Norco

1 What is Norco?

Brand: Anexsia, Ceta Plus, Co-Gesic, Dolorex Forte, Hycet, Lorcet, Lortab, Lortab 10/325, Lortab 5/325, Lortab 7.5/325, Lortab Elixir, Maxidone, Norco, Stagesic, Verdrocet, Vicodin, Vicodin HP, Xodol, Zydone

Generic: Hydrocodone and acetaminophen

The drug Norco is a semi-synthetic opioid synthesized from codeine with mild to moderate analgesic efficacy. It is generally indicated for the management of pain that would not be well controlled with non-steroidal anti-inflammatory drugs (NSAIDs) or other, non-narcotic analgesics. As an opioid narcotic pain-reliever, it stimulates receptors on nerves in the brain to increase the threshold to pain and reduce the perception of pain. It has a high potential to lead to dependency and addiction if it is abused.

Additionally, Norco is one of the most commonly used opioids to suppress a cough. Cough suppression often occurs with a much lower doses of opioids than those needed for analgesia. Currently, this narcotic pain reliever is commonly available in combination with acetaminophen and other non-steroidal anti-inflammatory drugs, or NSAIDs.

What is acetaminophen?

Acetaminophen, also known as paracetamol, is a reliable and promptly acting analgesic as well as an antipyretic. It is one of the most commonly used over-the-counter analgesics for such pain as headache, mild migraine, musculoskeletal pain, dysmenorrhea, etc., but is considered to be relatively ineffective when inflammation is prominent, as in rheumatoid arthritis and other similar inflammatory conditions of the body. It exhibits analgesic action by peripheral blockage of pain impulse generation. Its weak anti-inflammatory activity is related to inhibition of prostaglandin synthesis in the central nervous system (CNS).

Moreover, it is recommended as the first choice analgesic for osteoarthritis by many healthcare professionals. It is also one of the best drugs to be used as an antipyretic, especially in children, as there is no risk of Reye’s syndrome. It produces antipyretic effects by inhibiting the hypothalamic heat regulating center.

In what way is a hydrocodone and acetaminophen combination drug different?

Hydrocodone and acetaminophen combination drugs are usually used to relieve moderate to moderately severe pain such as osteoarthritis, rheumatoid arthritis, chronic low back pain, renal stone pain, neuropathic pain, toothache, migraine, and so on. Although acetaminophen is a less potent pain reliever, it works together with hydrocodone to increase its effects.

Doctors typically prescribe this combination drug only for patients with severe pain resulting from surgery, disease progression, or injury.

Before using Norco or any other similar medications, you should tell your doctor if you are pregnant or if you will plan to become pregnant. Studies performed in pregnant women with such medications have demonstrated a risk to the fetus. It may slightly increase the risk of birth defects if used during the first two months of pregnancy. Also, using it for a long time or in high doses near the expected delivery date may harm the unborn baby. But potential benefits may warrant the use of this medicine despite potential risks only when clearly needed. This medication passes into breast milk in small amounts; however, it has not been reported to cause problems in nursing babies.

This medicine is available in the market only with your doctor's prescription.

This product is available in the following dosage forms:
• Capsule
• Elixir
• Liquid
• Solution
• Syrup
• Tablet

2 What to Know Before Using

If you are about to start using Norco with a prescription, the risk-benefit ratio should be considered carefully by both you and your doctor who will prescribe the medication. Norco treatment plans are usually chosen by a doctor with active participation of the patient. There are some important factors such as drug interactions, presence of any metabolic impairment, history of hypersensitivity reaction, pregnancy, lactation etc. that may alter the desired therapeutic effects of Norco or any medicine.

Sometimes the presence of other health disorders affects the beneficial effects of Norco and even may cause serious toxic effects. Be sure to let your doctor know about any allergic reactions you've had to any medication. The use of Norco is contraindicated in pregnancy and in those who are hypersensitive to this drug or any of the ingredients of the formulation.

