The Dangers of Mixing Hydrocodone and Alcohol

For many people, alcohol is a familiar part of the day; some wine with dinner, a drink while watching a game, or a cocktail to unwind and start the weekend with.

But its familiarity can also make it easy to miss some potentially risky situations. Such as when you are taking medication.

Hydrocodone is an opioid pain reliever and fairly common for treating moderate to severe pain. It is relatively harmless when taken as directed, but if alcohol is introduced into the picture, the way either substance affects your body can change, and sometimes in dangerous ways.

This article will walk you through how hydrocodone and alcohol interact, what symptoms to watch for, and what you should do to prevent a serious medical emergency.

Why Hydrocodone and Alcohol Shouldn’t Be Mixed

Hydrocodone and alcohol are both central nervous system depressants.

When taken separately, they each slow the activity of the central nervous system in fairly predictable ways. However, when two depressants are combined, they intensify each other’s effects.

This combination comes with distinct warnings. According to the National Institute on Alcohol Abuse and Alcoholism, all opioids, including hydrocodone, significantly increase the risk of a fatal overdose when combined with alcohol.[1]

Put simply, even one drink can significantly amplify the effects of hydrocodone while it is active in the body.

The risk applies whether or not someone is using the medication as prescribed and is amplified if someone is misusing the medication or taking more than directed.

Side Effects of Mixing Hydrocodone and Alcohol

When hydrocodone is mixed with alcohol, the effects can range from mild discomfort to medical emergency. Many people first notice that they feel drowsy, dizzy, or nauseous. Others may become severely sedated very quickly.

Potential effects of mixing hydrocodone and alcohol include:

• Severe drowsiness
• Dizziness or fainting
• Nausea or vomiting
• Slowed thinking and reaction time
• Poor coordination
• Confusion
• Trouble remembering things
• Low blood pressure
• Impaired judgment
• Shallow breathing
• Loss of consciousness
• Opioid overdose
• Coma or death

The FDA has even issued a warning that combining opioids like hydrocodone with alcohol or other depressants carries a higher risk of overdose.[2] This warning applies to alcohol and other medications, including benzodiazepines, certain sleeping pills, muscle relaxers, anti-anxiety medications, and other prescription or over-the-counter depressants.

Mixing hydrocodone and alcohol can also worsen stomach irritation, vomiting, and dehydration. If a person vomits while deeply sedated, there is a risk of choking or aspiration.

Because of these risks, patients are urged to tell their healthcare provider about all prescription medications, over-the-counter medications, dietary supplements, and other substances they use before starting an opioid treatment. This allows a pharmacist or prescriber to catch a possible interaction before it causes harm.

Acetaminophen and Liver Damage Risk

Another risk of combining hydrocodone and alcohol is the risk of liver damage.

Many hydrocodone products contain acetaminophen.[3] Acetaminophen is also found in Tylenol and many over-the-counter medications for minor pain, fever, or headaches, and comes with its own warning about potential liver damage if too much is taken.[4]

Alcohol is processed primarily by the liver, and heavy or repeated drinking can damage liver cells and reduce the liver’s ability to function normally.

Because of this, drinking alcohol while on a hydrocodone and acetaminophen product like Vicodin and Lortab can increase the chances of liver toxicity. People who drink heavily and take more than the recommended dose of acetaminophen, or take more than one product containing it, raise their risk of acute liver failure.

Many people take acetaminophen without realizing it because it is found in so many common over-the-counter products. This is why reading labels carefully is so important. If you are not certain about a potential interaction between two substances, taking a few moments to ask your doctor or a pharmacist can make all the difference in preventing unintentional overdoses. Liver damage can also become life-threatening if left untreated, especially when combined with the complications of misusing prescription medications and alcohol together.

