Does Hydrocodone Have Codeine in It? Codeine vs. Hydrocodone Explained

What you will learn

• Hydrocodone does not contain codeine but is chemically synthesized from codeine or thebaine.
• Hydrocodone is more potent for moderate to severe pain; codeine treats mild to moderate pain.
• Both are opioids carrying risks of dependence, respiratory depression, and overdose.
• Individual genetics and health factors significantly affect how each medication works.

Quick Answer

No, hydrocodone does not contain codeine. Hydrocodone is a semisynthetic opioid [1] derived from codeine or thebaine, but it’s a distinct medication with its own chemical structure.

Why compare them? Both are opioids used for pain relief and cough suppression, so patients often want to understand their differences.

Understanding Codeine and Hydrocodone

Codeine

Codeine is a natural opioid extracted from the opium poppy, available in oral tablets, capsules, solutions, and syrups. It treats mild to moderate pain and suppresses coughs. You’ll find it in combination products, such as acetaminophen with codeine or prescription cough syrups. The DEA schedules codeine under different categories because pure codeine holds Schedule II status, which has a high potential for abuse, but combination pain relievers and low-dose cough medicines have Schedule III and Schedule V classifications, respectively. Schedule III drugs have moderate to low potential for physical dependence, and high potential for psychological dependence, while Schedule V drugs have a low potential for abuse compared to other medications.

Hydrocodone

Hydrocodone is a semisynthetic compound, created by chemically modifying codeine or thebaine in a laboratory setting. It’s available in tablets, capsules, solutions, and syrups. The key point: while hydrocodone is made from codeine, the final product is a different molecule that doesn’t contain codeine. Common brands include Vicodin, Norco, and Lortab, typically combined with acetaminophen. All hydrocodone products are Schedule II controlled substances [2].

At Ascendant New York, we understand that all opioid medications carry risks, including physical dependence and addiction. These are medical conditions requiring medical management, not personal failings.

How They Work in Your Body

Both codeine and hydrocodone bind to mu-opioid receptors in the brain and spinal cord, blocking pain signals. However, they’re metabolized differently.

Codeine requires the liver enzyme CYP2D6 to convert it into morphine for pain relief. Genetic variations mean that some people are “poor metabolizers,” who receive minimal relief, while “ultra-rapid metabolizers” may experience more potent effects and higher risks of side effects.

Hydrocodone is metabolized by CYP2D6 and CYP3A4 enzymes [1] into active compounds. This means it can interact with other medications that affect these pathways, potentially altering effectiveness or increasing risks.

When Doctors Prescribe Each Medication

Codeine is prescribed for mild to moderate pain from dental work, minor injuries, or post-surgical recovery when more potent opioids aren’t necessary. It’s also commonly used for persistent dry coughs that interfere with sleep or daily activities.

Hydrocodone treats moderate to severe pain from significant injuries, major surgeries, chronic pain conditions, or cancer-related pain. Because it’s more potent, doctors reserve it for situations where the severity of pain justifies the increased risks.

Important allergy note: If you’re allergic to codeine, healthcare providers typically avoid prescribing hydrocodone due to their structural similarity and the risk of cross-reactivity. Allergic reactions can range from mild rashes to life-threatening anaphylaxis.

Comparing Effectiveness

Hydrocodone is more potent than codeine, meaning it provides greater pain relief at comparable doses. This is why it’s used for more severe pain, while codeine handles milder cases.

However, “stronger” doesn’t automatically mean “better.” The most appropriate medication depends on several factors, including your pain severity, previous experience with opioids, medical history, current medications, and individual risk factors for side effects or dependence.

For someone with mild to moderate pain, codeine might provide perfectly adequate relief with a lower risk profile. For moderate to severe pain, codeine may be insufficient. The goal is to match the right medication to your specific needs using the lowest effective dose for the shortest necessary time.

Side Effects and Safety Considerations

Common Side Effects

Both medications share typical opioid side effects, including drowsiness and sedation, dizziness or lightheadedness, nausea and vomiting (especially when starting), constipation, dry mouth, and itching. These effects are dose-dependent (the intensity of the substance’s impact is proportional to the amount taken) and are most common at the beginning of treatment.

Serious Risks

The most dangerous risk with any opioid is respiratory depression, a potentially fatal slowing of breathing. This risk increases significantly with higher doses, when combining opioids with benzodiazepines or alcohol, or in people with underlying respiratory conditions.