Before you start Norco, make sure you inform your doctor if you have any other medical problems, especially:

  • History of alcohol abuse or drug dependency 
  • Breathing problems/lung diseases (e.g., asthma, emphysema
  • CNS depression 
  • Adrenal gland disorder (e.g., Addison’s disease) 
  • Enlargement of prostate (e.g., benign prostatic hypertrophy) 
  • Gastrointestinal problems 
  • Hypothyroidism 
  • Head injuries 
  • Liver and/or kidney diseases

Because of drug-drug interactions, certain medicines should not be used along with Norco. It is recommended to keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your physician. Besides, you should always consult with your doctor if you are in need of some other medications or even any over-the-counter medicine for another health problem in order to avoid unwanted toxic effects.

In addition, the following should be kept in mind:

  • Patients consuming alcohol, phenothiazine, tricyclic antidepressants, MAO inhibitors, amphetamine, neostigmine, antihistamines, or other central nervous system (CNS) depressants together with hydrocodone may exhibit an additive CNS depression.
  • Moreover, there are some drugs such as ketoconazole, serotonergic medications, narcotic antagonists (e.g., naltrexone, naloxone), and certain pain killers mixed with narcotic agonist/antagonists (e.g., pentazocine) which may interfere with Norco's intended effects.
  • Further, this medication slows absorption of many orally administered drugs by delaying gastric emptying. It also interferes with certain laboratory tests including amylase or lipase levels, possibly causing false or misleading test results. Thus, you must make sure laboratory personnel and your doctor know if you use this drug.
  • These drug interactions are possible, but do not always occur. Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Your doctor or pharmacist can often prevent or manage interactions by changing how you use your medications or by close monitoring.

Using Norco During Pregnancy and Lactation

Animal reproduction studies have shown an adverse effect, and there are no adequate and well-controlled studies in pregnant women. Thus, Norco should be used during pregnancy only if clearly needed. Besides, caution should be exercised when used in lactating women because studies in women suggest that this medication poses minimal risk to the infant when used during breastfeeding. An alternative to this medication should be used in such circumstances.

3 Proper Usage

Norco's dosage schedule and duration should be individualized and determined based on the physician’s advice for your particular condition. This medicine comes with patient information. You should read the instructions carefully before using this medicine. However, the dosages and administrations of this combination drug for moderate to moderately severe pain relief are described below:

For capsule dosage:

  • Adults—1 or 2 capsules every 4 to 6 hours as needed. Your doctor may increase your dose as needed. However, the dose is usually not more than 8 capsules per day.
  • Children—Use and dose must be determined by your doctor.

For oral solution dosage:

  • Adults and teenagers 14 years of age and older—15 milliliters (mL) or 1 tablespoonful every 4 to 6 hours as needed. Your doctor may increase your dose as needed. However, the dose is usually not more than 90 mL (6 tablespoonfuls) per day.
  • Children 10 to 13 years of age and weighing 32 to 45 kg—10 mL (2 teaspoonfuls) every 4 to 6 hours as needed. Your doctor may increase your dose as needed. However, the dose is usually not more than 60 mL (12 teaspoonfuls) per day.
  • Children 7 to 9 years of age and weighing 23 to 31 kg—7.5 mL (1 and 1/2 teaspoonfuls) every 4 to 6 hours as needed. Your doctor may increase your dose as needed. However, the dose is usually not more than 45 mL (9 teaspoonfuls) per day.
  • Children 4 to 6 years of age and weighing 16 to 22 kg—5 mL (1 teaspoonful) every 4 to 6 hours as needed. Your doctor may increase your dose as needed. However, the dose is usually not more than 30 mL (6 teaspoonfuls) per day.
  • Children 2 to 3 years of age and weighing 12 to 15 kg—3.75 mL (3/4 teaspoonful) every 4 to 6 hours as needed. Your doctor may increase your dose as needed. However, the dose is usually not more than 22.5 mL (4 and 1/2 teaspoonfuls) per day.
  • Children younger than 2 years of age—Use and dose must be determined by your doctor.

