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Signs and Symptoms of Vicodin Addiction

Vicodin is typically prescribed on a short-term basis to control moderate to severe pain, yet even at regular doses, it may be habit-forming. This can lead to problems including the need to escalate doses in order to achieve the desired effects, addiction, overdose or death. People who have used an MAO inhibitor in the past 14 days, such as isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline or tranylcypromine, should not take Vicodin because a dangerous drug interaction is possible. Vicodin is more likely to cause breathing problems in older adults and people who are severely ill, malnourished or otherwise debilitated.1

Short-term effects: Pain relief, drowsiness, nausea, constipation, stomach pain, dry mouth, itching, swelling in the hands or feet, muscle pain, back pain, diffuse muscle weakness, cold symptoms (e.g. congestion or sore throat), headache, dizziness, euphoria, anxiety/dysphoria, insomnia, nightmares, confusion, slowed breathing and death. The long-term effects are unknown, although acetaminophen by itself can cause liver damage or failure.1,2

High doses: This can result in an overdose. Signs of Vicodin abuse include any of the following:

  • Slow or irregular heartbeat
  • Chest pain or discomfort
  • Weak pulse
  • Irregular, fast, slow or shallow breathing
  • Muscle weakness
  • Increased sweating
  • Cold and clammy skin
  • Pale skin
  • Cyanosis (blue tint to lips and fingernails)
  • Pinpoint pupils
  • Blurred vision
  • Confusion
  • Nausea/vomiting
  • Hypotension (low blood pressure)
  • Seizures
  • Change in consciousness
  • Decreased awareness or responsiveness
  • Dizziness, faintness or lightheadedness
  • Sleepiness or unusual drowsiness
  • Respiratory arrest
  • Coma1,2,3

Even when taken as prescribed, serious side effects of Vicodin may occur. Stop using Vicodin and call your physician if you experience any of the following symptoms:

  • Shallow breathing
  • Slow heartbeat
  • A lightheaded feeling as though you might faint
  • Confusion
  • Seizures
  • Easy bruising or bleeding
  • Infertility or missed menstrual periods
  • Impotence, sexual problems or loss of interest in sex
  • Liver problems such as nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools or jaundice
  • Low cortisol levels: nausea, vomiting, loss of appetite, dizziness, worsening fatigue or weakness1

Symptoms of serotonin syndrome include agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting or diarrhea. This is considered a medical emergency so anyone experiencing symptoms unrelated to an underlying illness or condition should seek help right away.1

Behavioral Signs of Vicodin Addiction

  • An obsession with procuring and consuming Vicodin
  • An inability to focus on a given task
  • Extreme anxiety and paranoia
  • Severe mood swings
  • Unusual thoughts or behavior3

Risk of Liver Toxicity

Acetaminophen has a low therapeutic index, meaning the difference between an effective dose and a toxic dose is small. The “margin of error” is so minimal that the maximum daily dose of acetaminophen was reduced from 4,000 mg to 3,000 mg in 2011. Concurrently, the amount allowed in narcotics such as Vicodin and Percocet was reduced to 325 mg per pill. Although acetaminophen itself is not toxic to the liver, due to its effects on drug oxidation, the liver unintentionally poisons itself. The drug is oxidized in the liver to N-acetyl-p-benzoquinone imine (NAPQI), which under normal circumstances is quickly neutralized by ubiquitous glutathione. When too much is present, this process is overwhelmed, allowing NAPQI to build up and invoke permanent liver damage.5

The onset of liver injury can be difficult to identify because it may be asymptomatic or symptoms can be nonspecific (e.g. nausea or vomiting). Unresolved hepatotoxicity (drug-induced liver injury) can lead to multiple organ failure and death. To reduce the risk of liver toxicity, the U.S. Food and Drug Administration set a daily maximum limit (4 g/d) and a dosage unit limit (325 mg/unit). If dosage guidelines for Vicodin are strictly followed and do not exceed 4 grams per day, the drug may be safe for short durations in people without existing liver disease. If dosing exceeds the labeled dose, or if the drug is used with other acetaminophen-containing products (including more than 100 over-the-counter remedies or other prescription drugs), individuals may unintentionally ingest dangerous acetaminophen doses.4 A recent study involving individuals with liver disease revealed that the majority were unaware commonly prescribed pain medications contained acetaminophen. An estimated 79.9% to 86.8% in the study group didn’t know that Vicodin, Norco and Percocet contained acetaminophen and were also unaware of the risk of liver toxicity.6

  1. Vicodin, Drugs website. https://www.drugs.com/vicodin.html Accessed January 23, 2017
  2. Commonly Abused Drugs Charts. National Institute on Drug Abuse website. https://www.drugabuse.gov/drugs-abuse/commonly-abused-drugs-charts Updated January 2016. Accessed January 23, 2017.
  3. The Effects of Vicodin Use. Drug Abuse website. http://drugabuse.com/library/the-effects-of-vicodin-use/ Accessed January 23, 2017.
  4. DeVeaugh-Geiss A, Kadakia A, Chilcoat H, Alexander L, Coplan P. A retrospective cohort study of long-term immediate-release hydrocodone/acetaminophen use and acetaminophen dosing above the Food and Drug Administration recommended maximum daily limit among commercially insured individuals in the United States (2008-2013). J Pain. 2015 Jun;16(6):569-79.e1. doi: 10.1016/j.jpain.2015.03.004.
  5. Have Pain? Pick Your Poison. American Council on Science and Health website. http://www.acsh.org/news/2016/10/25/have-pain-pick-your-poison-10358 Published October 25, 2016. Accessed January 23, 2017.
  6. Saab S, Konyn PG, Viramontes MR, et al. Limited Knowledge of Acetaminophen in Patients with Liver Disease. J Clin Transl Hepatol. 2016;4(4):281-287. doi:10.14218/JCTH.2016.00049.
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