Watson 349 Pill – Acetaminophen and Hydrocodone Bitartarate

The drug is a white oval pill with the word “WATSON 349″ written on it. The size is about 15mm x 6mm with a thickness of about 4mm. See picture on the right. It is a combination of two important analgesics namely Acetaminophen and hydrocodone bitartarate. It contains 500 milligrams of acetaminophen and 5 milligram of hydrocodone bitartarate. Mechanism of action of both medications is different. Acetaminophen controls pain by inhibiting nitric oxide pathway mediated by a number of neurotransmitters mainly substance P and N-methyl-D-aspartate. Hydrocodone on the other hand, is an opioid analgesic that acts by activating opioid receptors present in the brain and spinal cord; activation of these receptors is a natural pain relief method also used by our body. Due to two different mechanism of pain relief, Watson 349 is more potent painkiller than either of the two drugs present in a single pill.

The pill is commonly available in most of the countries of the world. Most common brand is Vicodin manufactured by Watson Pharmaceuticals, United States of America. It is also marketed by other brand names for example Lortab and Narco. Combination of acetaminophen and hydrocodone are also available in strengths that are different from Watson 349. Other preparations with different strength are Watson 3202 (acetaminophen 325 milligrams and hydrocodone 5 milligrams) and Watson 503(acetaminophen 650 milligram and hydrocodone 10 milligrams.

What Is It Used For

The pill is an effective analgesic that can be used in a variety of medical conditions that need pain relief. The beauty of this drug is hidden behind the facts that on one hand it is moderately strong oral preparation of analgesics while on the other hand it is devoid of erosive effect on the stomach (a common problem with the use of non steroidal anti-inflammatory drugs). Despite of the long-term use it causes gastric inflammation or ulceration less commonly than non steroidal anti-inflammatory drugs. It relieves pain effectively but it should be ensured that patient don’t overdose, that may lead to serious consequences.

Some of the common conditions in which it is useful are:

  • Osteoarthritis of back, knee joints, shoulder joints, wrist joint, ankle joints and other joints. Osteoarthritis is a chronic condition and patient suffering from osteoarthritis does not get cure of this diseases. He or she needs painkillers off and on and sometimes on daily basis. This pill is an ideal choice for such a disease due to lesser side effects.
  • Rheumatoid arthritis: again it is a chronic condition which often starts in young to middle aged women and continues throughout life. It can be used in rheumatoid arthritis to control pain in mild to moderate disease.
  • Joint pains in systemic lupus arthritis, sacro-iliitis and other musculoskeletal disorders
  • It is also useful in acute back pain/ chronic back pain and neuropathic pains
  • Migraine or tension headaches may be relieved by taking the medication
  • It is also very useful in cancer palliative therapy to control pains of malignancies or cancer. Cancer patients who have advanced stage disease and cure of the disease is not possible, controlling pain becomes difficult. In such situation the pill is effective with few side effects of the medication.

Above mentioned are some of the conditions where it can provide effective pain relief. In addition, the doctors also prescribe it in a number of other conditions.


The drug should be used in the dosage prescribed by the doctor or pharmacist for the specific duration told. Dosage may vary according to severity of the problem for which this medicine is used. Usual dosage is one tablet every four to six hours for the prescribed period as advised by the doctor. Total daily dosage should not five tablets. Patient can take it empty stomach or with meals. Patients, who feel more nausea and vomiting, should take this medicine with meals to avoid these side effects.

If a dose is missed

In case a dose of Watson 349 is missed, it should be taken as early as remembered but if time for the next dose has reached, only take the usual dose. Two doses should not be taken at one time.

Over dosage

Over dosage of Watson 349 may result in a number of symptoms depending upon how much quantity or tablets have been taken. In case, a single extra tablet or two are taken usually don’t cause any symptoms. If patient has ingested more tablets either incidentally or as a suicidal attempt, local poisoning control service should be called and patient should get immediate management for over dosage.

Symptoms of over dosage include bluish discoloration of the skin, cold and clammy skin difficult drowsiness that may lead to coma, difficulty in breathing or slow breathing, excessive perspiration (sweating) disturbed functions of cardiovascular system, nausea or vomiting, convulsion (seizures) pain abdomen and bilateral constricted pupils (pin point pupils)

Management of over dosage should be done at medical emergency or intensive care setting. Management includes gastric lavage and decontamination with activated charcoal, anti-dote for acetaminophen and hydrocodone where signs of toxicity appear and supportive measures to breathing and cardiovascular dysfunction.

Please call 911 immediately if there are cases of overdose.

How to Store

Ways to store watson 349:

  • Keep it in the container, tightly close and away from direct sunlight.
  • Keep medicine away from children ( This medication is not suitable for children below 18 years old)
  • Store it as per the instruction stated in the packaging (Usually 15 and 30 degrees Celsius).
  • If medication is expired, do not consume.

Please always follow the prescription label closely on the storage of Watson 349. Read the patient information leaflet and the fine print carefully.


