Lortab: 7 things you should know
Medically reviewed by Carmen Fookes, BPharm. Last updated on Nov 6, 2020.
1. How it works
- Lortab is a brand name for a combination acetaminophen/hydrocodone tablet. Acetaminophen and hydrocodone are two different pain-relieving medicines with two different mechanisms of action.
- Experts aren't sure exactly how acetaminophen works, but suspect it blocks a specific type of cyclo-oxygenase (COX) enzyme, located mainly in the brain. Hydrocodone is metabolized to hydromorphone (the active component) which binds to specific receptors known as opioid receptors that block pain signals on their way to the brain.
- Lortab belongs to the group of medicines known as combination narcotic analgesics. It may also be called a combination opioid analgesic.
- Effective combination drug for the short-term relief of moderate-to-moderately severe pain. Use is limited by the addiction and dependence potential of the hydrocodone component. Hydrocodone can also cause constipation.
- Some people find taking fixed-dose combination tablets easier to take than taking two different medicines.
- Lortab is available as a generic under the name Acetaminophen/Hydrocodone.
If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:
- Drowsiness or dizziness which may impair reaction skills and affect a person's ability to drive or operate machinery (hydrocodone component). Avoid alcohol.
- Stomach upsets including nausea, vomiting, and constipation (laxatives may be required); shortness of breath; dizziness; and low blood pressure (hydrocodone component). Hydrocodone may be more likely to cause constipation than other opioids such as oxycodone.
- Excessive dosages of acetaminophen (a component of Lortab) can lead to liver injury or death. Care must be taken not to take additional acetaminophen from other sources.
- Unlike NSAID pain relievers like ibuprofen, acetaminophen (a component of Lortab) does not have any appreciable anti-inflammatory action.
- Hydrocodone (a component of Lortab) is habit-forming and potentially abusable. Lortab should only be used short-term at the lowest effective dose when other nonopioid analgesics are not effective. Legitimate supplies of products containing hydrocodone may be sought out by drug seekers. Hydrocodone is one of the most abused opioids in the United States.
- Abrupt discontinuation of any hydrocodone-containing medication in a person who has become physically dependent on it may lead to a withdrawal syndrome and symptoms such as restlessness, pupil dilation, watery eyes and a runny nose, sweating, muscle aches, insomnia, irritability, and gastrointestinal complaints. Babies born to mothers who are physically dependent on hydrocodone will also be physically dependent.
- The dosage of acetaminophen contained in one tablet of Lortab may not provide an effective dosage of acetaminophen; however, people taking Lortab should not supplement with extra acetaminophen.
- Rarely, serious, life-threatening, breathing problems may occur attributable to the hydrocodone component. The risk is greater with higher dosages of Lortab, in people with pre-existing respiratory disease, in seniors or the frail, or in those taking other medications that cause respiratory depression (such as benzodiazepines).
- Hydrocodone is metabolized to hydromorphone by liver enzymes, specifically CYP2D6. Because CYP2D6 exhibits genetic polymorphism, there is potentially a wide interindividual variation in the way individuals respond to hydrocodone.
- Interaction or overdosage may also cause serotonin syndrome. Symptoms include mental status changes such as agitation, hallucinations, coma, or delirium; a fast heart rate; dizziness; flushing; muscle tremor or rigidity; and stomach symptoms (including nausea, vomiting, and diarrhea).
- May not be suitable for people with pre-existing respiratory depression or respiratory disease, with seizure disorders or a head injury, people with gastrointestinal obstruction, or recent use of monoamine oxidase inhibitors.
Notes: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. For a complete list of all side effects, click here.
- Short-term use only. Not recommended for long-term use. Do not exceed the recommended total daily dosage.
- Do not drive or perform other hazardous tasks if Lortab makes you drowsy or impairs your reaction skills (attributable to the hydrocodone component). Avoid alcohol.
- Different strengths of Lortab are available. Make sure you take the correct tablet and do not exceed the recommended dosage.
- Seek urgent medical help if you experience any breathing difficulties, wheezing, itching, or facial swelling.
- Call your doctor if you experience nausea or vomiting, stomach pain, itching, yellowing of your skin or eyes (jaundice), or dark (brown) urine, or light-colored stools.
- Tell your doctor if you think you have become addicted to this combination drug.
- Avoid taking extra acetaminophen while taking Lortab (acetaminophen may be "hidden" in some combination cold and flu treatments).
- Keep out of the reach of children and pets.
6. Response and Effectiveness
- Peak effects of acetaminophen (a component of Lortab) are reached within 30-60 minutes of administration and the analgesic effects of acetaminophen last between three and four hours. Peak effects of hydrocodone (a component of Lortab) are reached within 1.3 hours and the effects last for four to six hours.
- Once absorbed, hydrocodone is metabolized by hepatic enzymes CYP2D6 to hydromorphone which is the major metabolite of hydrocodone and has an approximately 10 to 33 fold higher binding affinity (in some cases as much as a 100-fold higher binding affinity) for the mu receptor than hydrocodone. Other hepatic enzymes are involved in the elimination of metabolized hydrocodone.
- Because CYP2D6 exhibits genetic polymorphism, there is potentially a wide interindividual variation in the way individuals respond to hydrocodone.
Medicines that interact with Lortab may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with Lortab. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.
Common medications that may interact with Lortab include:
- antibiotics, such as erythromycin
- antidepressants, such as tricyclic antidepressants (eg, amitriptyline), monoamine oxidase inhibitors (eg, isocarboxazid, phenelzine, and tranylcypromine), or SSRIs (eg, fluoxetine, sertraline)
- antifungal agents, such as itraconazole and ketoconazole
- anticonvulsants, such as carbamazepine, lamotrigine, phenytoin, phenobarbital, or primidone
- antimigraine agents such as sumatriptan
- antipsychotics (such as butyrophenones, phenothiazines, or thioxanthenes) and atypical antipsychotics (eg, olanzapine, quetiapine, ziprasidone)
- any medication that may cause drowsiness, such as amphetamines, benzodiazepines (eg, diazepam, lorazepam), first-generation antihistamines (such as doxylamine or promethazine), metoclopramide, or opioids (such as codeine, morphine)
- HIV medications such as ritonavir
- muscle relaxants, such as cyclobenzaprine
- other medications that are CYP3A4 or CYP2D6 inhibitors or inducers
Avoid drinking alcohol or taking illegal or recreational drugs while taking Lortab.
Note that this list is not all-inclusive and includes only common medications that may interact with Lortab. You should refer to the prescribing information for Lortab for a complete list of interactions.
Lortab (hydrocodone bitartrate and acetaminophen) [Package Insert]. Revised 09/2020. UCB, Inc. https://www.drugs.com/pro/lortab.html
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Lortab only for the indication prescribed.
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Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
More about Lortab (acetaminophen / hydrocodone)
- Side Effects
- During Pregnancy
- Dosage Information
- Drug Images
- Drug Interactions
- Support Group
- Pricing & Coupons
- 143 Reviews
- Drug class: narcotic analgesic combinations
- FDA Alerts (11)
- Lortab (Hydrocodone and Acetaminophen Liquid)
- Lortab (Hydrocodone and Acetaminophen Tablets and Capsules)
- Lortab (Advanced Reading)