Lortab is a brand name pain medication. It’s the combination of the semi-synthetic opioid hydrocodone and acetaminophen (Paracetamol).

Similar to other opioid-based pain-killers, Lortab has a high potential for addiction, especially if used long-term (more than two weeks).

It works by binding to the mu-opioid receptors found in the spinal cord and brain that are responsible for controlling pain transmission to the brain. It also stops the inflammatory process to fight pain at its source.

In this article, we’ll go over what Lortab is, what makes it addictive, and how Lortab addiction is treated.

What is Lortab?

Lortab is a combination of two painkillers — hydrocodone and acetaminophen. The combination of these two painkillers provides greater degree of pain-relief than other painkillers. The combination is much more effective at managing pain than most over the counter opiates and acetaminophen (Tylenol).

Hydrocodone is a powerful opiate medication that stops pain signals from reaching the brain by activating the opioid receptors.

Acetaminophen (Tylenol) provides a separate mechanism of pain reduction by inhibiting inflammatory processes driven by the COX-2 enzyme.

There are several combination painkillers containing either Tylenol, hydrocodone, or other related molecules. Some versions may contain these ingredients in different ratios. Although many of these drugs are exactly the same, the only difference is the manufacturer.

Drugs Made With Hydrocodone & Acetaminophen:

Anexsia
Anolor DH
Lorcet
Lortab
Norco
Vicodin
Zydone

Other Drugs That Contain Hydrocodone

Brand Name	Ingredients
Vicoprofen	Hydrocodone & ibuprofen
Ibudone	Hydrocodone & ibuprofen
Reprexain	Hydrocodone & ibuprofen
Alor 5/500	Hydrocodone & aspirin
Azdone	Hydrocodone & aspirin
Damason-P	Hydrocodone & aspirin
Lortab ASA	Hydrocodone & aspirin
Panasal 5/500	Hydrocodone & aspirin
Hysingla ER	Controlled release hydrocodone
Zohydro ER	Controlled release hydrocodone

Lortab Addiction

Lortab is highly addictive, especially with long-term use.

Initially, Lortab is habit-forming through its positive effects on pain — physical addiction comes later.

People suffering from moderate to severe pain often get a prescription for the drug to ease symptoms. Many people will develop a habit around their Lortab use — as it becomes the most reliable way of eliminating pain. We call this a behavioral addiction. If you stop taking the medication, you won’t experience direct negative side-effects aside from experiencing the normal levels of pain. It’s called behavioral because you take the substance and associate a positive result, the relief from pain.

After several weeks of use, the addiction becomes physical — this is when Lortab becomes a problem for most people.

As you take the drug daily to manage pain, the central nervous system builds resistance from the effects of the opiates. This happens by switching off the opioid receptors the drug activates. This means more opiates are needed to produce the same pain relief.

At this point, if we stop taking the drug, our endorphins aren’t strong enough to activate the opioid receptors on their own — we need the drugs to do it for us.

When the opioid receptors aren’t stimulated, we experience negative side-effects — this is called withdrawal.

Withdrawal symptoms can be severe, depending on the extent of the addiction. The most common side-effects include severe pain, anxiety, and an inability to regulate temperature. As soon as symptoms appear, the brain craves more Lortab to alleviate withdrawal symptoms.

Cases of physical addiction are difficult to treat without support because as soon as the medication is stopped, the user becomes violently ill. Their body needs the medication to get to a comfortable baseline.

Signs of Lortab Withdrawal

Mood changes
Anxiety
Irritability
Muscle and joint pains
Flu-like symptoms
Chills/fever
Muscle tremors
Diarrhea
Stomach cramping
Nausea/vomiting
Depression
Suicidal thoughts

Lortab Addiction Treatment

There are plenty of resources available for people addicted to opiates like Lortab.

Depending on the severity of the addiction, there are at-home programs, support groups, or full-service rehabilitation centers available.

With all forms of addiction treatment, the process follows a similar process:

1. Detox

The first stage involves reversing drug dependency through detox programs. Some users quit their drug use cold-turkey, others wean-off gradually.

Although going cold turkey works for some people, it’s not recommended, especially with severe, or long-term Lortab addiction. The cold turkey method with Lortab can cause unbearable withdrawal symptoms and has been fatal in some cases.

Weaning off the Lortab is done with increasingly lower doses of the Lortab or through other drug therapies such as methadone, Suboxone, or buprenorphine. These treatment drugs have a longer duration of effects and are designed to prevent abuse and cuts habits tied with the opiate use.

Many users have found success with detoxing at home — but this isn’t recommended. The relapse rate with at-home detoxes is significantly higher than professional detox programs. Additionally, professional detox facilities have access to medical professionals and additional drug therapies to ensure the maximum outcomes possible.

2. Rehabilitation

After the detox process, people have the option of continuing treatment at-home, or attend a rehab facility.

At home treatments (outpatient therapy) involve weekly, biweekly, or daily visits to doctors, support groups, and councilors. This can be effective for some people, but it’s generally isn’t as effective as inpatient therapy (temporary living at a rehab center).

