Co-gesic Withdrawal

Co-Gesic withdrawal is the normal, predictable consequence of using Co-Gesic continually for a few weeks or more.


Anyone can become opioid-dependent and suffer Co-Gesic withdrawal symptoms when she stops using Co-Gesic. Co-Gesic withdrawal is not necessarily an indication of criminal drug abuse - it is possible to become opioid-dependant after using Co-Gesic as prescribed by a physician to treat an actual medical condition.

The human body adapts to the presence of certain substances, including the hydrocodone in Co-Gesic. Long-term Co-Gesic use can cause some of these changes to become more permanent as the body begins to rely on a certain amount of hydrocodone to feel "normal." When hydrocodone levels drop rapidly, the opioid-dependent body struggles to maintain chemical stability, a process doctors refer to as detoxification.

An opioid-dependent person feels this struggle through uncomfortable and demoralizing withdrawal symptoms. A physician will diagnose a person as being opioid-dependent if the patient feels flu-like symptoms after he stops using Co-Gesic. The detoxification process causes withdrawal symptoms in an opioid-dependent person.

Many events can initiate the detoxification process, including missing a dose, taking an insufficient dose or using a medication that rapidly lowers hydrocodone levels.

Co-Gesic withdrawal is similar to detoxification from other opioids and produces flu-like symptoms lasting several days. Co-Gesic withdrawal also causes demoralizing psychological symptoms that can leave the individual feeling incapable or unworthy of recovery.

During the initial doses, the consumer is sensitive to the effects of Co-Gesic. With continued, prolonged use, the consumer develops tolerance to this medication; a high tolerance means he must take stronger doses more often to achieve the same analgesic or euphoric effects. Someone with low tolerance is more sensitive to the effects of Co-Gesic.

Facts about this drug

Kremers Urban Pharmaceuticals Inc., packages Co-Gesic in a tablet. Co-Gesic is for oral administration only.

Co-Gesic contains 5 mg of hydrocodone bitartrate and 500 mg of the non-narcotic analgesic, acetaminophen. Hydrocodone is a powerful semi-synthetic opioid pain reliever, sometimes called a narcotic. Pharmacologists create hydrocodone from thebaine and codeine extracted from the opium poppy plant, Papaver somniferum.

Acetaminophen is a less potent non-narcotic analgesic. Together, the hydrocodone and acetaminophen in Co-Gesic relieves pain better than either medication could alone.

Physicians prescribe Co-Gesic to relieve moderate to moderately severe pain. Recreational users target Co-Gesic because of the way hydrocodone gets them high.

Using Co-Gesic for non-medical use increases the risk for physical dependence and addiction. To use a drug non-medically means to take it to get high or to treat a condition other than the one it was prescribed for.

Acetaminophen use has been associated with cases of acute liver failure, sometimes resulting in liver transplant and death. In most cases, patients had taken high doses of acetaminophen exceeding 4000 mg per day. Frequently, these high doses were the result of taking multiple products containing acetaminophen, as it is common ingredient in over-the-counter and prescription drugs.

U.S. physicians prescribe more hydrocodone products than any other type of drug. In 2010, American pharmacists filled more than 139 million prescriptions for drugs containing hydrocodone. Hydrocodone is also the most widely abused drugs in the United States.

The hydrocodone in Co-Gesic acts directly on the central nervous system, or CNS, to relieve pain, calm anxiety and cause relaxation and euphoria. Hydrocodone also works on smooth muscle groups, including those in the gastrointestinal tract, to slow digestion. Because of the way hydrocodone interacts with the CNS and gastrointestinal tract, Co-Gesic withdrawal causes nervous system and digestive symptoms such as anxiety and diarrhea.

Potential for Abuse

Using Co-Gesic for long-term medical therapy or for non-medical reasons increases the risk for developing opioid dependence. The U.S. Drug Enforcement Agency, or DEA, ranks drugs according to their relative risk for abuse. For example, heroin is a schedule I narcotic, meaning it poses a great risk for abuse. Robitussin AC is a schedule V, the lowest ranking, because someone would probably vomit before drinking enough to get high.

Co-Gesic is a schedule III narcotic, meaning it poses a moderate risk for abuse. According to the DEA classification, Co-Gesic carries the same relative risk for abuse as anabolic steroids. To reduce this risk, Co-Gesic is available only by prescription.

Abuse and Addiction Rates

Prescription drug abuse is widespread in the United States. In 2010, 12 million Americans used a prescription opioid for non-medical reasons. Prescription drug abuse now eclipses heroin abuse: In 2010, about 1.9 million Americans were addicted to prescription painkillers while only 329,000 were addicted to heroin that year.