Some medications and medical conditions may interact with Watson 349 resulting in unfavorable effects. So before starting this medication it is necessary to inform your doctor if you have any of the following conditions:

  • Brain tumor
  • Head injury, hydrocephalus or other central nervous system disorders
  • Kidney disease
  • Drug abuse or  drug addiction
  • Inflammatory bowel disease (IBD): ulcerative colitis or Crohn’s disease
  • Drinking alcohol more than three drinks in a day
  • Heart disease or other cardiovascular problems
  • Liver disease including acute and chronic hepatitis or cirrhosis of liver
  • Lung disease, bronchial asthma, obstructive sleep apnea or other breathing disorders
  • Know allergy to acetaminophen or hydrocodone bitartarate or narcotic analgesics or other medication or foods
  • If you are a lactating mother (breast-feeding the baby)
  • If you are planning to conceive or you are pregnant
  • If you already are taking some drugs both prescribed and unperceived, dietary supplement as well as herbal remedies.
  • If you have previously made suicidal attempt or have suicidal thinking
  • If you have intestinal or gastric problems, intestinal obstruction, recent abdominal surgery, chronic inflammation or ulceration of the gut, problems of adrenal gland; prostate gland enlargement

Also inform your doctor before starting Watson 349, if you are taking any of the following medications:

  • Barbiturate anesthetics (e.g., thiopental),
  • Monoamine oxidase inhibitors for example phenelzine
  • tricyclic antidepressants or TCAs e.g., amitriptyline
  • Naltrexone
  • Alcohol or medicines that contain alcohol
  • Cimetidine,
  • Antihistamines
  • Medicines for depression, anxiety, schizophrenia or other mental disorders
  • Medicines for pain management like buprenorphine, butorphanol, pentazocine, tramadol, propoxyphene and nalbuphine.
  • Sleeping pills
  • Muscle relaxants
  • Naltrexone
  • Isoniazid
  • Phenobarbital
  • Ritonavir

If have another surgery, always share with your doctor or health care provider that you are currently consuming watson 349 as this medicine may have conflicting effect with other medicine.

Conditions that Are Not Suitable for Watson 349

Below are the conditions that may not be suitable to take this medication:

  • Patient who have allergy to acetaminophen or opioid should not use it
  • Patients who use alcohol or certain other medicines that increases dizziness and drowsiness should not use this drug otherwise these symptoms may get worsened. For the same reason patients who are drivers or perform high risk tasks at some factory, should also avoid it
  • Concomitant use of sleeping pills or muscle relaxants with Watson 349 should be avoided. Before starting, if patient is taking such medication he or she should tell the pharmacist or doctor.
  • Use in elderly patients is not suitable because of the potential side effects like drowsiness, light-headedness and dizziness. This may lead to increased chances of falling and fractures in elderly
  • Patients with liver disease should avoid this drug because it may aggravate liver damage and push the patient to hepatic encephalopathy.
  • Use in small children is not safe and may result in harmful side effects so, it should not be used in children
  • People with lung disease and breathing problems should not use the drug especially patient who have chronic obstructive pulmonary disease, bronchial asthma, obstructive sleep apnea and respiratory failure
  • Patient with kidney disease, renal failure and analgesic abuse nephropathy should avoid Watson 349 otherwise serious outcomes may result. Such patient with organ failure becomes drowsy and even unconscious which may remain for days.
  • This medication is contraindicated in acute liver failure
  • Pregnancy and breast-feeding are the conditions in which the pill is relatively contra-indicated and should be avoided. If someone is on Watson 349 treatment and gets pregnancy, she should immediately contact her doctor. Breast-feeding mothers should not use it or avoid breast-feeding during its use.

Some of the conditions may not be listed in this website. Always consult your doctor or health care provider before consuming the drug.

Allergy symptoms

As we know that allergy or hypersensitivity to any drug can happen so is with Watson 349. Sometimes mild allergic symptoms appear which disappear on discontinuing the drug. Severe allergic symptoms warrant immediate contact with emergency medical service and urgent treatment of hypersensitivity.

Mild Symptoms

If a patient taking Watson 349 develops itching, hives and redness of the skin and no problem with breathing occurs, these are symptoms of mild hypersensitivity which will settle on withdrawing the medication and sometime use of anti-histamine drugs. Even the mild allergy symptoms indicate that this drug no more should be used. Doctor should be informed about these symptoms.

Severe Symptoms

Severe allergic reactions to this medication may appear within seconds to minutes after taking this medication in-patient who are allergic to either of the two components of Watson 349. Patient with severe allergy develop following symptoms:

  • Skin rash
  • Hives and urticaria
  • Symptoms of angioedema, which include swelling of lips throat and chest tightness, which cause difficulty in breathing and in severe cases no breathing at all.
  • Changes or loss of hearing
  • Unconsciousness
  • Severe anxiety along with mental and mood changes
  • Fear
  • Decreased urine output

These hypersensitivity symptoms need urgent treatment in medical emergency otherwise patient may die. Important measures to overcome this dangerous situation are use of anti-histamine drugs, steroids, adrenaline injection and maintaining the airway with passing endotracheal tube or performing emergency tracheotomy (in cases where swelling of the larynx does not allow endotracheal intubation). Patient needs admission in intensive care unit for extensive monitoring till his or her condition is out of danger.