What is cough syrup with hydrocodone?

Cough syrup with hydrocodone is a prescription medication used to treat cough and upper respiratory symptoms. It contains hydrocodone, which is an opioid analgesic that works as a cough suppressant. Hydrocodone suppresses the cough reflex in the brain, reducing the urge to cough. When taken as directed, cough syrup with hydrocodone can provide short-term relief for cough and upper respiratory symptoms caused by conditions like the common cold, bronchitis, allergies, or asthma. However, it also carries risks of misuse, abuse, dependence and overdose due to the hydrocodone component. Understanding what hydrocodone cough syrup contains, how it works, and its potential risks is important for safe and effective use of this medication.

What is hydrocodone?

Hydrocodone is a prescription opioid medication that is used for treating moderate to severe pain. It works by binding to opioid receptors in the brain and spinal cord to block feelings of pain. In addition to pain relief, hydrocodone also has cough suppressing effects. When taken orally, it acts centrally in the cough center of the brain to suppress the urge to cough. This makes it useful as a cough suppressant in prescription cough syrups and cold medications. Chemically, hydrocodone is similar to codeine and is considered a semi-synthetic opioid derived from either of the opiates thebaine or codeine. Common brand name cough syrups containing hydrocodone include Hycodan, Tussionex, and Hydromet. Hydrocodone is a Schedule II controlled substance due to its high potential for abuse and dependence.

How hydrocodone works as a cough suppressant

Hydrocodone works as a cough suppressant by acting on the cough center in the medulla region of the brain. It binds to specific opioid receptors that inhibit the cough reflex. This reduces the sensitivity and activity of the cough center, which suppresses the urge to cough. Hydrocodone’s antitussive (cough suppressing) effects occur at lower doses than its analgesic (pain relieving) effects. When taken orally in cough syrup, hydrocodone is absorbed into the bloodstream and crosses the blood-brain barrier to exert its effects directly in the central nervous system. The result is a reduction in both the frequency and intensity of coughing.

Strengths of hydrocodone in cough syrup

Hydrocodone cough syrup is available in various strengths, usually ranging from 1.25 mg/5 mL up to 10 mg/5 mL per teaspoon dose. The most common strengths are:

– Hydrocodone 2.5 mg/5 mL
– Hydrocodone 5 mg/5 mL
– Hydrocodone 7.5 mg/5 mL
– Hydrocodone 10 mg/5 mL

Higher strength hydrocodone syrups contain more hydrocodone per teaspoon or tablespoon dose. They are usually prescribed for more severe or persistent coughs. Lower strength syrups contain less hydrocodone and are given for milder cough symptoms. The appropriate strength depends on the individual patient and type of cough being treated.

Active and inactive ingredients in hydrocodone cough syrup

In addition to hydrocodone, cough syrup formulations contain other active and inactive ingredients such as:

Active ingredients:

– Antihistamines – help dry up secretions and reduce coughing; examples are chlorpheniramine, brompheniramine, diphenhydramine

– Expectorants – help loosen mucus; examples are guaifenesin, ammonium chloride

– NSAIDs (non-steroidal anti-inflammatory drugs) – reduces inflammation and pain; example is ibuprofen

Inactive ingredients:

– Flavoring – cherry, orange, grape, etc. to improve taste

– Sugars or sweeteners – sucrose, fructose, sorbitol to improve palatability

– Dyes and colors – FD&C dyes to give bright color

– Preservatives – potassium sorbate, sodium benzoate to prevent microbial growth

– Alcohol – used as solvent and preservative

– Purified water – used as a solvent and vehicle

The specific ingredients and amounts vary between different hydrocodone syrup brands and formulations. Reading the medication label will provide the details of exact ingredients and strengths.

Uses and effectiveness of hydrocodone cough syrup

Hydrocodone cough syrup is primarily used for the temporary relief of cough and upper respiratory symptoms associated with conditions such as:

– Common cold
– Flu
– Acute and chronic bronchitis
– Pneumonia
– Asthma
– Emphysema
– Allergies
– Environment irritants

When used appropriately, hydrocodone cough syrup can help control coughing so patients can rest. The medication takes effect within 15-30 minutes of taking a dose. The cough suppressing effects typically last for 4-8 hours.

Research indicates hydrocodone and codeine cough syrups are more effective than placebo at reducing cough frequency and intensity. However, there are limited studies comparing the efficacy of hydrocodone to other over-the-counter cough remedies. Overall, hydrocodone appears moderately effective based on patient reports of symptom relief. However, the risks associated with the opioid effects of hydrocodone need to be weighed against potential benefits, especially for long-term use.

Effectiveness considerations

– Hydrocodone may work better for dry, tickling coughs vs productive coughs with lots of mucus.

– It’s more effective when taken at first sign of cough rather than waiting until cough is severe.

– The antitussive effects diminish with repeated dosing as tolerance develops.

– Hydrocodone can cause side effects like drowsiness, dizziness, nausea that may limit its use.

