Hydrocodone acetaminophen alternatives: What can I take instead of hydrocodone acetaminophen?

In this article:

• Hydrocodone-acetaminophen alternatives
• Belbuca
• Tramadol
• Methadose
• Naprosyn
• Cymbalta
• OTC pain relievers
• Natural alternatives
• How to switch
• Choosing the right treatment

In this article

• Hydrocodone-acetaminophen alternatives
• Belbuca
• Tramadol
• Methadose
• Naprosyn
• Cymbalta
• OTC pain relievers
• Natural alternatives
• How to switch
• Choosing the right treatment

Hydrocodone-acetaminophen is a prescription pain reliever containing an opioid (hydrocodone) with an otherwise nonprescription pain reliever, acetaminophen. Doctors use it to treat moderate to severe pain that is due to a temporary problem (acute pain) or an ongoing problem (chronic pain). Unfortunately, hydrocodone-acetaminophen may not work in relieving pain for some. Or, even if it does, the use of opioids can produce serious side effects like sedation, impairment, constipation, and slowed breathing. Opioids come with some risk of dependency, withdrawal, abuse, overdose, or even death. Switching from an opioid to another drug is a complex process, so it should always be monitored by a healthcare professional.

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What can I take instead of hydrocodone-acetaminophen?

There are other options available to treat pain that does not improve with hydrocodone-acetaminophen or in patients who experience adverse events. 

To start with, the prescriber could switch to another opioid. Some opioids work longer than hydrocodone, like extended-release hydrocodone. Some opioids are more potent than hydrocodone, like oxycodone or buprenorphine. Some are weaker and less likely to cause certain side effects, like tramadol. 

Non-opioid medications include prescription nonsteroidal anti-inflammatory drugs (NSAIDs), like prescription Naprosyn (naproxen) or over-the-counter Advil, Motrin (ibuprofen), or Aleve (naproxen). For certain types of pain, healthcare providers can also use antidepressants, such as amitriptyline or Cymbalta (duloxetine), and nerve pain agents like gabapentin.

Prescription drug prices often change. These are the most accurate medication prices available at the time of publication in ZIP code 23666 as of November 6, 2025. The listed price, without insurance, refers to the price of brand-name drugs (unless otherwise specified). The listed SingleCare price references the price of generic drugs if available.

Top 5 hydrocodone-acetaminophen alternatives

The following are some of the most common alternatives to hydrocodone-acetaminophen.

1. Belbuca (buprenorphine)

Belbuca is a buccal film of a very powerful opioid, buprenorphine. In patients with poor pain control on other opioids, some data suggest that switching to buprenorphine may improve pain control.

Even though it’s powerful, buprenorphine is actually safer than many other opioids. It’s a “partial” opioid agonist that only works at some opioid receptors in the brain. Other opioids (called “full” opioids), like hydrocodone, work at all the opioid receptors. As a partial opioid, many of the central nervous system effects, like euphoria, level off as the dose increases, decreasing the incentive to abuse the drug. The risk of severe side effects also levels off, so doctors can use higher doses to manage pain. 

Some additional formulations of buprenorphine exist, including a transdermal patch (Butrans) and an injection. The buccal film takes about two hours to achieve maximum pain control but provides a relatively long duration of action.

2. Tramadol

Tramadol is a less potent opioid, so it is an alternative if opioid side effects or risks are an issue. It is similar to codeine, another weak opioid. Though less potent, it is still a controlled substance because of the risk of abuse. The maximum total daily dose of tramadol is 400 mg. Unfortunately, this may not provide the pain control needed by some people. In addition to the typical common side effects seen with opioids, tramadol can additionally cause seizures and low blood sugar.

3. Methadose (methadone)

Methadose is an option for patients with chronic pain when side effects have limited further dosage escalations, as well as when opioid treatment has made a patient hypersensitive to pain. Methadose may also be a good option for a person who has an allergic reaction to hydrocodone. Methadone, however, exhibits high interpatient variability in absorption, metabolism, and relative pain-relieving potency, so methadone must be dosed carefully even in people currently on an opioid analgesic. It also has many possible drug interactions, so make sure the prescriber is aware of all the prescription and over-the-counter medications being taken.