For oral elixir dosage:

Adults and teenagers 14 years of age and older and weighing 46 kg and above—11.25 milliliters (mL) every 4 to 6 hours as needed. Your doctor may increase your dose as needed. However, the dose is usually not more than 67.5 mL per day.

  • Children 10 to 13 years of age and weighing 32 to 45 kg—7.5 mL every 4 to 6 hours as needed. Your doctor may increase your dose as needed. However, the dose is usually not more than 45 mL per day.
  • Children 7 to 9 years of age and weighing 23 to 31 kg—5.6 mL every 4 to 6 hours as needed. Your doctor may increase your dose as needed. However, the dose is usually not more than 33.6 mL per day.
  • Children 4 to 6 years of age and weighing 16 to 22 kg—3.75 mL every 4 to 6 hours as needed. Your doctor may increase your dose as needed. However, the dose is usually not more than 22.5 mL per day.
  • Children 2 to 3 years of age and weighing 12 to 15 kg—2.8 mL every 4 to 6 hours as needed. Your doctor may increase your dose as needed. However, the dose is usually not more than 16.8 mL per day.
  • Children younger than 2 years of age—Use and dose must be determined by your doctor.

Above all, you should use Norco following all the directions given by your doctor only. If you miss a dose of this medicine, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. You must not double the dose to catch up. Further, you are advised not to use this drug in larger amounts, more often, or for a longer time than your doctor ordered.

Further, it is advised to store the medicine in a closed container at room temperature between 68-77 degrees F (20-25 degrees C) away from heat, moisture, and direct light. You should not store medicines in the bathroom.

All kinds of medicines should be kept out of the reach of children and pets. However, outdated medicines should be disposed by an appropriate way. You must not flush medications down the toilet or pour them into a drain unless instructed to do so. You may consult your pharmacist or local waste disposal company for more details about how to safely discard medicinal products.

4 Precautions to Take

There are many precautions associated with Norco and similar drugs. Firstly, regular visits to your doctor are recommended to check that this medicine is working properly or not. Additionally, the following guidelines should be followed strictly to prevent unwanted complications as well as for the better prognosis of the patients:

  • Before using this medicine, check with your doctor or pharmacist if you are allergic to this drug or if you have any other medicine as well as food allergies.
  • Norco and its associated brand names may contain certain inactive ingredients which can cause allergic reactions or other problems. If you have any questions regarding this matter, contact your doctor or pharmacist.
  • This combination medicine must not be used in undiagnosed acute abdominal pain because hydrocodone can aggravate certain conditions, e.g. diverticulitis, biliary colic, pancreatitis.
  • Infants and the elderly are more susceptible to the respiratory depressant action of hydrocodone.
  • Using hydrocodone is dangerous in patients with respiratory insufficiency (emphysema, pulmonary fibrosis, cor pulmonale); sudden deaths have occurred.
  • Hydrocodone should not be used in bronchial asthma as it precipitates an attack by its histamine releasing action.
  • Hypothyroidism, liver and kidney disease patients are more sensitive to hydrocodone.
  • Hydrocodone can be habit-forming, causing physical and psychological dependence. Unstable personalities are liable to continue with its use and become addicted.
  • Hypotensive and hypovolemic states exaggerate fall in BP due to hydrocodone.
  • Hydrocodone is contraindicated in patients with signs of head injury.
  • In elderly male patients, there are increased chances of urinary retention.
  • This drug is not recommended in premature infants (<2 kg) for fear of hepatotoxicity because of acetaminophen. The recommended dose is 325-650 mg which can be taken for 3-5 times in a day. In case of children, the therapeutic dose is 10-15 mg/kg.
  • Check with your doctor right away if you have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, unusual tiredness or weakness, or yellow eyes or skin. These could be symptoms of a serious liver problem.
  • Such combination drugs may cause drowsiness and impair your thinking or reactions. It may also impair the patient’s ability to drive and to use machineries. So, driving and operation of machineries should be avoided during treatment with such products.
  • Alcohol may increase your risk of liver damage while taking acetaminophen. You should avoid drinking alcohol while taking acetaminophen and hydrocodone.
  • This medicine may cause a serious type of allergic reaction called anaphylaxis that can be life-threatening. It requires immediate medical attention. Call your doctor right away if you have a rash, itching, hoarseness, trouble breathing, trouble swallowing, or any swelling of your hands, face, or mouth while you are using this medicine.