People in the United States consume more painkillers than any other nation. Even though Americans represent only about 5 percent of the world's population, it gobbles up 80 percent of the global opioid supply.

Facts about Withdrawal

Co-Gesic withdrawal symptoms will start a few hours after the last dose and last for five or more days, with symptoms growing acute on or about the fourth day. The duration and severity of Co-Gesic withdrawal symptoms may depend on how long the individual has been opioid-dependent and the dosages he would take.

Left untreated, withdrawal symptoms disappear and do not return unless the person becomes dependent on drugs again. There are a few ways to address Co-Gesic withdrawal symptoms. Some medications ease individual withdrawal symptoms, such as Imodium to curb diarrhea and vitamins for muscle aches.

Other drugs, like methadone, mimic the effects of hydrocodone. Someone can stop withdrawal symptoms and halt the detoxification process by taking more Co-Gesic. Neither relapse nor methadone cures opioid-dependence.

Opioid dependence is separate and independent from addiction. Someone can be physically dependent on Co-Gesic but not addicted to it. While a doctor would diagnose someone as being opioid-dependent if the patient suffers Co-Gesic withdrawal, the physician would say the individual is addicted if the patient craves Co-Gesic or engages in drug-seeking behaviors when his supply runs low.


Co-Gesic withdrawal causes painful and demoralizing physical and psychological symptoms that can interfere with recovery. While Co-Gesic withdrawal is uncomfortable and discouraging, it is not life threatening.

Withdrawal symptoms appear in two waves, with the first set of symptoms appearing several hours after the last dose of Co-Gesic.

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

Possible Complications

While the detoxification process is not life threatening, severe withdrawal symptoms can cause dangerous complications. Someone can vomit then inhale stomach contents, a condition known as aspiration that can result in fluid in the lungs and lung infections. Excessive and prolonged vomiting, diarrhea and sweating can cause dehydration and electrolyte imbalances.

The primary complication to Co-Gesic withdrawal is relapse to drug use. Without anti-withdrawal drugs or the guidance of a trained professional, many opioid-dependent people cannot tolerate withdrawal symptoms and take more Co-Gesic to stop the detoxification process.

Treatment options

Without treatment, opioid dependence disrupts lives, causing collateral damage including job loss, separation or divorce, child custody issues, homelessness, disability or premature death. Chronic hydrocodone use impairs a person's ability to work, take care of children or interact with others. Using high doses of Co-Gesic for a long time increases the risk for side effects, overdose or infectious diseases, such as HIV/AIDS, tuberculosis, and hepatitis B and C.

More than 23 million people in the United States needed treatment in 2010 but of those who needed it, only about 11 percent got treatment in a specialty facility. The rest went to a general hospital or psychiatric unit without trained staff, or tried to overcome opioid dependence and Co-Gesic withdrawal alone.

Treatment involves two phases: detoxification to lower hydrocodone levels and rehabilitation to teach the individual how to live without Co-Gesic.

Self Detoxification

Some people try to overcome Co-Gesic withdrawal alone. Doctors refer to this as self-detoxification but it is sometimes called "going cold turkey." Cold turkey refers to the skin's appearance during detoxification: pale, cold, clammy with goose bumps, resembling a frozen turkey.

Self-detoxification is associated with a high rate of complications including aspiration, dehydration and relapse. Without medicine to ease symptoms or professional guidance to help with complications and the psychological aspects of Co-Gesic withdrawal, self-detoxification is a prolonged, uncomfortable and demoralizing process with a poor success rate.

The Thomas Recipe

Some try to overcome Co-Gesic withdrawal symptoms with The Thomas Recipe, a homemade treatment plan that calls for Valium or Xanax to calm anxiety and insomnia, Imodium, Vitamin B6 and supplements along with hot baths to soothe muscle aches and restless leg syndrome. A dose of L-Tyrosine takes care of malaise.

The Thomas Recipe eases Co-Gesic withdrawal symptoms but this remedy does not shorten detoxification or reduce the risk for complications, especially overdose caused by relapse.


Relapse after any amount of detoxification increases risk for overdose due because the detoxification process lowers the body's tolerance to hydrocodone. It is possible for someone to overdose on a smaller amount of Co-Gesic than he used to take before experiencing even moderate withdrawal symptoms.

It is possible to overdose on either the hydrocodone or the acetaminophen in Co-Gesic. Overdose of prescription painkillers including Co-Gesic kill nearly 15,000 people every year in the United States. Acetaminophen overdose is one of the most common poisonings worldwide and is the leading cause of acute liver failure in the United States.

