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Drug Highlights

Generic Name: Hydrocodone-Acetaminophen

Brand Name: Norco, Vicodin

Classified as: Opioid (Narcotic)

What is Norco?

Norco is an oral administration tablet that consists of acetaminophen and hydrocodone. Hydrocodone/acetaminophen is an opioid and a non-opioid combination that works by binding the mu- receptor in the brain. It got approval for medical use in the USA in 1982. Norco is a schedule II-controlled substance under the CSA (Controlled Substance Act) 1970. It is one of the most prescribed pain medications in the United States.

Norco comes in different strengths of hydrocodone with 325 milligrams of acetaminophen. In addition to these drugs, Norco pills also contain some inactive ingredients such as croscarmellose sodium, colloidal silicon dioxide, microcrystalline cellulose, crospovidone, povidone, stearic acid, pregelatinized starch, sugar spheres made of corn starch, sucrose, and FDA approved color additives.

Uses

Norco is a two-ingredient formula consisting of an opiate and a non-opiate analgesic. It is useful in pain management. Norco relieves mild, acute, severe, chronic, or preoperative types of pain. It is available in tablet formulations in varying strengths. Due to its associated risk of abuse, misuse, and diversions, Drug Enforcement Administration (DEA) re-scheduled hydrocodone from schedule-III to schedule-II controlled substance.

The recreational use of Norco escalated in recent years due to the opioid effects of hydrocodone. It comes under the C category for pregnancy. Norco possesses risks for pregnant women and unborn babies. Patients with kidney impairment should use with caution. Liver impairment patients should not use Norco due to the presence of acetaminophen in it.

Side Effects

The most common side effects of Norco are sedation, lightheadedness, nausea, dizziness, and vomiting. These effects are more prominent in ambulatory patients, and they may alleviate if a patient lies down.

Other side effects include:

Gastrointestinal System

Continued use of Norco may produce constipation.

Central Nervous System

Lethargy, mental clouding, drowsiness, fear, anxiety, impairment of the physical or mental performance, mood changes, psychic dependence, dysphoria.

Respiratory Depression

Hydrocodone in Norco produces dose-related respiratory depression as it acts directly on the brain stem respiratory center.

Genitourinary System

Spasm of vesical sphincters, ureteral spasm, and urinary retention are some common genitourinary effects caused by the use of opiates.

Dermatological

Pruritus, skin rashes

Potential effects of acetaminophen can cause a rash, allergic reactions, agranulocytosis, thrombocytopenia.

Special Senses

Patients with a chronic overdose of Norco may suffer from cases of hearing impairment and permanent loss of hearing.

Dependence and Diversion

Physical or psychic dependence and tolerance may develop by the prolonged use of Norco. Hence, doctors should prescribe it with caution. However, there are lower chances of developing a psychic dependence when a patient uses Norco for short-term pain relief.

Physical dependence is due to the continued administration of Norco. It may develop even after a few weeks of administration. Physical dependence makes it difficult for a patient to quit medicine. It may cause severe withdrawal symptoms on discontinuation.

Tolerance is the requirement of increasingly large doses to produce the same level of analgesia or a shortened period of analgesic effects. It subsequently decreases the intensity of pain-relieving effects. The rate of tolerance development widely varies from patient to patient.

Interactions

Norco produces several severe drug interactions with other opioids, antipsychotics, antianxiety agents, antihistamines, or central nervous system depressants such as alcohol. These interactions may produce life-threatening CNS depression. When a patient needs to take a dosage of both medications, reduce the dose of one or both of them.

The use of tricyclic antidepressants or monoamine oxidase inhibitors with hydrocodone increases the effects of one or both drugs.

Acetaminophen may produce false urinary 5-hydroxy indole acetic acid test positive results.

Warnings

  • Abdominal conditions: Norco administration may obscure clinical course or diagnosis of acute intestinal conditions in patients.
  • Head injury: Norco produces respiratory depression and elevation of cerebrospinal fluid pressure. It exaggerates in patients with a head injury, intracranial lesions, or pre-existing increased intracranial pressure. Additionally, Norco causes some adverse reactions that may obscure the clinical course of head injury patients.
  • Respiratory depression: In sensitive patients or at high doses, hydrocodone produces dose-related respiratory depression. It also affects the center controlling respiratory rhythm, which can cause periodic or irregular breathing.
  • Hypersensitivity: The use of acetaminophen causes hypersensitivity and anaphylaxis. Clinical symptoms include respiratory distress, swelling of the mouth, face, and throat, rash, urticaria, vomiting, and pruritus. Life-threatening anaphylaxis requiring medical attention may occur in some rare cases. Patients with acetaminophen allergy should not take Norco in any case.
  • Severe skin reactions: Acetaminophen causes severe fatal skin reactions such as Stevens-Johnson Syndrome (SJS), Acute Generalized Exanthemata Pustulosis (AGEP), and Toxic Epidermal Necrolysis (TEN). Doctors should inform patients about the signs of severe skin reactions. Discontinue using Norco at the first appearance of any sign of hypersensitivity.
  • Hepatotoxicity: The use of acetaminophen causes acute liver failure, which results in liver transplant and even death. Acetaminophen doses exceeding 4000 milligrams per day cause liver injuries. Acute liver failure occurs mostly in patients with underlying liver diseases. Taking alcohol and acetaminophen together also has adverse effects on the liver. Doctors should instruct patients not to use more than one product containing acetaminophen.

Dosing

A doctor should adjust the dosage according to the intensity of pain and response of each patient.

While prescribing the dosage of Norco, keep in mind that hydrocodone tolerance and dependence could develop with continued use.

The usual daily dosage for an average adult is one to two pills of Norco 5/325 milligrams every 4-6 hours as required by an individual patient.

The daily dosage should not surpass 8 tablets of Norco 5/325 milligrams. Do not take additional acetaminophen than 4 grams of in a day.

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