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Codeine vs. Hydrocodone: Two Ways to Treat Pain

Two Powerful Pain Medications

Everyone responds to pain differently. Mild pain doesn’t always require treatment, but most people seek relief for moderate to severe or unremitting pain.

If natural or over-the-counter remedies don’t ease your pain, speak to your doctor about prescription medications. Codeine and hydrocodone are two commonly prescribed pain medications. While they can be quite effective in treating pain, these narcotic medications can easily be abused. Each should be taken with great care, and only under a doctor’s supervision.

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Codeine and Hydrocodone: How They’re Similar

Codeine and hydrocodone are opioid medications that are only available through a prescription. Opioids work by attaching to certain proteins (opioid receptors) throughout your brain and body and altering your perception of pain. Opioids are among the most effective painkillers. They also decrease activity in the part of the brain that controls coughing, and may also affect your mood and emotions.

Due to the potential for overdose and abuse, in 2014 all hydrocodone products were moved to a new category by the Food and Drug Administration (FDA). They now require a written prescription, which you must obtain from your doctor and take to a pharmacy.

Plain codeine has the same requirement. When codeine is combined with acetaminophen or other drugs, the prescription can be called into the pharmacy, but many health systems are also adopting more stringent guidelines on prescribing this drug.

Who Should and Who Shouldn’t Use Them

Both drugs are prescribed for pain as well as severe cough associated with respiratory infections. Most people can use them safely in the short term. However, these drugs may be habit-forming, so tell your doctor if you have a history of alcohol or substance abuse. You should not take codeine if you have severe liver or kidney disease. These medications should be used with caution in children. Talk to your doctor if you’re pregnant or breastfeeding.

Forms and Dosing

Plain codeine is available in tablets, in 15, 30, or 60 mg strengths.

Codeine is also available combined with several other drugs in tablet form:

  • codeine with acetaminophen
  • codeine with carisoprodol
  • codeine with butalbital/caffeine/acetaminophen
  • codeine with butalbital/caffeine/aspirin

These are used for different kinds of pain.

Codeine is also available in liquid form, combined with several other drugs:

  • codeine with acetaminophen
  • codeine with guifenesin
  • codeine with promethazine

Some are used for pain and some are used for pain with cough. Dosing varies depending on the patient, the purpose, and the drug used. Codeine is usually given every four to six hours as needed for pain.

Codeine can impair your judgement or ability to operate machinery. You should not drive if you taking codeine.

Hydrocodone is available in immediate release form, in strengths from 2.5 mg to 10 mg, combined with acetaminophen. Dosing for these products is usually every four to six hours as needed for pain.

It’s also available in extended-release form in a tablet, in strengths from 10 mg to 120 mg. Some kinds of extended-release tablets are dosed every 12 hours and some are dosed every 24 hours. The extended-release tablets are only given to people who have been taking hydrocodone for a long period of time because they are only available in higher doses.

Hydrocodone is also combined with other drugs. Combinations available include:

  • hydrocodone with acetaminophen (Vicodin, Norco and available generically in many strengths)
  • hydrocodone with ibuprofen
  • hydrocodone with homatropine (given for cough)

Hydrocodone is available in liquid forms, combined with other drugs:

  • hydrocodone combined with antihistamines and decongestants
  • hydrocodone with guifenesin
  • hydrocodone with acetaminophen

Dosing will vary depending on the drug combination and strength. If you have severe kidney or liver disease, you may need a different dose or dose schedule.

Hydrocodone can impair your judgement or ability to operate machinery. You should not drive if you’re taking hydrocodone.

With either codeine or hydrocodone, your doctor will probably start you off at the lowest possible dose. The strength and dosage can be adjusted accordingly.

Side Effects of Each

You may experience some side effects when taking codeine or hydrocodone.

Common side effects of codeine include:

  • dizziness
  • lightheadedness
  • drowsiness
  • shortness of breath
  • nausea
  • vomiting
  • constipation
  • sweating

Serious side effects of codeine include:

  • Respiratory depression; this is a higher risk for older adults, people with serious illnesses, and those who have respiratory disease.
  • Lowering of blood pressure; this is a greater risk in patients who have lost blood volume or who are in shock.
  • Hypersensitivity reaction, which could include swelling of the tongue or throat, trouble breathing, and skin rash. Get immediate medical attention (or call 911) if you experience these symptoms.
  • Morphine conversion; the body processes codeine into morphine and some people process codeine very fast, so the level of morphine in their blood can go up too high. Some ethnic groups are at higher risk than others. Children who have had their tonsils removed are at especially high risk after surgery. For this reason, they are not given codeine after tonsillectomy or adenoidectomy.

