Norco is a combination medication that contains hydrocodone (an opioid) and acetaminophen (an analgesic). It's used to manage pain for people who've tried non-opioid medications but haven't gotten enough relief. Norco (hydrocodone / acetaminophen) is a tablet that's taken by mouth. It takes about 30 minutes to start working. Side effects include constipation, nausea, and sleepiness. It's also a controlled substance because it has a high risk of misuse and dependency.
Please note: The brand name Norco is no longer available in the United States, but there are generic hydrocodone/acetaminophen tablets on the market.
Pain that isn't relieved by non-opioid pain medications alone
Norco (hydrocodone / acetaminophen) is a combination of two medications that work together to treat pain.
Hydrocodone is an opioid. It attaches to certain mu-opioid receptors in your brain to lower how much pain you feel.
Acetaminophen is an analgesic. It blocks the production of certain chemicals in your brain that play a role in pain. As a result, acetaminophen helps relieve pain.
Norco (hydrocodone / acetaminophen) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Risk factors: Personal or family history of alcohol or substance use disorder | Personal or family history of mental health conditions
Norco (hydrocodone / acetaminophen) is a controlled substance that has a risk for misuse and addiction. Take the medication exactly as prescribed. Don't change the dose or how often you take it without talking to your prescriber first.
Misusing Norco (hydrocodone / acetaminophen) might cause the medication to work less well. It can also raise the risk for serious and possibly life-threatening side effects, such as dangerously slow breathing, not able to stay awake, addiction, and opioid overdose. You'll be prescribed the lowest amount of Norco (hydrocodone / acetaminophen) that's necessary to manage your pain for the shortest period of time possible.
Because of the risk for misuse, addiction, and overdose, Norco (hydrocodone / acetaminophen) is only available through a Risk Evaluation and Mitigation Strategy (REMS) program called the Opioid Analgesic REMS program. Your prescriber and pharmacy must register with the program, receive training on proper medication use, and discuss with you about how to safely use Norco (hydrocodone / acetaminophen).
Risk factors: Taking medications that can cause slow breathing | Drinking alcohol | Older age | Being frail | Medical conditions that cause breathing problems (e.g., COPD, asthma, head injury) | Taking too much Norco (hydrocodone / acetaminophen)
Norco (hydrocodone / acetaminophen) can cause dangerously slow breathing, which can be life-threatening. This can happen to anyone and at recommended doses. But the risk is greatest when you first start treatment or when your dose goes up.
Don't drink alcohol while you're taking Norco (hydrocodone / acetaminophen). And don't take the opioid medication with other medications that slow your body down (e.g., benzodiazepines, other opioids, muscle relaxants). Doing so raises your risk of extremely slowed breathing.
Your prescriber might write a prescription for naloxone (Narcan), a medication that can reverse slowed breathing from opioids. Your prescriber will instruct you to carry it with you at all times. Use naloxone, call 911, and get medical help right away if you or your loved one notices that you have trouble breathing or have bluish-colored lips, fingers, or toes.
Risk factors: History of opioid use disorder | Previous opioid overdose | Taking high doses of Norco (hydrocodone / acetaminophen) | Taking more opioids than prescribed | Alcohol use
Take Norco (hydrocodone / acetaminophen) exactly as prescribed. Taking too much medication or taking it more often than prescribed can lead to an overdose. It can be very dangerous if someone accidentally swallows the medication. Be sure to keep the opioid medication out of reach from children, pets, or visitors to prevent accidental exposure or overdose.
Symptoms of an opioid overdose include not responding to sound or touch, extremely slowed breathing, extreme sleepiness, slow heartbeat, and cold or clammy skin. Be sure you and your loved ones know how to recognize an overdose. Your prescriber will probably write a prescription for naloxone (Narcan), a medication that can treat an opioid overdose. Carry naloxone with you at all times; use it and call 911 right away if an overdose happens.
Risk factors: Taking high doses of Norco (hydrocodone / acetaminophen) | Age 65 years or older | Drinking alcohol | Taking other medications that can cause sleepiness
Norco (hydrocodone / acetaminophen) can cause extreme sleepiness and lower your ability to think, react, and focus. Don't drink alcohol or take other medications that can cause sleepiness or "brain fog" (e.g., benzodiazepines, muscle relaxants, sleep medications) with Norco (hydrocodone / acetaminophen). Doing so can worsen these side effects.
Make sure you know how Norco (hydrocodone / acetaminophen) affects you before driving a car or doing activities that require your concentration. Talk to a healthcare professional (HCP) if you feel too sleepy from the medication.