Inpatient treatment offers clear advantages over at home treatment. With medical supervision, access to additional therapies, and separation from drug triggers go a long way in retraining old habits and temptations around the drug use. It also offers greater protection from relapse, emotional crisis, and fatal withdrawal symptoms during the recovery process.

3. Long-Term Support

Once official treatment is over, patients enter long-term support groups. This can involve a wide range of different levels of care — from weekly or monthly visits with a support group or counselor to intensive programs and periodic retreats throughout the year to maintain sobriety.

The goal of long-term support is to help people stay sober and provide tools to prevent relapse.

Lortab Overdose

Lortab is a combination of two painkillers — an opiate and acetaminophen — each with its own risk of causing an overdose.

The signs and symptoms of overdose will depend on which compound is primarily causing the overdose.

1. Opiate Overdose

An estimated 130 people die each day in the United States as a direct result of overdosing on an opiate [1].

Opiate overdose causes respiratory depression (slow breathing), pinpoint pupils, and sedation. As the nervous system is inhibited, the heart rate slows, blood pressure drops dangerously low, and all cognitive function is impaired. Many people become unresponsive, unable to call for help during an opiate overdose.

The most dangerous part of an opiate overdose is the effects on the breathing center in the brainstem — responsible for controlling our automatic breath rate. When this part of the brain is inhibited, we can’t help but breathe very slowly. Eventually, the cells in our brain, heart, and the rest of the body starve for oxygen. After just a few minutes, our blood oxygen levels drop to critical levels, causing cells to start to die.

When this happens in the heart or the brain, it can result in death.

Signs & Symptoms of Opiate Overdose:

Pinpoint pupils
Nausea/vomiting
Sedation
Slowed or abnormal breathing
Slow heart rate
Low blood pressure
Blue tinge around the mouth (cyanosis)
Excessive sleepiness
Dizziness/fainting
Limp or weak muscles
Cold, clammy skin
Seizures
Slow or stopped heartbeat
Stomach and intestinal spasms
Loss of consciousness or coma

2. Acetaminophen Overdose

Acetaminophen can also cause an overdose, but the symptoms are different — it primarily targets the liver.

Roughly 10% of calls to poison control centers involve acetaminophen overdose [3].

Signs of Acetaminophen Overdose:

Irreversible liver damage
nausea/vomiting
General malaise
Jaundice
Abdominal pain
Confusion
Death

The maximum safe dosage of acetaminophen is 4,000 mg per day, according to the FDA. The manufacturer of Tylenol — McNeil Consumer Healthcare —reduced the recommended maximum daily dose to 3000 mg due to increased reports of overdose and liver damage.

The risk of liver damage resulting from acetaminophen depends primarily on genetic factors. Certain variations of genes encoding for liver metabolism enzymes can place people at higher or lower risk of developing serious liver side-effects from acetaminophen.

These enzymes convert Tylenol into a toxic metabolite, which is then metabolized in a second round into a stable compound that can be safely eliminated through the kidneys. Some people have a harder time converting the toxic byproduct of acetaminophen metabolism into the safer, more stable metabolite during this second step [2, 3].

When these people take larger doses of Tylenol or acetaminophen from sources like Lortab, the toxic compound build up in the liver, causing serious, irreversible damage.

How much of the drug needed to lead to an overdose can vary depending on the genetic variability of different users?

Most people will show signs of overdose with 10 grams of acetaminophen.

Lortab only contains 325 mg of acetaminophen for every 5-7.5 mg of hydrocodone. To overdose on acetaminophen with Lortab, roughly 30 tablets of Lortab need to be ingested at one time. Doing this will also deliver 150-225 mg of hydrocodone, which is above the toxic dose (90 mg). This dose may increase with tolerance over many years of regular Lortab use.

Therefore, it’s more likely that overdosing on Lortab will be driven by an overdose on the hydrocodone than the acetaminophen. Some long-term users may experience acetaminophen overdose with larger doses of Lortab.

What Causes Lortab Overdose?

Lortab is a powerful medication, with a moderately high risk of causing overdoses, even among experienced users.

There are three main ways Lortab can cause an overdose:

1. Drug Abuse

The addictive potential of Lortab makes it a common drug of abuse. As the drug is used frequently, the body builds a tolerance to its effects. When this happens, ever-increasing doses of the drug are taken to receive the same level of benefit. When the dose becomes too high, it can result in an overdose.

Compounding this problem are other practices common with drug abuse. Users are desperate to get their dose of opiates like Lortab to stop their pain and ease withdrawal symptoms. A Lortab habit can become expensive, causing users to take extreme measures to get the hit they need for as little money as possible. One of the most common ways to achieve this is to snort or inject the drug.

Snorting or injecting Lortab significantly increases the potency (by making absorption more efficient). This can increase the chances of overdosing on the drug.

