausea (16%)
  • Constipation (9%)
  • Vomiting (7%)
  • Dizziness (7%)
  • Headache (7%)
  • Sleepiness (5%)

Extended-release capsule:

  • Constipation (11%)
  • Nausea (10%)
  • Sleepiness (5%)

Less Common Side Effects

  • Headache
  • Dizziness
  • Fatigue
  • Vomiting
  • Stomach pain
  • Itching
  • Dry mouth
  • Ringing in the ear

Hydrocodone ER (Hysingla ER) serious side effects

Contact your healthcare provider immediately if you experience any of the following.

  • Dangerously slow breathing: trouble breathing; bluish-colored lips, fingers, or toes
  • Accidentally taking too much (overdose): not responding to sound or touch, slowed breathing, slow heartbeat, extreme sleepiness, cold or clammy skin
  • Opioid withdrawal: return of pain, suicidal thoughts, anxiety, restlessness, irritability, body aches, stomach upset, yawning, sweating, chills
  • Abnormal heart rhythm (QT prolongation): chest pounding, chest pain, shortness of breath, feeling faint or lightheaded
  • Serious allergic reaction: itchy, red rash (hives); shortness of breath; chest tightness; swelling of lips, tongue, throat, face, or eyes
When do Hydrocodone ER (Hysingla ER) possible side effects begin and end?
Time passed since treatment started:
M
H
D
W
M
Constipation
Risk of slowed breathing
Seek immediate medical care if you experience this side effect.
If a line continues to the right, you'll likely keep experiencing this side effect once it starts.

Source: Dailymed

The following Hydrocodone ER (Hysingla ER) side effects have also been reported

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Less common

Bladder pain

bloating or swelling of the face, arms, hands, lower legs, or feet

bloody or cloudy urine

body aches or pain

chills

cough

depression

difficult or labored breathing

difficult, burning, or painful urination

ear congestion

fear or nervousness

fever

frequent urge to urinate

headache

loss of voice

lower back or side pain

nasal congestion

rapid weight gain

runny nose

sneezing

sore throat

tightness in the chest

tingling of the hands or feet

unusual tiredness or weakness

unusual weight gain or loss

Incidence not known

Agitation

darkening of the skin

diarrhea

difficulty swallowing

fast heartbeat

hives, itching, skin rash

loss of appetite

mental depression

nausea

overactive reflexes

poor coordination

puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue

restlessness

shivering

talking or acting with excitement you cannot control

trembling or shaking

twitching

vomiting

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose

Blue lips and fingernails

blurred vision

change in consciousness

chest pain or discomfort

cold and clammy skin

confusion

constricted pupil (black part of the eye)

coughing that sometimes produces a pink frothy sputum

decreased awareness or responsiveness

dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position

increased sweating

irregular, fast or slow, or shallow breathing

lightheadedness, dizziness, or fainting

pale skin

sleepiness or unusual drowsiness

slow or irregular heartbeat

weak muscle tone

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Difficulty having a bowel movement

Less common

Back pain

dry mouth

heartburn

muscle spasms

stomach pain or discomfort

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

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pros-and-cons-icon

Pros and cons of Hydrocodone ER (Hysingla ER)

Pros

  • An option if non-opioid pain relievers aren't enough for managing severe chronic pain
  • Provides long-lasting pain relief throughout the day
  • Can take with or without food

Cons

pharmacist-tips-icon

Pharmacist tips for Hydrocodone ER (Hysingla ER)

pharmacist
  • Take hydrocodone ER (Hysingla ER) exactly as prescribed. Don't change your dose or stop taking it suddenly without talking to your prescriber first. Sudden changes in your treatment plan can lead to an accidental overdose or uncomfortable withdrawal symptoms.
  • For the hydrocodone ER tablets (Hysingla ER): Take the tablet once per day. Don't take extra tablets to treat sudden pain. This can make you have very slowed breathing and raise your risk of overdose.
  • For the hydrocodone ER capsules: Take the capsule every 12 hours. Don't take the capsules to treat any breakthrough pain. This can raise your risk of serious side effects like very slowed breathing and overdose.
  • Swallow the pill whole, one at a time, with a glass of water. Don't pre-soak, lick, or wet the pill before you take it because it could get stuck in your throat and cause choking. Also don't chew, break, crush, or tamper with it. Too much medication can get released all at once into your body and lead to a life-threatening overdose.
  • Take hydrocodone ER (Hysingla ER) with or without food. If you get an upset stomach from the medication, you can try taking it with food next time. This might help lessen the risk of stomach upset.
  • A common side effect of opioids is constipation. Drink plenty of water each day and add more fiber-rich foods to your diet. Talk to a healthcare professional if constipation is bothering you. They can recommend medications for relief or a change in your pain treatment.
  • Don't drink alcohol while you're taking hydrocodone ER (Hysingla ER). Mixing them together can make you very sleepy or dizzy. It can also make it harder to think clearly. This can possibly cause accidents if you're not careful.
  • Always have naloxone (Narcan) with you. It can quickly reverse the effects of hydrocodone ER (Hysingla ER) in an emergency like an accidental overdose. Teach your loved ones how to use naloxone (Narcan) in case you can't do it yourself. Call 911 after giving naloxone (Narcan) because its effects are temporary.
  • Tell your care team about all the medications you take or plan to take. They can check if they're safe to take together. This is because many medications can interact with hydrocodone ER (Hysingla ER), which can be harmful. For example, taking hydrocodone ER (Hysingla ER) with sedatives, like benzodiazepines, can raise the risk of overdose.
  • Let your prescriber know if you're pregnant or breastfeeding. Hydrocodone ER (Hysingla ER) isn't recommended during pregnancy or while breastfeeding. This is because there are serious risks to the baby. Talk to them about safer options to relieve your pain.
  • Keep hydrocodone ER (Hysingla ER) out of reach from visitors, children, and pets. There are a few drug take-back options to get rid of the medication safely if you don't need it anymore. This lessens the risk for accidental overdose and medication misuse.
faq-icon