– High doses can potentially worsen cough due to effects on respiratory drive.

Proper dosage and administration

Hydrocodone cough syrup should be taken only as directed by a doctor and according to prescription instructions. Some general dosage guidelines include:

– Standard adult dose: 5-10 mL (1-2 tsp) taken every 4 to 6 hours as needed.

– Adult maximum dose: 20 mL (4 tsp) per 24 hours.

– Pediatric dosing based on weight, age, and severity of symptoms.

– Doses are carefully measured using dosing cups or oral syringes provided by the pharmacy.

Administration tips

– Shake bottle well before each dose.

– Measure dose carefully using proper dosing device – do not estimate!

– Take exact prescribed dose every 4-6 hours around the clock as needed.

– Don’t increase dose or frequency without consulting doctor.

– Follow directions for tapering off dosage before stopping.

Taking too much hydrocodone can cause serious risks including overdose and death. Carefully following dosage instructions is crucial. Never take extra doses or take more often than directed.

How long does hydrocodone cough syrup take to work?

Hydrocodone cough syrup typically starts working within 15 to 30 minutes after taking a dose. The effects reach peak strength around 1 to 2 hours post-dose. After taking hydrocodone for cough, patients usually notice a decrease in the frequency and severity of coughing episodes within the first hour. However, the medication needs to be taken round the clock as directed to maintain optimal cough suppression. The antitussive effects will diminish around 4 to 6 hours after each dose. This is why it’s taken every 4 to 6 hours for continued relief.

Patients should let their doctor know if hydrocodone cough syrup does not seem to be working within 1 hour of taking a proper dose. Either a different medication or adjustment of the hydrocodone dosage may be needed for adequate cough suppression. The doctor may also evaluate if the persistent cough could be due to an underlying illness needing additional treatment.

How long to take hydrocodone cough syrup

Hydrocodone cough syrup is intended only for short-term relief of cough and upper respiratory symptoms. It should be taken for the shortest time needed to manage cough, usually around 3-7 days. Taking hydrocodone cough syrup for more than 2 weeks is not recommended.

Long-term use has no proven benefit and carries serious risks of dependence, addiction and side effects. Tolerance to the medication can also develop with extended use, meaning higher doses would be needed to achieve the same effects.

It’s important to follow the doctor’s exact instructions for how many days to take the hydrocodone cough syrup. Only take it for as long as prescribed. Stopping hydrocodone suddenly after regular use can cause withdrawal symptoms. Patients should talk with their doctor about safely tapering off the medication when a course of treatment is complete.

Reasons to discontinue use

Reasons to stop taking hydrocodone cough syrup include:

– Cough resolves and is no longer troublesome
– Bothersome or severe side effects develop
– 7-10 day treatment course is completed
– Symptoms do not improve after 3 days of proper use
– Signs of dependence, addiction, or overdose occur

Patients should consult their doctor if cough persists after finishing a course of hydrocodone syrup. Underlying conditions causing the cough may need diagnosis and treatment. Chronic cough should not be treated long-term with hydrocodone due to risks of dependence.

Side effects and risks

Hydrocodone cough syrup can cause the following side effects:

Common side effects:

– Drowsiness
– Dizziness
– Lightheadedness
– Nausea, vomiting
– Constipation
– Dry mouth

Serious side effects and risks:

– Breathing problems – slowed, shallow breathing
– Seizures
– Addiction, dependence, withdrawal symptoms
– Tolerance requiring higher doses
– Overdose and death if taken in excess

Hydrocodone is a narcotic analgesic with psychoactive effects that can lead to misuse and abuse. Using it longer than advised or taking too much greatly raises risks of dependency and overdose, which can be fatal.

Signs of hydrocodone overdose include:

– Extreme drowsiness, will not wake up
– Slowed, irregular, or stopped breathing
– Small “pinpoint” pupils
– Cold, clammy skin
– Limp muscles

Seek emergency help immediately if any overdose symptoms are present after taking hydrocodone cough syrup.


People who should not use hydrocodone cough syrup include:

– Those allergic to hydrocodone or other opioids
– Patients with severe asthma, COPD, or other breathing problems
– Individuals currently using an MAO inhibitor medication
– People with a history of substance abuse issues or addiction

Pregnant women should only use hydrocodone if clearly needed and under medical supervision due to risks to the baby. Caution is advised for older adults who may be more sensitive to side effects.

Interactions with other medications

The following medications can potentially interact with hydrocodone:

– Antidepressants like SSRIs and MAO inhibitors – may increase risk of serotonin syndrome

– Antihistamines and anticholinergics – may increase drowsiness and CNS depression

– Anxiety medications like benzodiazepines – may worsen drowsiness and respiratory depression

– Sleep aids like zolpidem – can further depress the CNS leading to slowed breathing

– Antibiotics like erythromycin – can inhibit metabolism of hydrocodone, raising levels in blood

– Antifungal drugs like ketoconazole – may inhibit hydrocodone metabolism and increase effects

– Other opioid pain relievers – high risk for overdose if combined, avoid use together

Using hydrocodone with alcohol or marijuana is also unsafe due to increased central nervous system depression.

