Co-gesic Side Effects

Co-Gesic contains 5 mg of hydrocodone bitartrate, an opioid pain reliever, and 500 mg of the non-narcotic analgesic, acetaminophen. Kremers Urban Pharmaceuticals Inc., packages Co-Gesic in a tablet. Co-Gesic is for oral administration only.

Physicians prescribe Co-Gesic to relieve a patient's moderate to moderately severe pain. Recreational users like Co-Gesic because of the way hydrocodone gets them high.

Hydrocodone is a semi-synthetic opioid pain reliever, created from thebaine and codeine extracted from the opium poppy plant, Papaver somniferum. Like other opioids, Co-Gesic works with the central nervous system, or CNS, to change the way the brain perceives pain. Because of this action on the CNS, Co-Gesic may cause adverse reactions in the nervous system.

Hydrocodone also acts directly on the area of the brain responsible for the cough reflex. Co-Gesic's action on the brain's breathing center may cause respiratory depression and other serious breathing problems.

Opioids including hydrocodone work on smooth muscles, including those in the digestive tract. Consequently, Co-Gesic use may cause gastrointestinal side effects.

The acetaminophen component of Co-Gesic reduces fever by acting on the brain's temperature regulating center, the hypothalamus.

Side Effect Information

Any medication may cause adverse reactions in some people, including those who use Co-Gesic. Many Most side effects associated with Co-Gesic are not serious and disappear with continued use therapeutic doses. A few side effects are serious, requiring immediate medical attention.

The side effects associated with the hydrocodone in Co-Gesic are typical of any opioid. Side effects are dose-dependent, meaning that the risk for side effects increases at higher doses. Using Co-Gesic for a long time increases the risk for some side effects, including abuse and physical dependence.

Abuse and Physical Dependence

Hydrocodone is widely abused because of the euphoric feeling it provides. The U.S. Drug Enforcement Agency, or DEA, classifies substances according to their relative potential for abuse. Heroin is a schedule I narcotic because people can use it to get high easily. Robitussin AC is a schedule V drug because it carries a relatively low risk for abuse - someone would probably vomit before drinking enough to get high. Co-Gesic is a schedule III narcotic, meaning it carries a risk for abuse equal to that of anabolic steroids.

American doctors prescribe more hydrocodone-containing products than any other drug. In 2010, U.S. pharmacists filled more than 139 million prescriptions for products that contain hydrocodone. The widespread availability of this drug and the euphoric feeling it produces makes hydrocodone one of the most widely abused drugs in the United States.

Using Co-Gesic continuously for a few weeks may cause the consumer to grow opioid-dependent. An opioid-dependent person suffers flu-like withdrawal symptoms after she stops taking Co-Gesic; in fact, a doctor will diagnose someone as being opioid-dependent if the patient experiences withdrawal symptoms when she stops using Co-Gesic. Some medications, including naloxone, will reduce opioid levels and cause withdrawal symptoms in an opioid-dependent person.

To avoid withdrawal symptoms, someone who has use Co-Gesic continually for more than a few weeks should wean himself from this medication by taking successively smaller doses further apart. A qualified detoxification facility can someone whose withdrawal symptoms prevent him from quitting Co-Gesic.

Withdrawal symptoms appear in two stages with the first phase beginning a few hours after the last dose of Co-Gesic. Opioid withdrawal symptoms typically last five or more days with the worst symptoms appearing on or about the fourth day.

Early symptoms of withdrawal include:

  • Agitation
  • Anxiety
  • Muscle aches
  • Increased tearing
  • Insomnia
  • Runny nose
  • Sweating
  • Yawning

Late symptoms of withdrawal include:

  • Abdominal cramping
  • Diarrhea
  • Dilated pupils
  • Goose bumps
  • Nausea
  • Vomiting

Without intervention, withdrawal symptoms eventually disappear by themselves and do not return unless the person becomes opioid-dependent again. Some medicines ease withdrawal symptoms, including Imodium for diarrhea and supplements for muscle aches.

Many opioid-dependent individuals resort to relapse to make severe withdrawal symptoms go away. Taking another dose of Co-Gesic halts the detoxification process and eases withdrawal symptoms but relapse leaves the individual still dependent on hydrocodone.


It is possible to become addicted to the hydrocodone in Co-Gesic. A doctor will diagnose an individual as being addicted to Co-Gesic if the patient craves the drug or engages in drug-seeking behaviors when supplies run low. Left untreated or undertreated, Co-Gesic addiction can cause disability or premature death.


One side effect of continual Co-Gesic use is increased tolerance to hydrocodone. Someone who has become tolerant to hydrocodone must take stronger doses of Co-Gesic more often to relieve pain or to get high.

A person with low tolerance to Co-Gesic is more sensitive to its effects. Someone usually has a low tolerance to hydrocodone when she first begins Co-Gesic, experiencing a stronger analgesic and euphoric effect. The detoxification process lowers opioid tolerance increasing the risk for overdose if the individual relapses. It is possible for someone to overdose on a smaller dose than she used to take before she experienced even moderate withdrawal symptoms.