Common questions about Hydrocodone ER (Hysingla ER)

Yes, hydrocodone is an opioid. Hydrocodone ER (Hysingla ER) is an extended-release, long-acting version of hydrocodone. It's used to help with severe chronic pain when non-opioid options don't work well. Opioids like hydrocodone ER (Hysingla ER) have serious risks. These include misuse, addiction, slowed breathing, and overdose. Talk to your pain specialist about the risks and benefits of hydrocodone ER (Hysingla ER).

It takes about 3 days for most of hydrocodone ER (Hysingla ER) to leave your body after a single dose. Ask your prescriber if you have questions about how long the medication stays in your body.

Extended-release opioids, like hydrocodone ER (Hysingla ER), are used for long-term pain management. Studies show that some people might need to take hydrocodone ER (Hysingla ER) for a few weeks to feel its full pain-relieving effects. Talk to your prescriber if you have concerns about how quickly this medication will work for you.

No. Don't cut, chew, crush, or break the hydrocodone ER (Hysingla ER) pill. Cutting or breaking it can cause too much medication to get absorbed by the body too quickly. This can possibly lead to a life-threatening overdose. Swallow the hydrocodone ER (Hysingla ER) pill whole with a glass of water. Talk to your prescriber about your options if you're having trouble swallowing the pill whole.

Yes, sleepiness is a usual side effect of opioids like hydrocodone ER (Hysingla ER). Tell your care team if you take other medications that make you sleepy. They can include benzodiazepines and muscle relaxants. Also avoid alcohol. Taking hydrocodone ER (Hysingla ER) with alcohol or drowsy medications can make this side effect worse. Don't drive or do anything that needs your full attention until you know how hydrocodone ER (Hysingla ER) affects you.

Yes. The hydrocodone extended-release capsule is available as a generic only. The hydrocodone extended-release tablet is available as a generic as well as under the brand name Hysingla ER.

If it's part of your prescribed treatment plan, it's okay to take hydrocodone ER (Hysingla ER) with short-acting pain medications that also have hydrocodone. Hydrocodone ER (Hysingla ER) is a long-acting pain medication for chronic pain. But some people still have breakthrough pain that needs quick relief. A short-acting opioid medication, like Norco (hydrocodone / acetaminophen), could help with this sudden pain. Ask your pain specialist if you're not sure which pain medication to take and when.

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Hydrocodone ER (Hysingla ER) dosage

The average cost for 60 capsules of 10mg of Hydrocodone ER (Hysingla ER) is $159.42 with a free GoodRx coupon. This is 74.77% off the average retail price of $631.99.
capsuleCapsule
DosageQuantityPrice as low asPrice per unit
10mg60 capsules$159.42$2.66
15mg60 capsules$157.37$2.62
20mg60 capsules$162.67$2.71
30mg14 capsules$40.26$2.88
40mg10 capsules$32.27$3.23
50mg20 capsules$59.27$2.96
tabletTablet
DosageQuantityPrice as low asPrice per unit
20mg30 tablets$86.45$2.88
30mg30 tablets$117.55$3.92
40mg30 tablets$156.29$5.21
60mg28 tablets$200.23$7.15
80mg30 tablets$286.57$9.55
100mg20 tablets$243.99$12.20
120mg30 tablets$1,252.02$41.73

Typical dosage for Hydrocodone ER (Hysingla ER)

Your prescriber will work with you to find the right dose for your individual needs. It's recommended to take the lowest dose possible for the shortest amount of time to manage your pain.

Your starting dose might differ if you have liver problems or kidney problems. It also depends on what opioid pain medications you were taking before hydrocodone ER (Hysingla ER).

Your prescriber will then adjust your dose depending on how well it's helping your pain.

interactions-icon

Interactions between Hydrocodone ER (Hysingla ER) and other drugs

Hydrocodone ER (Hysingla ER) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Hydrocodone ER (Hysingla ER). Please note that only the generic name of each medication is listed below.

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

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How much does Hydrocodone ER (Hysingla ER) cost?

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contraindications-icon

Hydrocodone ER (Hysingla ER) contraindications

Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Hydrocodone ER (Hysingla ER) will not be safe for you to take.

  • Severely slowed breathing (respiratory depression)
  • Severe asthma
  • Medical conditions that cause blockage of the stomach passageway
  • Allergy to hydrocodone
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What are alternatives to Hydrocodone ER (Hysingla ER)?

There are a number of medications that your doctor can prescribe in place of Hydrocodone ER (Hysingla ER). Compare a few possible alternatives below.
Hydrocodone ER (Hysingla ER)
Used for:
$32.27Lowest GoodRx priceView prices
Used for:
$95.32Lowest GoodRx priceView prices
Used for:
  • Pain that isn't relieved by non-opioid medications
$7.03Lowest GoodRx priceView prices

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References

Best studies we found

Alvogen Inc. (2023). Hydrocodone bitartrate capsule, extended release [package insert]. DailyMed.

Alvogen Inc. (2024). Hydrocodone bitartrate tablet, extended release [package insert]. DailyMed.

American College of Obstetricians and Gynecologists. (2017). Opioid use and opioid use disorder in pregnancy.

GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.

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