Patients should provide their doctor a complete medication list to screen for unsafe interactions with hydrocodone. Dosage adjustments may be required if it’s used with other sedating drugs. Only use other medicines with hydrocodone under medical supervision.

Risk for dependence and addiction

Hydrocodone has a high risk for dependence and addiction due to its opioid effects on the brain. People prone to substance abuse disorders are more likely to misuse hydrocodone cough syrup. However, anyone can develop psychological and physical dependence, even when taking it for legitimate medical purposes at normal doses.

Signs of hydrocodone addiction may include:

– Taking more than prescribed or taking more often
– Going through medicine too quickly
– Continued use despite harmful effects
– Drug cravings and inability to stop using it
– Obtaining hydrocodone illegally or through multiple doctors
– Faking or exaggerating symptoms to get more of the drug

Dependence produces withdrawal symptoms if hydrocodone use suddenly stops after a period of regular dosing. Withdrawal can involve:

– Anxiety, irritability, restlessness
– Sweating, tremors, muscle cramps
– Insomnia
– Rapid heart rate, high blood pressure
– Nausea, vomiting, diarrhea

Hydrocodone addiction requires professional substance abuse treatment. With proper support, the addiction can be successfully overcome through a combination of medication-assisted treatment, counseling, behavioral therapies, and support groups.

Is hydrocodone cough syrup safe during pregnancy?

Hydrocodone cough syrup is generally not recommended for pregnant women, especially during the first trimester. Hydrocodone can cross the placenta and potentially impact the fetus. Infants born to mothers taking opioids may experience neonatal opioid withdrawal syndrome (NOWS).

However, hydrocodone may be prescribed in some cases if the benefit of controlling severe cough outweighs potential risks. The lowest effective dose is given for the shortest possible duration.

Under medical guidance, hydrocodone may be safer to use during pregnancy than other cough suppressants. Expectorants like guaifenesin have not been proven totally safe for fetuses. Suppressing cough with hydrocodone may help prevent risks like rib fractures or preterm birth from severe coughing.

If hydrocodone is used, babies may need monitoring for NOWS after delivery. Symptoms of NOWS include:

– Excessive crying
– Fever, sweating
– Tremors, hypertonia
– Gastrointestinal problems

Treatment for NOWS aims to wean infants off opioid dependence safely with medications like morphine, while providing supportive care.

Alternatives to hydrocodone cough syrup

For those wanting to avoid or unable to use hydrocodone, some alternative cough treatments include:

Non-opioid cough suppressants

– Dextromethorphan (DXM) – OTC cough medicine ingredient
– Benzonatate – prescription medication
– Lidocaine – viscous solutions can numb cough reflex


– Guaifenesin – OTC medication to thin mucus
– Mucolytics like acetylcysteine – break up mucus


– Diphenhydramine (Benadryl) – reduces post-nasal drip
– Doxylamine (NyQuil) – antihistamine with sedative effects

Cough drops and throat lozenges

– Numbs throat and reduces urge to cough
– Look for anesthetics like benzocaine


– Has demulcent and antitussive properties
– Helps coat and soothe throat

Non-drug remedies like steam inhalation, hydration, humidifiers, and cough hygiene may also provide relief alongside alternative medicines. For chronic, persistent, or worrisome cough symptoms, doctors can evaluate the cause and provide appropriate treatment options.

Warnings and precautions

– Hydrocodone can impair physical and mental abilities. Use caution operating vehicles or machinery.

– Measure doses carefully and only take medication as prescribed.

– Never crush, break, chew, or dissolve extended-release tablets or capsules.

– Avoid alcohol and other sedating drugs while taking hydrocodone.

– Store syrup securely away from children and properly dispose of unused medication.

– Do not use for coughs that produce a lot of mucus unless also taking an expectorant.

– Seek medical help immediately if overdose reaction occurs.

– Hydrocodone is not safe for treating cough in patients with severe lung disease.

– Tell your doctor about any past substance abuse issues before starting hydrocodone.


When used correctly under medical supervision, hydrocodone cough syrup can provide short-term relief for irritating coughs related to colds, bronchitis, or allergies. However, hydrocodone does carry risks of side effects, dependence, and overdose if improperly used. Patients on hydrocodone cough syrup need careful monitoring and should be aware of potential interactions and contraindications. Following dosage instructions precisely while using the lowest effective amount for the shortest duration is key to safe use. Alternatives like expectorants, antihistamines, anesthetics, and natural remedies may also be options in certain cases. With its potential for abuse and misuse, hydrocodone cough syrup must be taken with caution to avoid adverse outcomes. Patients should discuss benefits and risks thoroughly with their doctor when prescribed this medication.

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