Risk factors: Drinking alcohol | Taking other medications containing acetaminophen | Taking too much Norco (hydrocodone / acetaminophen) | History of liver problems
Norco (hydrocodone / acetaminophen) contains acetaminophen. Taking too much acetaminophen can cause liver damage that can be life-threatening. The risk for liver damage is higher if you're taking more than one medication that contains acetaminophen, if you already have liver problems, or if you regularly drink alcohol.
Let your prescriber know about your medical history, especially if you have liver problems, before you take Norco (hydrocodone / acetaminophen). Also avoid drinking alcohol while you're taking this medication. Your prescriber can discuss how much acetaminophen you can take per day depending on your age and your risk for liver damage.
Call an HCP right away if you notice any symptoms of liver damage. These symptoms can include tiredness, dark urine, upset stomach, stomach pain, or yellowing of the skin or whites of the eyes.
Norco (hydrocodone / acetaminophen) interacts with a lot of common medications. So it's important to tell your prescriber and pharmacist about the medications you're taking and planning to take with Norco (hydrocodone / acetaminophen). Your care team can check that your medications are safe to take together. Also talk to your care team first before making any changes to your medications because sudden dose adjustments can also lead to harm.
Some interactions can raise the level of Norco (hydrocodone / acetaminophen) in your body. This can raise your risk for serious side effects, including potentially life-threatening slowed breathing. Examples of medications that can lead to this type of interaction with Norco (hydrocodone / acetaminophen) include erythromycin, ketoconazole, and ritonavir (Norvir).
Other drug interactions can lower the levels of Norco (hydrocodone / acetaminophen) in your body. This can cause the opioid medication to work less well for pain and possibly lead to withdrawal symptoms. These interactions include taking Norco (hydrocodone / acetaminophen) with rifampin (Rifadin) or carbamazepine (Tegretol).
Long-term use of Norco (hydrocodone / acetaminophen) during pregnancy can cause your unborn baby to become dependent on the medication. This is because the opioid in the medication (hydrocodone) can pass through the placenta to your unborn baby.
Once your baby is born, they can experience withdrawal symptoms, such as high-pitched crying, poor feeding behavior, trembling, abnormal sleep patterns, and seizures. This condition is called neonatal opioid withdrawal syndrome and can be life-threatening if not recognized and treated in time. Let your HCP know if you've used Norco (hydrocodone / acetaminophen) during pregnancy or if you notice these symptoms in your baby.
Risk factors: Allergy to other opioids
Severe allergic reactions to Norco (hydrocodone / acetaminophen) are possible, including life-threatening reactions like facial swelling, shock, and anaphylaxis (e.g., closing of the throat). Additionally, acetaminophen can rarely cause serious skin reactions, such as rash, blisters, skin reddening, or skin peeling. Get medical attention right away if you notice these types of changes in your skin, swelling of the lips or tongue, or difficulty breathing after you take this medication.
Risk factors: Long-term use of Norco (hydrocodone / acetaminophen)
Norco (hydrocodone / acetaminophen) can cause physical dependence when it's taken for a long period of time. This means that your body starts to rely on the medication to function. You might experience withdrawal if you suddenly stop taking the medication or lower your dose too fast. Withdrawal symptoms can be bothersome and include anxiety, restlessness, irritability, runny nose, sweating, and chills.
Don't lower your dose or stop taking the medication suddenly without talking to your prescriber first. Your prescriber will slowly lower your dose to prevent withdrawal symptoms. Talk to your prescriber about alternative pain medications if you have concerns about the risk for dependence and withdrawal with Norco (hydrocodone / acetaminophen).
Norco (hydrocodone / acetaminophen) can cause extremely low blood pressure. Your blood pressure might drop when you stand from a sitting or lying down position. This can lead to dizziness and fainting. To avoid falling, get up slowly if you've been sitting or lying down. Talk to your HCP if any dizziness or lightheadedness doesn't go away.
Risk factors: Taking Norco (hydrocodone / acetaminophen) for longer than 1 month
Some people taking opioid medications like Norco (hydrocodone / acetaminophen) have had low adrenal hormone levels. This might be more likely to happen after taking opioids for longer than 1 month. Symptoms include tiredness, dizziness, weakness, not feeling hungry, nausea, and vomiting. Tell your HCP if you have these symptoms. If your adrenal hormone levels are too low, you might need to stop Norco (hydrocodone / acetaminophen) and be treated with corticosteroids.
Risk factors: History of seizure conditions
Opioids such as hydrocodone can raise the risk of having seizures more often in people who've had one before. Norco (hydrocodone / acetaminophen) can also raise your risk of seizures in certain situations. Get medical help right away if you have a seizure while you're taking this medication.
