Can a Patient Take Vicodin While Having COVID-19?
Yes, a patient can take Vicodin (hydrocodone/acetaminophen) for pain management during COVID-19, but acetaminophen alone is preferred as first-line therapy, and the opioid component requires careful monitoring for drug interactions if the patient is receiving certain COVID-19 treatments. 1
Acetaminophen Component - Safe and Preferred
Acetaminophen (paracetamol) is the recommended first-line antipyretic and analgesic for COVID-19 patients with fever and pain, making the acetaminophen component of Vicodin appropriate. 1
Use acetaminophen for fever control when temperature exceeds 38.5°C, and it can be safely used for pain management in COVID-19 patients. 1
Acetaminophen has no significant drug interactions with COVID-19 therapies including lopinavir/ritonavir, remdesivir, hydroxychloroquine, tocilizumab, or interferon beta. 1
The maximum daily dose should not exceed 4 grams in 24 hours to avoid hepatotoxicity, which is particularly important since COVID-19 itself can cause liver injury in 14.8% to 53% of patients. 2
Hydrocodone (Opioid) Component - Use With Caution
If the patient is receiving lopinavir/ritonavir for COVID-19 treatment, opioid metabolism may be significantly affected, requiring dose adjustments or enhanced monitoring. 1
Morphine exposure decreases when used with lopinavir/ritonavir, while oxycodone exposure increases by 160%, suggesting that hydrocodone metabolism could similarly be altered. 1
Avoid using opioid medications in opioid-naive patients during COVID-19 due to increased psychological stress that may elevate requirements and risk of use for non-pain conditions like anxiety, depression, and insomnia. 1
Liver Function Monitoring is Critical
Patients with COVID-19 should have liver function tests monitored, especially when using potentially hepatotoxic medications or if they have pre-existing liver disease. 3
Monitor liver tests twice weekly in patients on potentially hepatotoxic medication or those with pre-existing liver disease. 3
If liver injury develops (ALT/AST elevation), consider whether it is due to COVID-19 itself, drug-induced liver injury from COVID-19 treatments, or the acetaminophen component of Vicodin. 3, 2
Off-label COVID-19 treatment should be withheld in cases of moderate-to-severe (category 2-3) liver injury, which may influence the decision to continue Vicodin. 3
Practical Recommendations
For mild to moderate COVID-19 pain, consider acetaminophen alone (without the opioid component) as the safer first-line option. 1, 4
If Vicodin is necessary for adequate pain control, use the lowest effective dose and shortest duration possible. 1
Document all medications the patient is receiving for COVID-19 treatment to assess for potential drug-drug interactions with hydrocodone. 1
Implement safe opioid prescribing procedures including monitoring for signs of respiratory depression, especially in patients with COVID-19 respiratory symptoms. 1
Common Pitfalls to Avoid
Do not exceed maximum daily acetaminophen doses (4 grams/24 hours) when combining Vicodin with other acetaminophen-containing products. 1
Do not assume all analgesics are contraindicated in COVID-19; acetaminophen is specifically recommended and safe. 1, 4
Do not ignore potential opioid-related drug interactions if the patient is on lopinavir/ritonavir or other protease inhibitors for COVID-19 treatment. 1
Avoid relying solely on pharmacological management without addressing the underlying cause of pain and monitoring for COVID-19 progression. 5