Factors That Increase Risk

While anyone can be harmed by combining hydrocodone and alcohol, certain groups are at greater risk, including people who:

• Take more than their prescribed dose of hydrocodone
• Drink large amounts of alcohol while hydrocodone is still active in their body
• Drink heavily or binge drink
• Take other depressants, such as benzodiazepines, sleep aids, muscle relaxers, or other opioids
• Have sleep apnea or other breathing problems
• Have chronic liver disease or reduced liver function
• Have high blood pressure or cardiovascular disease
• Have a mental health condition or a history of substance use or addiction
• Have had a previous suicide attempt

For many people, misusing both substances at the same time can worsen depression, increase impulsivity, and impair judgment. This raises the risk of harm for people with mental health conditions or previous suicide attempts. If you believe a friend or family member may harm themselves, contact the 988 Suicide and Crisis Lifeline or call 911 right away.

What to Do if You Accidentally Drink Alcohol While Taking Hydrocodone

Stop drinking immediately. Do not take another dose of hydrocodone, do not drive, and avoid taking any other medications until your prescribing doctor, pharmacist, or Poison Control says it is safe.

Contact your prescribing doctor, pharmacist, or Poison Control at 1-800-222-1222 for guidance. Tell them how many drinks you had, how much hydrocodone you took and when, and whether you were taking any other medications, over-the-counter remedies, dietary supplements, or drugs.

Call 911 right away if you notice extreme drowsiness, confusion, vomiting, fainting, slow or shallow breathing, blue lips, chest pain, unconsciousness, or a person who cannot be woken. Do not wait, because the situation can escalate very quickly.

When Hydrocodone or Alcohol Use Points to a Bigger Problem

Some people mix hydrocodone and alcohol by accident. Many others do it intentionally to feel more sedated, manage severe pain, reduce anxiety, fall asleep, avoid emotions, for the euphoria, or get other effects from one or both drugs.

If you cannot stop drinking even if you know you shouldn’t because you are taking medication, it is probably time to seek professional help.

Other signs that you may need professional help include:

• Using hydrocodone that was not prescribed to you
• Taking higher doses of hydrocodone than prescribed
• Drinking alcohol specifically to enhance the effects of hydrocodone
• Hiding or lying about your alcohol or hydrocodone use
• Running out of prescriptions early or using them sooner than planned
• Withdrawal symptoms when drinking or hydrocodone use stops
• Craving hydrocodone or alcohol regularly
• Continuing to use either or both substances despite problems with your health, work, school, or relationships
• Needing substances to feel “normal”
• Using one or more additional drugs along with hydrocodone or alcohol

These signs can point to a substance use disorder involving alcohol, prescription opioids, or both. Co-occurring mental health disorders are common alongside substance use disorders and should be treated as part of a person’s overall care rather than as secondary concerns.[5]

Treatment Options for Hydrocodone and Alcohol Use

Treatment options vary widely depending on the severity of a person’s substance use disorder, their medical risks, any mental health issues, and the presence or severity of withdrawal symptoms.

Detoxification may be needed as a first step before therapy or outpatient programs for people with heavy, long-term alcohol use, regular heavy opioid use, or withdrawal symptoms.

Treatment for opioid or alcohol use disorder commonly include:

• Medical detoxification for symptom management and safety
• Inpatient or residential rehab for structured living
• Partial hospitalization for structure during the day
• Intensive outpatient treatment for structured therapy with more flexibility
• Standard outpatient treatment for continued support
• Medications for opioid use disorder when clinically indicated
• Psychotherapy for mental health issues or trauma
• Support services for families and spouses
• Relapse prevention planning
• Alumni and recovery support services

According to the Substance Abuse and Mental Health Services Administration, there are multiple treatment options available for people with substance use disorders, including medications, counseling, behavioral therapies, and recovery support.[6]

Our recovery advocates and admissions team at SOBA New Jersey are here to discuss treatment options, confirm insurance coverage, schedule appointments, and talk through next steps. We offer phone support and a confidential helpline to help you take the next step.

Hydrocodone and alcohol should never be used at the same time. Together, they raise the risk of overdose, respiratory depression, liver damage, injuries, and addiction, and alcohol intensifies the effects of the drug.

Whether you are concerned about your use of prescription opioids or alcohol, a mental health condition, or another substance use disorder, help is available. With the right treatment, people can stabilize, begin recovery, and build a better future.

Frequently Asked Questions About Hydrocodone and Alcohol