Other serious risks include severe low blood pressure, allergic reactions, liver damage (particularly with acetaminophen combination products taken in excess), and physical dependence with withdrawal symptoms if stopped abruptly after regular use.

Codeine or Hydrocodone Overdose

Early signs of codeine or hydrocodone overdose can include extreme drowsiness, confusion, slurred speech, and pinpoint pupils. As the overdose progresses, breathing may become slow, shallow, or stop altogether, and the person may become unresponsive. Bluish lips or fingernails, cold or clammy skin, and a very slow heartbeat are red-flag signs of a life-threatening emergency.

Managing a suspected codeine or hydrocodone overdose requires urgent medical attention. The most crucial step is to call emergency services immediately. Overdoses can worsen quickly, even if symptoms seem mild at first. If available, administer naloxone (Narcan), which temporarily reverses opioid effects, but professional care is still essential. While waiting for help, keep the person awake if possible, monitor their breathing, and place them on their side to prevent choking if they are semi- or unconscious. Treating an overdose promptly greatly improves the chances of survival and recovery.

Misuse and Dependence

Hydrocodone carries a higher potential for misuse, as reflected in its Schedule II classification. Many codeine combination products are Schedule III or V, indicating somewhat lower abuse potential. However, both medications can lead to opioid use disorder. Physical dependence can develop with regular use over time, even when taken exactly as prescribed.

Drug Interactions

Overdose risk increases dramatically when opioids are combined with benzodiazepines like Xanax or Valium, alcohol, muscle relaxants, or certain psychiatric medications. These combinations can dangerously compound respiratory depression [3].

Ensure that your healthcare provider is aware of all medications, supplements, and substances you use. Naloxone (Narcan) is an opioid overdose reversal medication [4] that should be available to anyone taking prescription opioids, and household members should know how to use it.

Individual Variability

Genetic differences in liver enzymes, age (older adults are more sensitive to opioid effects), liver or kidney impairment, general health, and body composition all influence how you respond to these medications and your risk of side effects. This variability underscores the importance of medical oversight.

Making Informed Decisions with Your Doctor

If you’re considering either medication, discuss these important points with your healthcare provider:

Pain assessment: How severe is your pain? Have non-opioid options like ibuprofen or acetaminophen been tried?

Opioid history: Have you taken opioids before? How did you respond?

Medical conditions: Do you have liver or kidney problems, respiratory issues, or a history of substance use disorder?

Other medications: What else are you currently taking? Drug interactions can be serious.

Treatment duration: How long will you need pain medication, and what’s the plan for tapering off?

Safer Use Guidelines

If prescribed either medication, follow these practices: take the lowest effective dose for the shortest necessary duration, store medication securely away from children and others, never share your prescription with anyone, follow your prescriber’s tapering schedule when discontinuing, and dispose of unused medication properly through drug take-back programs.

Recognizing When You Need Help

Warning signs that you should reach out for support include taking more medication than prescribed or more frequently, running out of your prescription early, feeling preoccupied with your next dose, continuing to use beyond the prescribed period, seeking prescriptions from multiple providers, or experiencing withdrawal symptoms between doses.

At Ascendant New York, we understand that opioid dependence can develop even when medications are initially taken as prescribed. Our team provides medically supervised detoxification, comprehensive residential treatment programs, and ongoing support for co-occurring mental health conditions. If you’re concerned about your relationship with prescription opioids, reaching out is a sign of strength.

When Professional Support Makes the Difference

Understanding the difference between codeine and hydrocodone helps you make informed healthcare decisions. However, if you’re reading this because you’re concerned about dependence on prescription opioids, know that compassionate help is available.

At Ascendant New York, we understand that reaching out takes courage. Our experienced team recognizes that opioid dependence is a medical condition requiring medical treatment, not a moral failing. Whether you’re taking the first step in exploring your options or you’re ready to begin treatment today, we’re here to help.

Ascendant New York serves all five boroughs of New York City, including Manhattan, Queens, Bronx, Brooklyn, and Staten Island, plus Long Island. For confidential support or to learn more about our programs, contact us today. Recovery is possible, and you don’t have to navigate this journey alone.

Amanda is a prolific medical content writer specializing in eating disorders and addiction treatment. She graduated Magna Cum Laude from Purdue University with a B.S. in Social Work. Read more