How bad is it to mix vicodin with alcohol?

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Vicodin is a mixture of hydrocodone and paracetamol (aka acetaminophen, the active ingredient in Tylenol). Paracetamol is actually the most common cause of drug-related emergency room admissions, both because it's so commonly available and because an overdose is pretty toxic to the liver (Aspirin is more common but somewhat less toxic). A typical tab has 5mg hydrocodone and 500mg paracetamol.

The paracetamol is partly for additional pain relief, but the main reason for adding it is to discourage recreational use of the hydrocodone. Pretty sick way to accomplish that if you ask me, because most people don't really know how dangerous paracetamol overdose is, especially combined with alcohol.

The reason paracetamol is more dangerous with alcohol is that your body relies on the same chemical pathway in your liver to deal with both, and it can only do so much at a time (it's also the same pathway for aspirin or ibuprofen, so they don't combine well with alcohol). If your liver does fail your odds of survival start to look poor without emergency medical attention. If you happen to be genetically susceptible, it's worse and you might end up needing a liver transplant. The mortality is actually highest about 2-4 days after overdose, because the partial breakdown products are more toxic than the paracetamol itself.

Hydrocodone is about the same strength of opiate as morphine, and that's also dangerous to mix with alcohol, but not because of the effect on the liver. In this case the problem is that both drugs suppress the part of your brain that regulates breathing. People who die from overdose on opiates and/or alcohol generally asphyxiate before something else kills them. That doesn't happen days later, but when the drugs are at their peak concentration in the bloodstream.

So basically, not a very good idea for two different reasons. The safe limit for Vicodin is about eight tablets per 24 hours for an adult, and adding alcohol basically multiplies the danger from each pill by an unknown amount. You could also be relatively more susceptible to either of the effects mentioned above, and you wouldn't find out until you caused a medical emergency - which besides the risk to yourself puts a lot of strain on other people, like medical workers and the people who have to donate more organs for you. ;)

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