2. Novice Users

Some people are using Lortab as a recreational drug. If novice users take Lortab recreationally without following the advice of a doctor, it’s easy to take a high dose — resulting in an overdose.

This is especially common with recreational novice users because often times, the people supplying the drug to the new users already have a high tolerance for the drug, while the new users don’t. This means that experienced users can handle a larger dose, but if the novice user tries to match this same dose, it may be far too high for their body to handle.

3. Mixing Lortab with Other Drugs

Every time a drug enters the body, it’s mixed with the other contents present in the digestive tract and bloodstream. If other drugs are present, they may interact together to cause greater harm on the body.

There are Two Main Ways Drugs Can Interact Negatively:

They compete for liver metabolism — causing both to increase to higher than normal concentrations in the blood
They cause compound effects — opiates mixed with other sedatives can have a compound effect, resulting in symptoms of an overdose

Drugs to Avoid When Taking Lortab

Benzodiazepines
Alcohol
Muscle relaxants
Tranquilizers
Sedatives
Other acetaminophen drugs (Tylenol, Paracetamol)

What to do for Lortab Overdose

Follow these three steps if you find someone overdosing on Lortab or similar opiate-based painkillers.

1. Count Their Breaths and Check for a Pulse

The first thing you should do if you find someone overdosing on any drug is to check their breathing and pulse. If neither of these are present, immediately call emergency services and start CPR.

If they are breathing, count the breaths. In one minute, a healthy person will take about 12 breaths. In people overdosing on opiates like Lortab, this will be closer to 4 breaths per minute.

Also, look for things like blueness around the lips as this is a sign of hypoxia (reduced oxygen levels in the bloodstream).

All of this information is going to be relevant when you get to step three (calling emergency services). This type of information gives emergency responders an idea of the timeline they have before the overdose becomes fatal. It also gives them vital information they can use to guide you in what you should do to help them while you wait for help to arrive.

2. Administer Narcan (If Available)

Narcan is the universal antidote for opiate overdoses — it completely reverses the effects of the opiates for about 30-60 minutes. Recently, the Trump administration recognized the opiate crisis as an epidemic and took measures to get life-saving medications like Narcan into the hands of those who need it.

This is a great medication to keep on hand if you or someone you know is ever at risk of overdosing on opiates.

It’s important to note that although Narcan is a powerful emergency treatment for the effects of overdose caused by opiates, it’s not effective for an acetaminophen overdose — this requires immediate care and attention in a hospital.

With that said, giving Narcan to someone experiencing an overdose on acetaminophen won’t negatively affect them at this state. The drug only works on the opiate system, and rarely causes any adverse side-effects.

If you’re not sure if you should use Narcan or not, follow this simple checklist.

If the at Least Three of These Signs are Present, You’re Safe to Administer Narcan:

Breath rate is very slow (0-6 breaths per minute)
Heart rate is slowed
Pupils are constricted (pinpoint)
The patient is either unresponsive or excessively drowsy

3. Call Emergency Services

There are other drugs emergency services can administer that can go a long way in saving the lives of people overdosing on Lortab. Additionally, even if you administered Narcan and the victim woke up and seem okay, the Narcan will wear off in about 30 minutes. If they still have enough of the hydrocodone in their bloodstream when the Narcan wears off, they’ll go right back into a state of overdose again.

Therefore, it’s critical that anybody going through an overdose is taken to the hospital where they can be monitored and given more doses of Narcan or related drugs if necessary.

With drugs like Lortab, it’s also important to investigate the reason for the overdose, especially if suicide is a possibility.

Questions You Should be Prepared to Answer:

The person’s age, weight, and health condition(s)
Name of the product taken (ingredients and strength, if known)
The time it was swallowed
Amount swallowed
If the medication is prescribed for the patient

Conclusion

Lortab is a prescription combination of an opiate and acetaminophen (Tylenol). It’s primarily used for managing chronic pain involving inflammation.

Like other opiate-based prescription drugs, Lortab is addictive, especially with long-term habitual use. An addiction to Lortab poses significant short-term and long-term health concerns for those affected. An overdose on the compound can cause irreversible liver damage, respiratory depression, coma, and death.

Seeking help for Lortab addiction as early as possible is the best way to prevent long-term consequences of the drug and reduce the chances of experiencing an overdose.

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References

CDC/NCHS, National Vital Statistics System, Mortality. CDC WONDER, Atlanta, GA: US Department of Health and Human Services, CDC; 2018. https://wonder.cdc.gov.
Hutt, A. J., Caldwell, J., & Smith, R. L. (1986). The metabolism of aspirin in man: a population study. Xenobiotica, 16(3), 239-249.
Larson, A. M. (2007). Acetaminophen hepatotoxicity. Clinics in liver disease, 11(3), 525-548.
Molina, D. K., & Hargrove, V. M. (2011). What is the lethal concentration of hydrocodone?: a comparison of postmortem hydrocodone concentrations in lethal and incidental intoxications. The American journal of forensic medicine and pathology, 32(2), 108-111.