4. Naprosyn (naproxen)

Naprosyn is a prescription NSAID and may serve as a good alternative to opioid pain medications. Its active ingredient, naproxen, can be purchased over the counter, but prescription naproxen comes in higher doses. Prescription naproxen is effective at relieving certain types of pain without the side effects of opioids, such as drowsiness or constipation. NSAIDs like Naprosyn do come with their own set of potential side effects and risks, including high blood pressure and an increased risk of cardiovascular events. NSAIDs can also increase the risk of bleeding and stomach ulcers. For these reasons, healthcare professionals typically prescribe NSAIDs for as short a time as possible.

5. Cymbalta (duloxetine)

Cymbalta is an effective non-opioid pain reliever for certain types of chronic pain. Its active ingredient, duloxetine, is a type of antidepressant called a serotonin/norepinephrine reuptake inhibitor (SNRI). However, the FDA has approved its use for chronic musculoskeletal pain, such as low back pain, as well as diabetic neuropathy and fibromyalgia. Doctors sometimes use it off-label for chemotherapy-induced peripheral neuropathy. 

Duloxetine is considered safe and tolerable, but it comes with a black box warning for increased suicidal thoughts and behavior. During the initial months of treatment, patients or their caregivers should watch closely for such thoughts and unusual behaviors. 

Over-the-counter pain relievers

Store shelves are abundantly stocked with nonprescription painkillers, but they may not work well enough to treat pain that requires opioid therapy. These familiar drugs include Tylenol (acetaminophen) and NSAIDs (aspirin, ibuprofen, and naproxen). Though safer than prescription pain relievers, they can also cause problems. Taking too much acetaminophen can cause severe and even life-threatening liver damage. OTC NSAIDs can cause bleeding problems or serious gastrointestinal problems when they are used for too long or taken in excess. 

Natural alternatives to hydrocodone-acetaminophen

The management of pain should be approached from all angles, and approaches other than medication use may provide effective relief. 

Depending on the source of the pain, physical therapy may be an effective way to manage both acute and chronic pain, especially lower back pain, neck pain, shoulder pain, and some types of injuries or surgeries. By employing therapeutic exercise, manual therapy, heat, cold, and electrical stimulation, physical therapy aims to achieve optimal neuromuscular and skeletal function. 

The most effective non-drug treatment for chronic pain is cognitive behavioral therapy (CBT-CP). It is a form of psychotherapy, but the CDC, NIH, and healthcare professionals consider it a first-line treatment for chronic pain along with pain medicine. CBT doesn’t provide immediate relief, but typically requires several months of therapy to produce noticeable effects. The goal is long-term pain management without the need for strong or potentially harmful medications.

Other holistic approaches, such as acupuncture, turmeric, topical capsaicin, magnesium supplements, or the use of aromatherapy with different essential oils like peppermint oil or lavender oil, may also provide some pain relief or reduce inflammation over time. 

RELATED: 8 non-narcotic pain meds and other pain management tips

How to switch to a hydrocodone-acetaminophen alternative

If discontinuation of hydrocodone-acetaminophen is necessary for whatever reason, tapering the dose under the direct supervision of a healthcare provider is critical. Tapering helps to avoid unwanted side effects and minimize withdrawal symptoms—particularly in patients who have been on opioids long-term. 

Even switching to another opioid is a complex process. Opioids are not precisely interchangeable, so there’s a risk that the new opioid won’t be dosed correctly. This is why medication changes should always be executed under direct medical advice and supervision of a healthcare provider.

Choosing the right path for pain management

There is no perfect drug for pain. To start with, pain is subjective, so doctors must balance effective pain control with possible side effects and risks. As a result, pain treatment is always individualized, nuanced, and involves several modalities, including nonpharmaceutical therapies.

To ensure you receive the safest and most effective treatment, please provide as accurate and detailed information as possible about the pain you experience and its impact on your daily life. Do not exaggerate the pain and its effects on your life, but don’t minimize them, either. Keeping a pain diary can help the doctor determine whether treatment is working or creating new problems.

Always understand the treatment plan and commit to it. That includes non-drug therapies, as well. Start by asking the doctor how much pain relief is possible. In many cases, getting to zero pain is not a reasonable expectation, at least in the short term. Ask the doctor how long opioid medications are needed, what the alternatives are, what side effects to report, and when you can switch to a non-opioid pain medication.