Most Frequently Observed Side Effects

The most frequently reported adverse reactions associated with Co-Gesic include lightheadedness, dizziness, sedation, nausea and vomiting. Ambulatory consumers report these side effects more frequently than do those confined to a bed or wheelchair. Lying down relieves these side effects for most consumers.

Allergic Reaction

Anyone can suffer an allergic reaction to any medication, including Co-Gesic. Those who are allergic to hydrocodone, acetaminophen or any other ingredient in Co-Gesic should not use this product. Individuals allergic to other opioids, including morphine or codeine, should not use Co-Gesic.

An allergic reaction is a serious medical emergency. Stop using Co-Gesic and contact professional medical care immediately at the first sign of an allergic reaction. Bring the Co-Gesic bottle along with all other medications to help doctors determine the cause of the reaction.

Common symptoms of a mild allergic reaction include:

  • Hives, especially over the neck and face
  • Itching
  • Nasal congestion
  • Rashes
  • Watery, red eyes

Symptoms of a moderate to severe reaction include:

  • Abdominal pain
  • Abnormal or high-pitched breathing sound
  • Anxiety
  • Chest discomfort or tightness
  • Cough
  • Diarrhea
  • Difficulty breathing
  • Difficulty swallowing
  • Dizziness or light-headedness
  • Flushing or redness of the face
  • Nausea or vomiting
  • Palpitations
  • Swelling of the face, eyes or tongue
  • Unconsciousness
  • Wheezing

Anaphylaxis is a serious, potentially deadly form of an allergic reaction. Anaphylaxis usually starts within seconds or minutes of exposure to Co-Gesic, but anaphylaxis may start as late as a half an hour or longer after contact with this substance. Transport all suspected cases of anaphylaxis to the nearest medical care facility; call for an ambulance if it results in faster care.

Symptoms of anaphylaxis include:

  • Abdominal pain
  • Abnormal, high-pitched breathing sounds
  • Anxiety
  • Chest discomfort or tightness
  • Cough
  • Diarrhea
  • Difficulty breathing
  • Difficulty swallowing
  • Dizziness or light-headedness
  • Hives, itchiness
  • Nasal congestion
  • Nausea or vomiting
  • Palpitations
  • Skin redness
  • Slurred speech
  • Swelling of the face, eyes, or tongue
  • Unconsciousness
  • Wheezing

Signs include:

  • Abnormal heart rhythm
  • Blue skin from lack of oxygen
  • Fluid in the lungs
  • Hives
  • Low blood pressure
  • Mental confusion
  • Pale skin from shock
  • Rapid pulse
  • Swelling in the throat
  • Swelling of the eyes or face
  • Weakness
  • Wheezing


Some individuals may be hypersensitive to the effects of Co-Gesic. A person hypersensitive to opioids other than hydrocodone may experience cross-over hypersensitivity to Co-Gesic.

Serious Side Effects

The most serious side effects associated with Co-Gesic are respiratory depression, apnea, respiratory arrest, circulatory depression, hypotension and shock. Respiratory depression is a condition where the lungs do not adequately exchange oxygen and carbon dioxide, causing the body to suffer a lack of oxygen and build-up of toxic gases. Symptoms of respiratory depression include slow, shallow or irregular breathing and a blue color around the eyes, mouth and fingertips.

The acetaminophen in Co-Gesic has been associated with cases of acute liver failure, sometimes ending in liver transplant and death. Most of these cases involved high doses of acetaminophen, often exceeding 4000 mg of acetaminophen in a 24-hour period. Frequently, these cases involved the consumption of multiple acetaminophen-containing products, as acetaminophen is a common ingredient in prescription and over-the-counter medications.

By body system

Central Nervous System

Hydrocodone acts directly on the central nervous system to ease pain and cause sedation, relaxation and euphoria; using Co-Gesic may result in adverse reactions affecting the nervous system, including drowsiness, mental clouding and lethargy. Co-Gesic may impair mental or physical performance. Other neurological side effects include anxiety, fear, psychological dependence, mood changes and the emotional opposite of euphoria, dysphoria.

Gastrointestinal System

Using Co-Gesic continually for a long time may cause constipation.

Genitourinary System

The hydrocodone in Co-Gesic may cause urinary problems including spasms and urinary retention.

Respiratory System

Hydrocodone may cause breathing problems, especially respiratory depression, because of the way it acts on respiratory centers in the brain.

Special Senses

Some consumers, especially those taking a chronic overdose of Co-Gesic, have reported hearing impairment or permanent hearing loss after using this medication.


The hydrocodone in Co-Gesic use may cause skin reactions including rash and itching. The acetaminophen component of Co-Gesic may cause allergic reactions, rash and blood disorders including low white cell counts or low platelet counts that could lead to slow clotting.