Does Hydrocodone Have Codeine in It? Comparing These Two Opioids

Hydrocodone and codeine are two of the most commonly prescribed pain medications in the United States, and it is easy to understand why people might mix them up. However, they are two completely different types of medications.

Understanding the differences between hydrocodone and codeine is extremely important both for safe medical use, as well as for recognizing the warning signs if opioid use starts to become a problem. Below we provide a detailed comparison.

Does Hydrocodone Have Codeine in it?

No. Hydrocodone does not contain codeine.

They are separate opioid medications that have different chemical structures, prescribing guidelines, and formulations. A major source of confusion comes from the fact that hydrocodone is a semi-synthetic opioid, meaning that it was developed in a lab by making modifications to a naturally occurring opiate, in this case, typically either codeine or thebaine, both of which are found in the opium poppy.[1]

However, despite being manufactured in this way, hydrocodone is still chemically different and does not retain any codeine as part of its formulation.

Differences Between Codeine and Hydrocodone

Chemical Origin

Codeine is a naturally occurring opiate found in the opium poppy plant.[2] Hydrocodone, on the other hand, is a semi-synthetic opioid that has been manufactured in a laboratory setting by making chemical alterations to either codeine or thebaine. These alterations result in a more potent compound.

Strength and Potency

Milligram for milligram, hydrocodone is generally considered stronger than codeine.[3] A relatively small dose of hydrocodone may have a more powerful effect on pain relief and other side effects associated with opioids, compared to a similar dose of codeine. This explains why hydrocodone is often prescribed for pain that is more severe than what can be treated with codeine.

Common Uses

Codeine is commonly prescribed to treat mild to moderate pain, and it’s also included in many prescription cough medicines.

Hydrocodone is commonly prescribed to treat moderate to severe pain, including after surgery or injury, and is less frequently used as a cough suppressant in combination products like Hycodan, for treating nonproductive cough in adults.[4]

Common Formulations and Brand Names

Both drugs are rarely prescribed by themselves.

• Hydrocodone is commonly combined with acetaminophen and sold under brand names like Vicodin, Norco, and Lortab. Less frequently, it may be combined with ibuprofen. It’s available in both immediate-release and extended-release versions, depending on the patient’s needs.
• Codeine is most often combined with acetaminophen and commonly found in prescription cough medicines.

Both hydrocodone and codeine are regulated as controlled substances by the Drug Enforcement Administration (DEA), though the specific scheduling can vary depending on the formulation and the amount of active ingredient per dose.

Codeine vs Hydrocodone: Strength and Effects

Because hydrocodone is considered the more potent substance, it is most commonly used for pain that codeine isn’t strong enough to manage. However, potency alone doesn’t make one medication more effective than the other. Individual response to any prescription opioid can vary for many reasons, including the patient’s metabolic rate, kidney disease or liver function, additional medications currently being taken, and the patient’s overall health.

Both medications work by binding to opioid receptors in the central nervous system, which is what produces the medications’ pain-relieving effects as well as many of the side effects associated with taking them.[5]

The side effect profiles of hydrocodone and codeine are similar due to their shared mechanism of action, though hydrocodone’s effects tend to be stronger at a given dose level.

Side Effects of Hydrocodone and Codeine

Common side effects of hydrocodone and codeine include:

• Drowsiness and sleepiness
• Constipation
• Lightheadedness
• Reduced appetite
• Nausea

More serious side effects, though less common, can include:

• Shortness of breath or slowed breathing
• Significant changes in blood pressure
• Confusion or unusual mood changes
• Signs of an allergic reaction

Anyone experiencing severe or life-threatening symptoms, particularly shortness of breath, extreme drowsiness, or difficulty waking someone up, should seek immediate medical assistance, as this can indicate respiratory depression, a potentially fatal complication of opioid use. This risk increases significantly when either drug is combined with alcohol, other opioids, or other medications that also slow breathing.[6]

Risks, Dependence, and Withdrawal

Both hydrocodone and codeine carry a risk of physical dependence, especially with extended or higher-dose use. Over time, the body can also become used to the presence of the substance and, depending on the length of treatment and doses taken, withdrawal symptoms like anxiety, muscle aches, excessive sweating, and gastrointestinal issues may develop after discontinuing use.

Because both medications are prescription opioids with real potential for misuse, they are intended to be used strictly according to a healthcare provider’s instructions. Combining either drug with other CNS depressants, or exceeding recommended dosages, significantly increases the likelihood of negative outcomes, including the development of opioid use disorder and possibly life-threatening respiratory depression.[7]

If you find yourself unable to control your use of either medication, or if you begin experiencing withdrawal symptoms after stopping, that is a sign that it is time to talk to a healthcare provider instead of trying to manage the situation without support. Mental health can also influence someone’s ability to discontinue an opioid safely, since anxiety, depression, and chronic stress can complicate this process.[8]