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Norco (Hydrocodone/Acetaminophen): Uses, Risks and Addiction

Addiction is not a life sentence. There is hope, and recovery is possible.

Norco is a brand-name prescription pain reliever that combines hydrocodone, an opioid, with acetaminophen, the pain reliever in Tylenol. The hydrocodone can be habit-forming and can slow or stop breathing. The acetaminophen adds its own risk: too much of it can cause severe liver damage.

What Norco Is and Its Approved Use

Norco is one of several hydrocodone combination products. According to MedlinePlus, hydrocodone combinations that contain acetaminophen, such as Norco and Vicodin, are used to relieve severe pain. Other hydrocodone products, combined with different ingredients, are used for cough.

The two ingredients work in different ways:

  • Hydrocodone is an opioid. It changes the way the brain and nervous system respond to pain.
  • Acetaminophen is a pain reliever and fever reducer. It is not an anti-inflammatory drug like ibuprofen or naproxen.

The risk of addiction comes from the hydrocodone. The main added risk from the acetaminophen is liver damage.

How Norco Affects the Body and Brain

Opioids such as hydrocodone attach to receptors in the brain, spinal cord and body. NIDA explains that opioids block pain signals and also release large amounts of dopamine, a brain chemical linked to reward. That reward effect can reinforce taking the drug again.

Common side effects include nausea, vomiting, stomach pain, sweating, dizziness, constipation and reduced sex drive. Because Norco can make you drowsy and slow your reactions, avoid driving until you know how it affects you.

Short- and Long-Term Risks

  • Breathing problems. Hydrocodone can cause serious or life-threatening breathing problems, especially in the first 24 to 72 hours of treatment and after any dose increase.
  • Addiction. Hydrocodone combination products can be habit-forming. Regular use can lead to tolerance, physical dependence and opioid use disorder.
  • Harm to others. Norco can harm or kill a child or adult it was not prescribed for. Store it securely and dispose of leftover tablets safely.
  • Pregnancy. Regular use during pregnancy can cause life-threatening withdrawal symptoms in the newborn.
  • Serious side effects. Get medical help right away for extreme drowsiness, slowed breathing, seizures, chest pain, severe agitation or confusion, or signs of an allergic reaction such as rash, hives or swelling of the face or throat.

The acetaminophen and your liver

The FDA warns that taking too much acetaminophen can lead to liver failure and death. The risk rises if you have three or more alcoholic drinks a day while using it. Acetaminophen is in many prescription and over-the-counter products, including cold, flu and sleep medicines, and labels sometimes list it as “APAP.” Do not take more than one acetaminophen-containing product at a time, and do not add Tylenol to Norco unless your doctor tells you to. The FDA has also limited how much acetaminophen prescription combination products may contain.

Norco with Alcohol, Benzodiazepines and Other Sedatives

Combining hydrocodone with alcohol, benzodiazepines such as Xanax or Valium, sleep medicines or street drugs raises the risk of life-threatening breathing problems, deep sedation and coma. NIDA notes that taking opioids with alcohol or sedatives increases the risk of dangerously slowed breathing. With Norco, alcohol also adds to the liver risk from acetaminophen. Tell your doctor about every medicine and substance you use.

Drug Interactions

Hydrocodone interacts with many common medicines. Tell your doctor and pharmacist about everything you take, including over-the-counter medicines and supplements.

  • Antidepressants and migraine medicines. In 2016 the FDA required all opioid labels to warn that opioids taken with medicines that raise serotonin, such as SSRI, SNRI, tricyclic and MAOI antidepressants and triptans for migraine, can cause serotonin syndrome, a serious reaction. Get medical help right away for agitation, hallucinations, a fast heartbeat, fever, heavy sweating, shivering, muscle twitching or stiffness, or trouble with coordination.
  • Some antifungals and antibiotics. The prescribing information warns that medicines that block the liver enzyme CYP3A4, such as certain azole antifungals, some macrolide antibiotics and some HIV medicines, can raise hydrocodone levels. That can make side effects stronger and last longer, including dangerously slow breathing.
  • Muscle relaxants and other sedating medicines. Muscle relaxants, antipsychotics and other opioids add to hydrocodone’s sedation and can deepen breathing problems.
  • Asthma, COPD and other lung problems. Hydrocodone is riskier for people who already have breathing problems, because it can slow breathing further. Your doctor may decide a hydrocodone product is not right for you.

Overdose: Signs and What to Do

Signs of an opioid overdose include:

  • Slow, shallow or stopped breathing
  • Extreme sleepiness, or being unable to respond or wake up
  • Pupils that are very narrow or very wide
  • Cold, clammy or bluish skin
  • A slow heartbeat

Call 911 right away. Naloxone (Narcan) can reverse an opioid overdose if it is given quickly, and in 2023 the FDA approved Narcan nasal spray for sale without a prescription. Give the first dose, call 911 and stay with the person. If symptoms return before help arrives, another dose may be given every 2 to 3 minutes. Naloxone does not treat acetaminophen poisoning, so anyone who may have taken too much Norco needs medical care even if they wake up. Poison Control (1-800-222-1222) can also help.

