Hydrocodone and Alcohol: Risks and Side Effects

This article is general information, for education only. It is not medical advice.

If you have been prescribed hydrocodone for pain and you also drink alcohol, you may be wondering whether the two are safe to use together. According to the National Institute on Drug Abuse (NIDA), opioids account for nearly two-thirds of overdose deaths annually.[1] Hydrocodone use becomes more dangerous when combined with alcohol because of the increased risk of slowing your breathing and your heart rate.

Paramount Wellness in Connecticut believes the more you learn about how hydrocodone and alcohol affect each other, the more empowered you will be to protect yourself from the dangers of mixing the two.

Understanding Hydrocodone

Hydrocodone is an opioid prescribed for mild to severe pain. It is sold under several different names such as Vicodin or Norco.

Some versions of the product are sold with acetaminophen (the main ingredient found in Tylenol). Hydrocodone is classified as a Schedule II controlled substance by the U.S. Drug Enforcement Administration (DEA), meaning that while it has medical value, it also carries a high potential for abuse and can lead to dependence and addiction, even when used exactly as prescribed.[2]

How Does Hydrocodone Work?

Hydrocodone works by attaching to opioid receptors located in the central nervous system and body, blocking pain signals sent to the brain and causing feelings of relaxation or euphoria.[3] As the brain adapts to hydrocodone over time, it can develop tolerance (requiring larger doses to achieve the same effect) and physical and psychological dependence.

Common Side Effects of Hydrocodone

Common side effects include:

• Sedation
• Dizziness or lightheadedness
• Vomiting
• Constipation
• Slowing of breathing

Why Hydrocodone is High Risk for Dependence

Since hydrocodone influences the brain’s reward pathways, continued use can result in physical and psychological dependence, tolerance, and addiction. The Centers for Disease Control and Prevention (CDC) states that prescription opioid pain relievers, like hydrocodone, are responsible for thousands of overdose deaths per year, many of which occur when it’s combined with other depressants.[4]

Effects of Alcohol on the Body

Alcohol acts as a depressant, causing decreased activity within the brain. This is the cause of many of the effects that are characteristic with alcohol intoxication, including slurred speech, slower reaction time, poor decision-making abilities, and drowsiness.

Long-term heavy drinking poses additional dangers such as liver damage, cardiovascular disease, cognitive decline, and mental health disorders such as depression and anxiety.

Since alcohol works on many of the same pathways as hydrocodone, the two substances together create effects that are much greater than either would produce by itself.

What Happens When Mixing Hydrocodone and Alcohol?

When hydrocodone and alcohol are taken together, their depressive effects do not just add together; they are synergistic. Each substance reduces respiration and heart rate as well as impairs the brain’s response to stimuli. Combining opioids with alcohol or other depressants can lead to extreme sedation, respiratory depression (inadequate breathing), coma, or death.

Risks of Mixing Hydrocodone and Alcohol

Using hydrocodone and alcohol together increases the risk of the following:

• Respiratory distress (impaired breathing so that your body cannot get sufficient oxygen)
• Loss of consciousness
• Falls and accidents
• Coma
• Death
• Acute alcohol poisoning
• Liver damage
• Heart complications

Acetaminophen and Liver Toxicity Risks

Some hydrocodone medications include acetaminophen, which is metabolized in the liver. Alcohol is also metabolized in the liver. Studies conducted by the National Institutes of Health demonstrate that combining acetaminophen with even moderate amounts of alcohol increases the risk of liver injury and, in some circumstances, liver failure.[5]

Warning Signs of Hydrocodone and Alcohol Overdose

Emergency Symptoms

Overdose caused by the combination of hydrocodone and alcohol requires immediate medical attention. Warning signs include:

• Blue lips or fingers
• Extremely slow breathing or stopped breathing
• Severe drowsiness or unconsciousness
• Vomiting
• A weak or irregular pulse

What To Do During an Overdose

Take the following steps in order if you suspect someone is overdosing:

1. Immediately call 911
2. Give Naloxone (if available) as instructed
3. Attempt to keep the person awake
4. Place them on their side
5. Remain with them until paramedics arrive

Can Naloxone Reverse a Hydrocodone Overdose?