Common side effects of hydrocodone include:

  • dizziness
  • drowsiness
  • itching
  • constipation
  • loss of appetite
  • nausea and vomiting

Most of these side effects will lessen with time.

Serious side effects of hydrocodone can include:

  • Lowering of blood pressure; this is a greater risk in patients who have lost blood volume or who are in shock.
  • Respiratory depression, especially with extended-release products, and when increasing the dose. This risk is greatest in older adults and those who are chronically ill.
  • Hypersensitivity reaction, which could include swelling of the tongue or throat, trouble breathing, and skin rash. Get immediate medical attention (or call 911) if you experience these symptoms.
  • Hydrocodone comes with a black box warning about the potential for abuse and misuse of this drug. According to the Drug Enforcement Administration (DEA), hydrocodone is associated with more drug abuse than any other opioid.
  • Other serious side effects could be gastric obstruction, seizures, and confusion or mood problems.

Side effects of both drugs are more likely or can be more intense if you are an older adult, if you have kidney or liver disease, chronic obstructive pulmonary disease, or other chronic diseases.

Because each of these drugs is often prescribed in combination with other drugs, it’s important to read the warning labels carefully. There may be additional side effects.

Warnings and Interactions

Signs of an allergic reaction include shortness of breath, itching, and hives. If you experience swelling in your mouth, lips, or throat, seek medical attention immediately or call 911.

High doses and excessive use of these drugs can increase risk of urinary retention, infections, or liver damage. 

Children

Opioids may harm unborn babies, and they can be born with dependence on the drug and require withdrawal treatment. These drugs can also pass through the breast milk.

Substance Abuse

Long-term use of codeine and hydrocodone can lead to dependence. You may experience temporary symptoms of withdrawal when you stop taking either medication, especially if you’ve used them for a long time.

Taking these medications with alcohol or other drugs can intensify the effect and result in overdose. Never share your medication with anyone else, particularly children. The dose that’s effective for you may be lethal for someone else.

Keep your prescription medications locked and away from children. Taking one tablet of extended-release hydrocodone can be fatal for a child.

Interactions

Tell your doctor about all other medications you take (including vitamins and supplements) before you begin taking either medication. Opioids affect your central nervous system (CNS) and it’s dangerous to mix them with other medications that slow down the brain. These may include:

  • anticholinergic drugs (antihistamines or drugs used for urinary spasms)
  • muscle relaxers
  • sedatives, tranquilizers, sleeping pills
  • barbiturates
  • anti-seizure medications (like carbamazepine and phenytoin)
  • anti-depressants
  • anti-psychotic drugs
  • alcohol
  • other opioids

Some drugs interact with codeine, but you still may be able to take them together. Before taking codeine, talk to your doctor if you take any of these drugs:

  • erythromycin
  • ketoconazole
  • phenytoin
  • CNS stimulants
  • magnesium sulfate
  • sodium oxybate
  • ritonavir
  • rifampin

These drugs interact with hydrocodone, but you may still be able to take them together. Before taking hydrocodone, talk to your doctor if you take any of these drugs:

  • erythromycin
  • ketoconazole
  • CNS stimulants
  • magnesium sulfate
  • sodium oxybate
  • ritonavir
  • rifampin

These drugs should not be taken with hydrocodone:

  • alcohol
  • azelastine
  • monoamine oxidase inhibitors
  • orphenadrine

Seek medical attention if you feel confused, experience hallucinations, or have trouble staying awake.

Which Medication Is Best?

Because both of these are prescription medications, your doctor will decide which one would be best for you based on your symptoms and the cause of the pain.

Codeine is typically used for mild to moderately severe pain. Hydrocodone is more potent, and is used for moderate to moderately severe pain. Both are used to treat severe cough associated with respiratory infections and they can be combined with other drugs for specific pain conditions.

Depending on your needs, your doctor may prescribe either of these medications alone, or in combination with something else.

Read This Next

Vicodin vs. Percocet for Pain Reduction
Oxycodone vs. Hydrocodone for Pain Relief
Tramadol vs. Vicodin: How They Compare
Tramadol vs. Hydrocodone: Two Powerful Drugs for Pain
Understanding Hydrocodone Addiction
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