Norco (Hydrocodone/Acetaminophen): Opioid Combination for Moderate-Severe Pain
Norco is a brand name for hydrocodone bitartrate + acetaminophen (APAP). Schedule II controlled substance (US).
Formulations
| Hydrocodone | Acetaminophen | Common Strengths |
|---|
| 5 mg | 325 mg | Norco 5/325 |
| 7.5 mg | 325 mg | Norco 7.5/325 |
| 10 mg | 325 mg | Norco 10/325 |
Mechanism
- Hydrocodone: μ-opioid receptor agonist → ↓ pain perception, ↑ pain threshold, euphoria, respiratory depression.
- Acetaminophen: Central COX inhibition → antipyretic, analgesic; synergistic with opioid.
Risks & Monitoring
- Addiction, misuse, diversion (opioid).
- Hepatotoxicity: APAP >4 g/day (all sources) → acute liver failure. Check all meds for APAP.
- Respiratory depression: High dose, opioid-naïve, concurrent benzos/alcohol.
- Constipation, nausea, sedation, hypogonadism (chronic).
Prescribing Principles
Lowest effective dose, shortest duration, PDMP check, treatment agreement, urine drug screen, naloxone co-prescription if risk factors.
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