Key takeaways:
Norco (hydrocodone / acetaminophen) and Percocet (oxycodone / acetaminophen) are prescription pain medications. They both contain opioids and acetaminophen (Tylenol).
The opioid in Norco is hydrocodone. The opioid in Percocet is oxycodone. One may be more likely to cause certain side effects than the other.
Both Norco and Percocet are Schedule 2 controlled substances. They have a high risk for misuse and dependence.
Norco (hydrocodone / acetaminophen) and Percocet (oxycodone / acetaminophen) are pain medications with many similarities. They’re both opioids. They’re both FDA approved to treat severe pain that doesn’t improve with non-opioid medications. And they’re both controlled substances with similar risks, including physical dependence, misuse, and overdose.
While Norco and Percocet have many similarities, they have a few differences, too. Here, we’ll cover three major differences between Norco versus Percocet.
Good to know: Brand-name Norco is no longer available. But hydrocodone / acetaminophen is still known by this name. So we’ll refer to it as Norco throughout this piece.
1. Norco and Percocet contain different opioids
Norco and Percocet each have two ingredients: an opioid and acetaminophen, which is the main ingredient in Tylenol. But the opioids in Norco and Percocet are different. Norco contains hydrocodone and Percocet contains oxycodone. They’re both short-acting medications that are effective at treating pain in certain situations.
Acetaminophen, hydrocodone, and oxycodone are all pain relievers. But acetaminophen isn’t an opioid like hydrocodone and oxycodone are. While opioids work by attaching to opioid receptors throughout the body, the way acetaminophen works isn’t as clear. But it likely affects multiple chemicals in the brain and spinal cord. Besides reducing pain, it can also lower fevers (opioids don’t have this effect).
2. Some side effects may be more likely with Norco or Percocet
Norco and Percocet have many similar side effects. Common opioid side effects include:
Nausea
Constipation
Feeling tired
Dizziness
It's possible that certain side effects may be more likely with Norco versus Percocet. For example, in a study of people with bone fractures treated in an emergency department, more people taking hydrocodone had constipation than those taking oxycodone. But keep in mind that this was a small study of less than 100 people. Other research shows that oxycodone may be more likely to cause nausea and dizziness than hydrocodone. Though different studies show conflicting results.
Even though Norco and Percocet are similar, some people may tolerate one better than the other. For example, if you’re taking Norco and experiencing bothersome side effects that don’t improve over time, your healthcare provider may switch you to Percocet to see if these side effects improve.
Serious side effects
More severe opioid side effects of Norco and Percocet include slowed breathing and overdose. This can be fatal. Overdose is more likely to happen if opioids are taken with other substances that can also slow breathing. Examples include alcohol and benzodiazepines like alprazolam (Xanax).
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You may also experience acetaminophen side effects with Norco and Percocet. Although acetaminophen isn’t known to cause side effects, it potentially can lead to serious risks like:
Liver damage. Liver damage is more of a risk in people who take high doses of acetaminophen, have existing liver problems, or drink a lot of alcohol. Symptoms of liver damage include stomach pain, vomiting, and low blood pressure.
Skin reactions. Severe skin reactions from acetaminophen are rare but possible. They include toxic epidermal necrolysis (TEN), acute generalized exanthematous pustulosis (AGEP), and Stevens-Johnson Syndrome (SJS). Let your healthcare provider know if you have an unusual rash or skin blisters while taking these medications.
These risks are possible, but rare.
Good to know: Acetaminophen is an ingredient in many over-the-counter (OTC) medications, including NyQuil Cold & Flu (acetaminophen / dextromethorphan / doxylamine) and Excedrin Migraine (acetaminophen / aspirin / caffeine). Make sure you read the medication labels of any OTC products you take to avoid taking too much acetaminophen. For most people, the maximum acetaminophen dosage for most adults is 4,000 mg per day (or lower in some situations). If you’re not sure whether a medication contains acetaminophen, ask your pharmacist.
3. Norco and Percocet are schedule 2 substances, but Norco wasn’t always in this category
Norco and Percocet are controlled substances. But some people perceive Norco as having less risk for misuse or dependence than Percocet. This, however, isn’t true. To understand what this means, let’s talk about what exactly a controlled substance is.
These are substances and medications that are more likely to cause dependence and misuse than medications that aren’t controlled. The Drug Enforcement Administration (DEA) divides controlled substances into “schedules.” The medications and substances in each schedule have different levels of risk.
Schedule 1 substances have the highest risk for misuse. This group contains illegal substances, such as heroin and lysergic acid diethylamide (LSD). Schedule 5 medications are considered least likely to cause dependence and misuse. But they’re still more risky than non-controlled medications. This includes cough medications that contain the opioid codeine.
Norco and Percocet are Schedule 2 substances. But Norco was a schedule 3 controlled substance until 2014. This meant that at that time, it was considered less risky than Percocet. In 2014 the DEA changed their stance, stating that Norco was just as risky. Both Norco and Percocet have a greater risk for dependence and misuse than most other medications.
Good to know: If you take an opioid, it’s a good idea to have a naloxone (Narcan, Zimhi) product on hand. This antidote to opioid overdose can be lifesaving. And it’s now available OTC.
Can you take Norco and Percocet together?
It’s usually not safe to take more than one opioid at a time. Taking Norco and Percocet together raises your risk of having too many opioids in your system. This can lead to trouble breathing and overdose. It also increases your risk of taking too much acetaminophen. This can increase your risk of liver damage.
In some situations, your healthcare provider may believe the benefit of combining opioids outweighs the risk. For example, some people with cancer pain may need a short-acting and long-acting opioid to treat severe pain. But keep in mind that Norco and Percocet are both short-acting opioids, so combining them (even in cancer pain) is usually not recommended.
No matter what, you shouldn’t take more than one opioid at a time unless instructed to by a qualified healthcare provider.
The bottom line
Norco (hydrocodone / acetaminophen) and Percocet (oxycodone / acetaminophen) are both prescription pain medications. They each contain an opioid and acetaminophen. They’re Schedule 2 controlled substances with a high risk for dependence and misuse. But when comparing Norco versus Percocet, Norco contains hydrocodone and Percocet contains oxycodone. And they may have differing side effects.
If you’re prescribed Norco or Percocet, follow your healthcare provider’s instructions carefully. This minimizes your risks of serious side effects.
Why trust our experts?
If you or someone you know struggles with substance use, help is available. Call SAMHSA’s National Helpline at 1-800-662-4357 to learn about resources in your area.
References
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Parisi, R., et al. (2023). Acute generalized exanthematous pustulosis: Clinical features, differential diagnosis, and management. American Journal of Clinical Dermatology.
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