Norco: 7 things you should know
Medically reviewed by C. Fookes, BPharm Last updated on Oct 3, 2019.
1. How it works
- Norco is a brand (trade) name for a combination narcotic pain-relieving medication (analgesic) that contains acetaminophen and hydrocodone.
- Acetaminophen and hydrocodone both relieve pain, but each works in a different way. Experts aren't sure exactly how acetaminophen works, but suspect it blocks a specific type of cyclo-oxygenase (COX) enzyme, located mainly in the brain. Hydrocodone binds to specific receptors known as mu opioid receptors and blocks pain signals on their way to the brain.
- Norco belongs to the group of medicines known as combination narcotic analgesics.
- Effective for the management of moderate to moderately-severe pain unresponsive to other nonnarcotic treatment options. Norco should be reserved for more severe types of pain, such as that caused by cancer.
- The combination is more effective than either drug alone.
- Norco is available as a generic under the name acetaminophen/hydrocodone.
If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:
- Stomach upsets, including nausea, vomiting, and constipation; shortness of breath; dizziness; low blood pressure; and headache (hydrocodone component).
- Drowsiness which may impair reaction skills and affect a person's ability to drive or operate machinery (hydrocodone component). Alcohol should be avoided as it may enhance drowsiness.
- Rarely, serious, life-threatening, breathing problems (hydrocodone component). Use of concomitant drugs that also cause respiratory depression or sedation (such as benzodiazepines or muscle relaxants), alcohol, or use in people with pre-existing respiratory disease may further increase the risk of respiratory depression.
- Risk of addiction, dependence, and withdrawal reactions (hydrocodone component); people with psychiatric disorders or a history of drug abuse are at the greatest risk. May be misused or sought after by drug addicts. Norco should only be taken at the minimum effective dosage for the shortest possible time. Babies born to mothers who have been taken Norco may suffer from withdrawal symptoms.
- Two different strengths of Norco exist: 7.5mg hydrocodone and 325mg of acetaminophen, and 10mg of hydrocodone and 325mg acetaminophen. These are not interchangeable.
- The duration of effect of the acetaminophen component is shorter than that of the hydrocodone component.
- Tolerance may develop if Norco is taken for long periods of time (relates to the hydrocodone component). This means that the same dosage may no longer provide the same pain-relieving effect.
- Rarely, liver failure has been reported (related to the acetaminophen component). The risk is highest when acetaminophen has been taken at dosages greater than 4000 mg/day or too frequently throughout the day.
- May not be suitable for some people including those with pre-existing respiratory disease; bowel blockages or problems; head injuries; liver, kidney or thyroid disease; difficulty urinating; a history of seizures or drug abuse. Rarely, adrenal insufficiency or serious skin reactions may occur.
- May interact with a number of other drugs including those metabolized by the cytochrome p450 3A4 enzyme such as erythromyicn, ketoconazole, and ritonavir.
Notes: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. For a complete list of all side effects, click here.
- May be taken with or without food.
- Norco should only be used for short periods of time, unless the pain being treated is caused by a terminal condition. Take exactly as directed by your doctor. Do not increase the dosage without his or her advice. Norco can be addictive and may cause withdrawal symptoms if abruptly discontinued; do not stop suddenly. When the time comes to discontinue Norco, your doctor will advise you how to taper it down.
- Norco may cause drowsiness which may impair reaction skills and affect your ability to drive or operate machinery (related to the hydrocodone component). Do not drive or perform hazardous tasks if affected. Avoid alcohol as this will contribute to the sedative effects of Norco.
- Two different strengths of Norco are available: one that contains 7.5mg of hydrocodone and 325mg of acetaminophen, and the other contains 10mg of hydrocodone and 325mg acetaminophen. Make sure you take the correct tablet and do not exceed the recommended dosage.
- Seek urgent medical advice if you experience any breathing difficulties, wheezing, itching, or facial swelling.
- Tell your doctor if you think you have become addicted to Norco or you feel that it is no longer relieving your pain.
- Avoid taking extra acetaminophen while taking Norco. Acetaminophen may be a component of many cold and flu combination medicines and you may not realize that you are doubling up on your acetaminophen dosage if you take these while you are taking Norco. Always ask your doctor or pharmacist if an over-the-counter medicine you wish to buy is compatible with Norco before buying it
6. Response and Effectiveness
- The hydrocodone component of Norco takes on average 1.3 hours to reach peak concentrations, and the acetaminophen component takes approximately 30 to 60 minutes to reach peak concentrations.
- The effects of the hydrocodone component last for about 4 to 6 hours, whereas the effects of the acetaminophen component last approximately 3 to 4 hours.
Medicines that interact with Norco may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with Norco. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.
Common medications that may interact with Norco include:
- antibiotics, such as erythromycin
- antidepressants, such as tricyclic antidepressants (eg, amitriptyline), monoamine oxidase inhibitors (eg, isocarboxazid, phenelzine, and tranylcypromine), or SSRIs (eg, fluoxetine, sertraline)
- antifungal agents, such as itraconazole and ketoconazole
- anticonvulsants, such as carbamazepine, lamotrigine, phenytoin, phenobarbital, or primidone
- antimigraine agents such as sumatriptan
- antipsychotics (such as butyrophenones, phenothiazines, or thioxanthenes) and atypical antipsychotics (eg, olanzapine, quetiapine, ziprasidone)
- any medication that may cause drowsiness, such as amphetamines, benzodiazepines (eg, diazepam, lorazepam), first-generation antihistamines (such as doxylamine or promethazine), metoclopramide, or opioids (such as codeine, morphine)
- HIV medications such as ritonavir
- muscle relaxants, such as cyclobenzaprine
- other medications that are CYP3A4 or CYP2D6 inhibitors or inducers
Avoid drinking alcohol or taking illegal or recreational drugs while taking Norco.
Note that this list is not all-inclusive and includes only common medications that may interact with Norco. You should refer to the prescribing information for Norco for a complete list of interactions.
Norco (hydrocodone bitartrate and acetaminophen) [Package Insert]. Revised 10/2018. Allergan, Inc. https://www.drugs.com/pro/norco.html
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Norco only for the indication prescribed.
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