Using narcotics for a long time can cause severe constipation. To prevent this, you need to drink a lot of fluids, or increase the amount of fiber in your diet. Your doctor may direct you or your child to take laxatives. Be sure to follow the directions carefully, because continuing constipation can lead to more serious problems.

This medicine will add to the effects of CNS depressants such as antihistamines or medicine for allergies or colds, sedatives, tranquilizers, medicine for seizures or barbiturates, muscle relaxants, anesthetics, or other narcotics. 

Additionally, you should not use any prescription or nonprescription medicines, herbal preparations, or dietary supplements without checking with your doctor.

5 Potential Side Effects

Along with the beneficial effects, this medicine may cause some unwanted effects that may not need any medical attention. These side effects usually go away during the treatment episode as your body adjusts to the medicine.

Your healthcare professional may advise you about the ways how to prevent or reduce those unwanted side effects. Sometimes you may need to consult with the doctor if you notice any of the following toxic effects below.

Adverse effects of hydrocodone

  • Common side effects of hydrocodone are sedation, mental clouding, lethargy, chest tightness, constipation, and other subjective effects. Vomiting is occasional in recumbent patients.
  • Respiratory depression, blurring of vision, urinary retention (especially in elderly male) are other side effects. BP may fall, especially in hypovolemic patient and if he/she walks about.
  • Allergic reactions manifesting as skin rashes, swelling of lips occur infrequently. Anaphylactic reaction may occur but rarely.
  • Apnea of the newborn may occur when hydrocodone is given to the mother during labor. The blood-brain barrier of the fetus is undeveloped; hydrocodone attains higher concentration in fetal brain than in that of mother. Naloxone 10 µ/kg injected in the umbilical cord is the treatment of choice.
  • Acute poisoning may occur. It may be accidental, suicidal or seen in drug abusers. Manifestations are extensions of the pharmacological action. Stupor or coma, flaccidity, shallow and occasional breathing, cyanosis, pinpoint pupil, fall in BP and shock; convulsions may be seen in few, pulmonary edema occurs at terminal stages, death is due to respiratory failure.

Adverse effects of acetaminophen (paracetamol):

  • Nausea and rashes occur occasionally, and leukopenia is rare.
  • If a large dose (>150 mg/kg or >10 g in an adult) is taken, serious toxicity can occur.
  • Acute paracetamol poisoning occurs especially in small children who have low hepatic glucuronide conjugating ability.
  • Fatality is more common with >250 mg/kg.

Other side effects not listed may also occur in some patients. Symptoms of a serious allergic reaction to this medicine are unlikely but may occur in certain individuals manifesting as rash, itching, swelling, severe dizziness, or troubled breathing. If you notice any other effects including symptoms like these, check with your healthcare professional right away.

If your doctor has directed you to use Norco, keep in mind that he or she has determined that the intended positive benefit to you is greater than the risk of side effects. Most people using this medication do not have serious side effects.

You may call your doctor for medical advice about side effects. Also, you may report side effects to the FDA at 1-800-FDA-1088.

If overdose is suspected, you need to get an emergency medical help right away. You may contact a Poison Control Center right away. US residents can call their local poison control center at 1-800-222-1222.

Symptoms of Norco overdose include:

  • Bluish-colored fingernails and lips
  • Breathing problems, including slow and labored breathing, shallow breathing, or no breathing
  • Cold, clammy skin
  • Coma
  • Confusion
  • Dizziness
  • Drowsiness
  • Fatigue
  • Lightheadedness
  • Liver failure (from acetaminophen overdose)
  • Loss of consciousness
  • Low blood pressure
  • Muscle twitches
  • Tiny pupils
  • Seizures
  • Spasms of the stomach and intestines
  • Weakness
  • Weak pulse
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