Is Norco Addictive? Dependence and Withdrawal

Yes. The risk grows with higher doses, longer use, and a personal or family history of substance use. Physical dependence, where the body has adjusted to the drug, can develop with regular use even when it is taken as prescribed. Opioid use disorder is different: it means continuing to use despite harm and struggling to cut back.

Do not stop taking a hydrocodone product without talking to your doctor. Stopping suddenly can cause withdrawal symptoms such as restlessness, sweating, chills, muscle pain, anxiety, nausea, diarrhea and a fast heartbeat. A doctor can lower the dose gradually. If you are dependent on Norco or have been taking it in ways other than prescribed, a medically supervised detox can make stopping safer.

Signs that use has become a problem

Warning signs include taking more Norco than prescribed or more often, running out early, getting pills from more than one prescriber, taking someone else’s pills, using it to get high or to cope with stress, and wanting to cut back but not being able to. If any of these sound familiar, talk with your doctor honestly. They are a reason to get help, not a reason for shame.

Norco and the Law

Hydrocodone combination products, including Norco, are Schedule II controlled substances, the federal category for drugs with accepted medical use and a high potential for misuse. They were moved from Schedule III to Schedule II in 2014, after the DEA concluded that their abuse potential is similar to that of other Schedule II opioids such as oxycodone. Having or sharing Norco without a valid prescription is illegal.

Treatment for Norco Use in Florida

Opioid use disorder is a treatable medical condition. The most effective approach combines medication with counseling and support. SAMHSA lists three FDA-approved medications for opioid use disorder:

  • Methadone fully activates opioid receptors in a controlled way to ease withdrawal and cravings.
  • Buprenorphine partly activates the same receptors, which also eases withdrawal and cravings.
  • Naltrexone blocks opioids from attaching to the receptors. People usually need to be off opioids for about 7 to 10 days before starting it.

According to NIDA, people with opioid use disorder who receive methadone or buprenorphine are less likely to overdose or die than people who do not get treatment, and both medicines help people stay in treatment. SAMHSA describes these medicines as safe for long-term use, and they work for prescription opioids as well as for heroin. Talk with your doctor before stopping any of them.

Florida programs offer these medicines alongside counseling at every level of care, from detox and residential treatment to outpatient care. Explore Florida medication-assisted treatment, or search licensed Florida rehabs by location. Our directory lists facilities using SAMHSA FindTreatment.gov data.

Getting Help Now

  • Emergency or possible overdose: call 911.
  • SAMHSA National Helpline: 1-800-662-4357. It is free, confidential, open 24/7 and available in English and Spanish. They can help you find treatment and support near you.
  • Crisis or thoughts of suicide: call or text 988 to reach the Suicide & Crisis Lifeline.
  • Poison Control: 1-800-222-1222 for questions about a possible overdose or a medicine taken by mistake.

Sources

Frequently Asked Questions About Norco (Hydrocodone/Acetaminophen): Uses, Risks and Addiction

What is Norco?

Norco is a brand-name prescription pain reliever that combines hydrocodone, an opioid, with acetaminophen. It is a Schedule II controlled substance, the federal category for drugs with accepted medical use and a high potential for misuse. Hydrocodone combination products were moved into Schedule II in 2014 because their abuse potential is comparable to oxycodone.

How addictive is Norco?

Norco carries a real risk of addiction because hydrocodone is an opioid. Regular use can lead to tolerance, physical dependence and opioid use disorder, and the risk grows with higher doses, longer use and a personal or family history of substance use. Take it only as prescribed, never share it, and dispose of leftover pills safely.

Is it safe to take Tylenol while taking Norco?

No, you should not take Tylenol or other acetaminophen products with Norco unless your doctor says so, because Norco already contains acetaminophen. Too much acetaminophen can cause severe liver damage, and the risk is higher if you drink alcohol. Many cold, flu and sleep medicines also contain acetaminophen, so check labels or ask your pharmacist.

What should I do if someone overdoses on Norco?

Call 911 immediately if someone on Norco has slow or shallow breathing, cannot be woken, has pinpoint or widened pupils, or has cold, bluish skin. Give naloxone (Narcan) if you have it, since it can reverse an opioid overdose and is sold over the counter. Stay with the person; another dose may be needed if symptoms return.

Can you mix Norco with alcohol or anxiety medicine?

No, mixing Norco with alcohol, benzodiazepines such as Xanax or Valium, sleep medicines or street drugs can cause life-threatening breathing problems, deep sedation and coma. Alcohol also adds to the liver risk from acetaminophen. Tell your doctor about every medicine you take, and avoid driving until you know how Norco affects you.

Where can I get help for Norco addiction in Florida?

You can get help for Norco addiction at licensed Florida programs that offer medication for opioid use disorder alongside counseling. Buprenorphine, methadone and naltrexone are FDA-approved for this purpose, and stopping opioids suddenly on your own can bring painful withdrawal. Explore Florida medication-assisted treatment, or call SAMHSA's free helpline at 1-800-662-4357.