Naloxone (brand name: Narcan) reverses the effects of an opioid overdose by blocking opioid receptors in the brain.[6] Therefore, it is highly effective in reversing an overdose. Naloxone does not counteract alcohol intoxication or poisoning. Even if someone is revived, emergency medical care remains necessary after administering Naloxone.

Why Following Prescription Instructions Matters

• Take hydrocodone as directed by your physician: The safest way to take hydrocodone is by the ordered dose amount, frequency, and duration stated by your physician. Taking excessive doses of hydrocodone or increasing dosages after missing a dose creates an increased risk for sedation, dependence, or overdose.

• Do not combine other substances with hydrocodone without talking to your doctor: Hydrocodone interacts with many substances such as alcohol, benzodiazepines, sleeping pills, certain types of antidepressants, non-prescription sedatives, and other medications including herbal supplements. Talk with your doctor or pharmacist prior to introducing any new medications or substances into your regimen.

• Risks of abusing prescription opioids: Abuse involves consuming more than the prescribed amounts of medication, using the medication for purposes unrelated to pain management or combining it with substances such as alcohol.[7] These practices can lead to dependence, addiction,  and accidental overdose.

How to Stay Safe

Safety Tips for People Prescribed Hydrocodone

To protect yourself from harmful interactions while taking hydrocodone, follow these precautions:

• Avoid all forms of alcohol while on this medication
• Read all labels for hidden alcohol content such as cough medicines, syrups, and mouthwashes
• Follow all warnings provided by your pharmacy or healthcare provider
• Safely store your hydrocodone beyond reach of children and pets

Useful Questions To Ask Your Doctor or Pharmacist

Getting support from a health or mental health provider can be helpful.[8] Questions to consider asking your providers about hydrocodone and alcohol use:

• Am I allowed to consume any alcohol while taking this medication?
• Can I combine this medication with other drugs or substances I am currently taking?
• How long should I wait before having a drink after my last dose?

Special Risks for Older Adults and People With Health Conditions

Certain populations have an elevated risk for adverse effects when combining hydrocodone and alcohol.[9] These populations include:

• Older adults
• Individuals with sleep apnea or COPD
• Patients diagnosed with liver disease
• Anyone prescribed multiple medications

If any of these categories apply to you, exercise caution and consult your healthcare professional regarding concerns.

Can Mixing Hydrocodone and Alcohol Lead to Addiction?

Yes. Regular consumption of hydrocodone and alcohol can increase your risk for developing a substance use disorder (SUD). When you consume both substances at the same time, you reinforce each substance’s effects on your brain’s reward pathway, making stopping the use of one or both increasingly difficult.

Signs of addiction involve cravings for the substance, consuming more of the substance than initially planned or intended, obtaining prescriptions from multiple physicians or providers, withdrawal symptoms present when not using the substance(s), and increasing emotional or cognitive impairment related to substance use, impacting social or work obligations.

Please note that if you identify with any of these indicators, asking for help is a courageous act. Support is available, and treatment is most successful when initiated early.

Treatment Options for Hydrocodone and Alcohol Misuse

Medical Detoxification: Medical detoxification often serves as the initial phase in treatment. During this time, medical professionals monitor clients’ withdrawal symptoms and provide intervention using medications and other therapeutic modalities to ensure a safe withdrawal.[10]

Inpatient Rehabilitation Programs: Following detoxification clients receive ongoing care to establish a foundation for sustained recovery. Examples of modalities used during this stage include individual counseling, group support, and relapse prevention planning. Clients can opt for an inpatient program offering full-time care with trained professionals available whenever needed.

Evidence-Based Therapies Used During Recovery: Throughout recovery, numerous evidence-based therapeutic models are used for treating opioid and alcohol misuse. Common examples include cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT). Both CBT and DBT are effective in teaching clients about contributing factors to their misuse and teaching them coping strategies for situations that previously triggered substance misuse.

Compassionate Support at Paramount Wellness

Mixing hydrocodone and alcohol is dangerous even in small amounts, but you do not have to navigate this on your own.

If you or someone you love is struggling with hydrocodone use, alcohol use, or both, our team at Paramount Wellness in Connecticut is here for you. We offer adult-focused detox and rehabilitation services rooted in compassion and evidence-based care. Please reach out today.