Codeine vs. Vicodin

• Both codeine and Vicodin (acetaminophen and hydrocodone) are narcotic analgesics.
• Vicodin contains an additional ingredient, acetaminophen, which is a non-narcotic pain reliever.
• These narcotics are indicated for moderate to severe pain.
• One difference is that codeine is also prescribed as a cough suppressant.
• Codeine is a generic brand while Vicodin is a brand name for a combination of acetaminophen and hydrocodone. Other brands containing acetaminophen and hydrocodone include Vicodin ES, Vicodin HP, Anexsia, Lortab, Lorcet, and Lorcet Plus.
• Side effects of both codeine and Vicodin include:
  • lightheadedness,
  • dizziness,
  • nausea,
  • vomiting,
  • shortness of breath,
  • drowsiness,
  • sedation,
  • allergic reactions,
  • constipation,
  • abdominal pain,
  • sweating,
  • rash, and
  • itching.
• Serious side effects of both codeine and Vicodin include slowed breathing, cessation of breathing, shock, and loss of heart function (cardiac arrest).
• Combining opioids such as codeine and Vicodin with alcohol or other central nervous system depressants may result in severe sedation, respiratory depression, coma, and death.
• Both codeine and Vicodin have potential for abuse and addiction. Withdrawal symptoms for both drugs include restlessness, watery eyes, runny nose, yawning, sweating, chills, muscle pain, and dilated pupils.

Codeine is an opioid pain reliever, similar to morphine, indicated for the relief of mild to moderately severe pain where the use of an opioid analgesic is appropriate. It is also sometimes used as a cough suppressant. The precise mechanism of the pain relieving action of codeine is unknown, but it binds to receptors in the brain and can increase tolerance to pain, which decreases discomfort.

Vicodin contains a combination of a non-narcotic pain reliever (acetaminophen) and an opioid analgesic (hydrocodone). Acetaminophen helps increase the effects of hydrocodone. Vicodin is used for the relief of moderate to moderately severe pain.

Codeine is habit forming (addictive). Mental and physical dependence can occur but are unlikely when used for short-term pain relief. Using codeine during pregnancy can cause opioid withdrawal syndrome in the newborn, which may be life-threatening if not treated.

You need a prescription for codeine. Codeine is a schedule II controlled substance in the US.

Hydrocodone may be habit forming. Mental and physical dependence can occur but are unlikely when used for short-term pain relief.

Codeine

The most frequent side effects of codeine include:

• Lightheadedness
• Dizziness
• Nausea
• Vomiting
• Shortness of breath
• Sedation
• Allergic reactions
• Constipation
• Abdominal pain
• Rash
• Itching

Serious side effects of codeine include:

• Life-threatening respiratory depression
• Severe low blood pressure
• Adrenal insufficiency
• Accidental ingestion of codeine can result in fatal overdose

Vicodin

Common side effects of hydrocodone/acetaminophen are:

• lightheadedness,
• dizziness,
• sedation,
• nausea, and
• vomiting.

• drowsiness,
• constipation, and
• spasm of the ureter, which can lead to difficulty in urinating.

Hydrocodone can impair thinking and the physical abilities required for driving or operating machinery. Hydrocodone can depress breathing, and should be used with caution in elderly, debilitated patients and in patients with serious lung disease.

Hydrocodone may be habit forming. Mental and physical dependence can occur but are unlikely when used for short-term pain relief.

Acetaminophen can cause severe liver failure if excessive amounts are used and when combined with chronic alcohol use or other drugs that also impair liver function.

Codeine

The usual adult dose of codeine for pain is 15-60 mg every 4-6 hours as needed. The dose for cough is 10 to 20 mg every 4-6 hours as needed. The maximum dose for treating cough is 120 mg every 24 hours.

Vicodin

The usual dose for adults is 1 to 2 tablets or capsules (hydrocodone 2.5 to 10 mg; acetaminophen 300 to 750 mg) every 4 to 6 hours or 15 mL of liquid every 4 to 6 hours as needed.

Both codeine and Vicodin can impair thinking and physical abilities required for driving or operating machinery.

Alcohol and other sedatives such as alprazolam (Xanax) can produce further brain impairment and even confusion when combined with codeine or Vicodin. Therefore, alcohol and other sedatives should not be used when taking either drug.

Drugs that stimulate and also block opioid receptors (for example, pentazocine) reduce the effect of both codeine and Vicodin. Such drugs should not be combined with either.

Drugs that block the action of acetylcholine (anticholinergic drugs) increase the occurrence of urinary retention and constipation when combined with codeine or Vicodin.

Monoamine oxidase inhibitors (MAOIs) class of antidepressants (for example, isocarboxazid [Marplan], phenelzine [Nardil], tranylcypromine [Parnate], selegiline [Eldepryl], and procarbazine [Matulane]) significantly increase the action of codeine and Vicodin. Neither codeine nor Vicodin should be used in patients taking MAOIs or within 14 days of stopping MAOIs.

Small amounts of codeine are secreted in breast milk, but the risk of adverse events in the infant is small.

There are no adequate studies of hydrocodone and acetaminophen in pregnant women.

Hydrocodone/acetaminophen is excreted in breast milk, and, therefore should be used cautiously by nursing mothers.