Source:Â DailyMed
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Dizziness
lightheadedness
Incidence not known
Back, leg, or stomach pains
black, tarry stools
bleeding gums
blood in the urine or stools
blood in vomit
bluish lips or skin
chills
choking
dark urine
decrease in the frequency of urination
decrease in urine volume
difficult or trouble breathing
difficulty in passing urine (dribbling)
difficulty with swallowing
fast heartbeat
fever with or without chills
general body swelling
general feeling of tiredness or weakness
headache
hoarseness
irregular, fast or slow, or shallow breathing
light-colored stools
loss of appetite
lower back or side pain
nosebleeds
not breathing
painful or difficult urination
pale or blue lips, fingernails, or skin
pinpoint red spots on the skin
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
severe or continuing stomach pain
sore tongue
sores, ulcers, or white spots on the lips or in the mouth
tightness in the chest
unable to speak
unusual bleeding or bruising
unusual tiredness or weakness
upper right abdominal or stomach pain
vomiting
yellow eyes and skin
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
Bloody or cloudy urine
change in consciousness
chest pain or discomfort
cold and clammy skin
decreased awareness or responsiveness
extreme drowsiness
general feeling of discomfort or illness
increased sweating
irregular heartbeat
lightheadedness, dizziness, or fainting
loss of consciousness
no blood pressure or pulse
no muscle tone or movement
not breathing
severe sleepiness
slow or irregular heartbeat
stopping of heart
sudden decrease in the amount of urine
unpleasant breath odor
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Drowsiness
relaxed and calm feeling
sleepiness
Incidence not known
Belching
changes in mood
difficulty having a bowel movement
fear or nervousness
feeling of indigestion
hearing loss
impaired hearing
pain in the chest below the breastbone
unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Can be habit-forming
Not recommended to take with other medications containing acetaminophen since it can raise the risk of liver damage
Is a controlled medication, so there are special requirements to get a prescription filled
It's common to have constipation as a side effect of Norco (hydrocodone / acetaminophen). Drink enough water each day and add more foods with fiber to your diet. Speak to your care team if these lifestyle changes aren't enough to help with this side effect. They can recommend medications or a change in your pain treatment.
Don't drink alcohol while you're taking Norco (hydrocodone / acetaminophen). Mixing them together can make you very sleepy or dizzy and unable to think clearly. It can also harm your liver.
Take Norco (hydrocodone / acetaminophen) exactly as your prescriber instructed you to. Don't change your dose or stop taking the medication without talking to your prescriber first. Your prescriber might lower your dose slowly over a period of time before you can completely stop the medication. This lowers your risk for bothersome withdrawal symptoms like muscle aches, chills, and trouble sleeping.
Make sure to always have naloxone (Narcan) with you. Naloxone is a medication that's used to help reverse the effects of Norco (hydrocodone / acetaminophen) in situations like an accidental overdose. Teach your loved ones about how to give naloxone to you if you can't do it yourself. Be sure to call for emergency help if you need to use naloxone because its effects are temporary.
Let your prescriber know if you're pregnant before you start taking Norco (hydrocodone / acetaminophen) or if you become pregnant while you're taking this medication. Norco (hydrocodone / acetaminophen) isn't recommended during pregnancy.
Tell your healthcare team if you're breastfeeding. It's typically recommended to avoid Norco (hydrocodone / acetaminophen) because the opioid medication can get into breast milk. This raises the risk for serious side effects to your baby (e.g., sleepiness, slowed breathing).
Keep Norco (hydrocodone / acetaminophen) out of reach from children, pets, or visitors. There are a few drug take-back options to safely get rid of the medication if you don't need to take it anymore. This lessens the risk for accidental overdose and medication misuse.
Your prescriber will work with you to find the right dose of Norco (hydrocodone / acetaminophen) for your individual needs. It's recommended to use the lowest dose possible for the shortest duration of time to manage your pain.
The typical starting dose is 5 mg/325 mg (hydrocodone/acetaminophen) by mouth every 4 to 6 hours as needed for pain.
Keep in mind that this medication is available in different strengths — the tablets can contain different amounts of hydrocodone and acetaminophen in them. Make sure you know which strength you're using and how to take it properly. Ask your prescriber or pharmacist if you have any questions about your dose.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Severely slowed breathing (respiratory depression)
Severe asthma
Medical conditions that cause blockage of the stomach passageway
Allergy to hydrocodone or acetaminophen
Pain that isn't relieved by non-opioid pain medications alone
Short-term relief of minor aches and pains due to headache, muscle aches, minor arthritis pain, toothache, backache, the common cold, or menstrual cramps
Fever
Mild-to-moderate pain
Pain from rheumatoid arthritis (RA) or osteoarthritis (OA)
Pain from menstrual cramps
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