Overdose is a serious, life threatening medical emergency that requires immediate attention. Emergency department doctors will administer the antidote to acetaminophen, N-acetylcysteine, along with naloxone to reduce hydrocodone levels. Nurses will establish an airway to help the victim breathe and pump the stomach or introduce charcoal to absorb excess Co-Gesic. Nurses will also start intravenous fluids to stabilize electrolytes and fluid balance, and monitor the patient for complications. Doctors and nurses will perform CPR and other life-saving measures as needed.

Drug Replacement Therapy

Someone who is not in immediate danger of overdose may choose DRT, or drug replacement therapy. DRT drugs include methadone, Suboxone and buprenorphine. DRT drugs mimic the effects of hydrocodone without producing euphoria, meaning the consumer does not experience euphoria or withdrawal symptoms. DRT delays the detoxification process temporarily while the individual engages in rehabilitation. Once he learns how to live without Co-Gesic, he weans himself from the DRT medication by taking smaller doses increasingly further apart.

DRT allows patients to continue going to work, taking care of children and participating in the activities of daily living while he participates in treatment, rather than spending time in a hospital. But DRT is not for everyone - some people have a hard time quitting the DRT drug. While detoxification is not usually life threatening, DRT drugs are associated with some risk: methadone now accounts for a third of opioid pain reliever deaths, even though it is not widely prescribed.

Standard detox

Many institutions now offer inpatient detoxification services. During standard detoxification, physicians administer naloxone to reduce hydrocodone levels and then give the patient multiple medications to address the ensuing Co-Gesic withdrawal symptoms. Nurses monitor the patient for complications. While standard detoxification helps the body adjust to the absence of hydrocodone, the process is still demoralizing and uncomfortable.

Rapid Detox

Rapid detox is the most humane, efficient way to deal with Co-Gesic withdrawal. During rapid detox, specially trained, board-certified anesthesiologists administer anesthesia and sedatives alongside the usual detoxification and anti-withdrawal drugs. As a result, the patient dozes in a comfortable "twilight sleep," unaware of the grueling detoxification process. After nurses stabilize the patient's condition, she is ready for meaning rehabilitation.


There is a growing need for rehabilitation and treatment for substance abuse problems including Co-Gesic withdrawal. In 1997, only seven individuals in every 100,000 people needed treatment for non-heroin opioid abuse; by 2007, this number had leaped to 36 people per 100,000. This is an astounding 414 percent in just ten years.

Detoxification is only the first step in recovering from substance abuse problems such as Co-Gesic withdrawal. By itself, the detoxification process does not change the behaviors associated with drug abuse, increasing the odds the individual will return to drug abuse. Rehabilitation teaches him how to avoid environments that promote drug use and gives him the tools to refuse drugs when offered the opportunity. Rehabilitation also helps the individual deal with environmental factors that increase the risk for drug abuse, including stress, peer pressure and other forms of substance abuse.

Rehabilitation can take place at an outpatient clinic or in a residential setting. Many outpatient clinics offer DRT along with counseling. Long-term facilities provide inpatient care with treatment plans lasting up to six months or a year.

The goal of any substance abuse treatment plan is to stop drug use and help the individual lead a normal life. Rehabilitation curbs criminal activity, improve the individual's job performance, personal relationships and restores healthy thought patterns.

Most rehabilitation treatment plans include behavior modification along with individual, family and group counseling. Medications are an important part of many treatment plans, as someone struggling with Co-Gesic withdrawal is also likely to have coinciding physical or mental health problems that could interfere with recovery efforts. Effective treatment tends to the multiple needs of the individual and not just her Co-Gesic withdrawal.

Substance abuse problems, including Co-Gesic dependence and withdrawal, are chronic conditions subject to cycles of relapse and remission. Even with treatment, relapse rates for drug addiction are 40 to 60 percent. Relapse is not an indication of failure, but it does mean the individual needs to return to treatment, modify his treatment plan or engage in a different type of treatment.

Dependence on hydrocodone and Co-Gesic withdrawal are complex, but treatable, medical conditions that require long-term, professional care. No one treatment is right for everyone and most people engage in several different types of treatment throughout the course of recovery. Treatment does not need to be voluntary to be effective; in fact, many people stay in treatment longer when under legal coercion to do so.

No matter which form of therapy the person chooses, treatment needs to be readily available to encourage maximum participation and improve the individual's chances of completing treatment. It is critical to remain in treatment long enough to make behavioral changes substantial enough to avoid relapse.

A professional rehabilitation counselor will develop a treatment plan based on an initial assessment of the patient's condition. The counselor will monitor the patient's progress and modify the treatment plan to ensure it continues to fit the patient's changing needs.

The treatment plan will likely include mandatory drug testing, as relapses do happen during treatment. The treatment plan may also screen the individual for infectious diseases and provide information to help the participant reduce her chances for contracting or spreading these diseases.