Codeine vs. Hydrocodone: Two Ways to Treat Pain

Medically reviewed by Aleah Rodriguez, PharmD on April 4, 2017Written by Ann Pietrangelo

Overview

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 common prescription drugs for pain.

While they can be quite effective in treating pain, these narcotic medications can easily be misused. Learn more about appropriate use and the differences between these pain medications.

What they do

Codeine and hydrocodone are opioid medications. Opioids work by altering your perception of pain. They are among the most effective painkillers.

Each is available with a prescription. Codeine and hydrocodone are prescribed for different types of pain. Codeine is typically used for mild to moderate pain, while hydrocodone is more potent and used for more severe pain.

Forms and dosage

Codeine is available in immediate-release oral tablets. They come in 15-mg, 30-mg, and 60-mg strengths. Your doctor will usually direct you to take them every four hours as needed.

Hydrocodone is also available in immediate-release oral tablets, but only when it is combined with acetaminophen. These tablets are available in 2.5-mg, 5-mg, 7.5-mg and 10-mg strengths of hydrocodone. Typically, you take a tablet every 4 to 6 hours as needed for pain.

Learn more: Drug information for hydrocodone-acetaminophen »

By itself, though, hydrocodone is only available in extended-release oral tablets. These come in many strengths that range from 10 mg to 120 mg. Some of the extended-release tablets you take every 12 hours, and some you take every 24 hours, depending on the product. The higher strengths are only given to people who have been taking hydrocodone for a long time and who no longer get relief from the lower strengths.

For either drug, your doctor will probably start you off at the lowest possible dose. Then your doctor can adjust strength and dosage according to your pain.

Side effects of each

You may have some side effects when taking codeine or hydrocodone. Common side effects of both drugs include:

  • dizziness
  • drowsiness
  • constipation
  • nausea and vomiting

Codeine may also cause:

  • lightheadedness
  • shortness of breath
  • sweating

On the other hand, hydrocodone can also cause:

  • itching
  • loss of appetite

Most of these side effects will lessen with time. Side effects of both drugs are more likely or can be more intense in certain cases. These include if you are an older adult, if you have kidney or liver disease, or if you have chronic obstructive pulmonary disease or other chronic diseases.

Warnings

Codeine and hydrocodone are both very effective at relieving pain. Misuse of these drugs, including giving them to someone who isn’t prescribed them, can have dangerous consequences.

Misuse

High doses and excessive use of either drug can cause additional side effects. It can increase your risk of urinary retention, infections, and liver damage.

Due to the potential for overdose and abuse, all hydrocodone products were moved to a new category by the Food and Drug Administration in 2014. Instead of simply calling your hydrocodone prescription in to the pharmacist, your doctor must now give you a written prescription that you need to take to the pharmacy.

Withdrawal

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. Tell your doctor right away if you have withdrawal symptoms when you stop taking either of these drugs.

In children

Extended-release hydrocodone can be fatal for children. Taking even one tablet can be fatal. Keep your prescription medications locked and away from children.

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, so it’s dangerous to mix them with other medications that slow down the brain. These drugs may include:

  • anticholinergic drugs, such as antihistamines or drugs used for urinary spasms
  • muscle relaxers
  • sedatives, tranquilizers, and sleeping pills
  • barbiturates
  • antiseizure medications, such as carbamazepine and phenytoin
  • antidepressants
  • antipsychotic drugs
  • alcohol
  • other opioids

You can find a more detailed list of interactions for both drugs at the interactions for codeine and hydrocodone.

Which medication is best?

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

Codeine is typically used for mild to moderately severe pain. Hydrocodone is stronger, so it’s used for moderate to moderately severe pain. Depending on your needs, your doctor may prescribe either of these medications alone or in combination with something else.

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