To prevent this, your doctor may direct you or your child to take laxatives, drink a lot of fluids, or increase the amount of fiber in your diet. This medicine may cause sleep-related breathing problems (eg, sleep apnea, sleep-related hypoxemia). Your doctor may decrease your dose if you have sleep apnea (stop breathing for short periods during sleep) while using this medicine. Monitor closely, especially upon initiation or following a dose increase. Use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals see WARNINGS.
If concomitant use is necessary, consider increasing the NORCO dosage until stable drug effects are achieved. If a CYP3A4 inducer is discontinued, consider NORCO dosage reduction and follow for signs of respiratory depression. Explain to patients and caregivers that naloxone’s effects are temporary, and that they must call 911 or get emergency medical help right away in all cases of known or suspected opioid overdose, even if naloxone is administered see OVERDOSAGE. Opioids can cause sleep-related breathing disorders including central sleep apnea (CSA) and sleep-related hypoxemia. In patients who present with CSA, consider decreasing the opioid dosage using best practices for opioid taper see DOSAGE AND ADMINISTRATION.
- Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
- Assess each patient’s risk before prescribing, and monitor for development of these behaviors and conditions.
- Both tolerance and physical dependence can develop during chronic opioid therapy.
- Monitor for respiratory depression, which can be serious, life-threatening, or fatal, especially during initiation or following a dose increase.
- Speak to your doctor about how drug interactions should be managed.
There are no standard opioid tapering schedules that are suitable for all patients. Good clinical practice dictates a patient-specific plan to taper the dose of the opioid gradually. For patients on NORCO who are physically opioid-dependent, initiate the taper by a small enough increment (e.g., no greater than 10% to 25% of the total daily dose) to avoid withdrawal symptoms, and proceed with dose-lowering at an interval of every 2 to 4 weeks.
It is important to ensure ongoing care of the patient and to agree on an appropriate tapering schedule and follow-up plan so that patient and provider goals and expectations are clear and realistic. When opioid analgesics are being discontinued due to a suspected substance use disorder, evaluate and treat the patient, or refer for evaluation and treatment of the substance use disorder. Treatment should include evidence-based approaches, such as medication assisted treatment of opioid use disorder.
Adverse Reactions/Side Effects
Assess each patient’s risk for opioid addiction, abuse, or misuse prior to prescribing NORCO, and monitor all patients receiving NORCO for the development of these behaviors and conditions. Risks are increased in patients with a personal or family history of substance abuse (including drug or alcohol abuse or addiction) or mental illness (e.g., major depression). The potential for these risks should not, however, prevent the proper management of pain in any given patient. Patients at increased risk may be prescribed opioids such as NORCO, but use in such patients necessitates intensive counseling about the risks and proper use of NORCO along with intensive monitoring for signs of addiction, abuse, and misuse. Consider prescribing naloxone for the emergency treatment of opioid overdose see WARNINGS; Life-Threatening Respiratory Depression, DOSAGE AND ADMINSTRATION; Patient Access to Naloxone for the Emergency Treatment of Opioid Overdose.
- Initiate the dosing regimen for each patient individually, taking into account the patient’s severity of pain, patient response, prior analgesic treatment experience, and risk factors for addiction, abuse, and misuse.
- Despite the common belief that you must take ibuprofen with food, you can safely take low-dose ibuprofen (up to 1200 mg daily in divided doses for 1 to 7 days) on an empty stomach, and this provides faster pain relief than taking ibuprofen with food.
- Hydrocodone is a drug of abuse and you should be aware if anyone is using your medicine improperly or without a prescription.
OTC Pain Relievers: First-Line Treatment for All Types of Pain
CYP3A4 mediated N-demethylation to norhydrocodone is the primary metabolic pathway of hydrocodone with a lower contribution from CYP2D6 mediated O-demethylation to hydromorphone. Hydromorphone is formed from the O-demethylation of hydrocodone and may contribute to the total analgesic effect of hydrocodone. Therefore, the formation of these and related metabolites can, in theory, be affected by other drugs see PRECAUTIONS; Drug Interactions. N-demethylation of hydrocodone to form norhydrocodone via CYP3A4 while O-demethylation of hydrocodone to hydromorphone is predominantly catalyzed by CYP2D6 and to a lesser extent by an unknown low affinity CYP enzyme.
Pain Type-Specific Treatment Approaches
This symptom is a significant clinical clue and can be caused by various drugs and toxins. Some examples include opioids, clonidine, buspirone, and metoclopramide. Because opioids usually work better in combination with other analgesics, both oxycodone and hydrocodone are available formulated with other ingredients such as acetaminophen or ibuprofen.
Hydrocodone and its metabolites are eliminated primarily in norco and alcohol food interactions the kidneys. Pinpoint pupils are a sign of opioid overdose but are not pathognomonic (e.g., pontine lesions of hemorrhagic or ischemic origins may produce similar findings). Marked mydriasis rather than miosis may be seen due to hypoxia in overdose situations. However, specific CNS opioid receptors for endogenous compounds with opioid-like activity have been identified throughout the brain and spinal cord and are thought to play a role in the analgesic effects of this drug.
Mechanical/Injury Pain (Strains, Fractures, Post-Surgical)
Limit dosages and durations to the minimum required and follow patients for signs and symptoms of respiratory depression and sedation. Neonatal opioid withdrawal syndrome presents as irritability, hyperactivity, abnormal sleep pattern, high pitched cry, tremor, vomiting, diarrhea and failure to gain weight. The onset, duration, and severity of neonatal opioid withdrawal syndrome vary based on the specific opioid used, duration of use, timing and amount of last maternal use, and rate of elimination of the drug by the newborn. Observe newborns for symptoms of neonatal opioid withdrawal syndrome and manage accordingly see WARNINGS. If urgent use of an opioid is necessary, use test doses and frequent titration of small doses to treat pain while closely monitoring blood pressure and signs and symptoms of CNS and respiratory depression.
Hydrocodone Advantages:
Never share Norco with another person, especially someone with a history of drug abuse or addiction. Follow patients for signs and symptoms of respiratory depression and sedation. Under the requirements of the REMS, drug companies with approved opioid analgesic products must make REMS-compliant education programs available to healthcare providers. Use with CYP3A4 inhibitors or inducers may change hydrocodone plasma levels resulting in prolonged adverse effects or potentially fatal respiratory depression; monitoring is recommended. Instruct patients to swallow extended release forms whole to avoid potentially fatal overdose. When prescription pain medication is truly necessary, hydrocodone offers lower abuse risk for chronic conditions while oxycodone provides lower constipation risk for short-term use.
Just one dose can cause death in someone using this medicine accidentally or improperly. Ask your pharmacist where to locate a drug take-back disposal program. If there is no take-back program, flush the unused medicine down the toilet. Humira is a tumor necrosis factor blocker used to treat many inflammatory conditions in adults …
Norco – Clinical Pharmacology
Strategies to reduce these risks include prescribing the drug in the smallest appropriate quantity and advising the patient on the proper disposal of unused drug see PRECAUTIONS; Information for Patients. Contact local state professional licensing board or state-controlled substances authority for information on how to prevent and detect abuse or diversion of this product. Take hydrocodone and acetaminophen exactly as it was prescribed for you. Never take hydrocodone and acetaminophen in larger amounts, or for longer than prescribed. Tell your doctor if you feel an increased urge to use more of this medicine. Other drugs may interact with acetaminophen and hydrocodone, including prescription and over-the- counter medicines, vitamins, and herbal products.
Chronic use of opioids may influence the hypothalamic-pituitary-gonadal axis, leading to androgen deficiency that may manifest as symptoms as low libido, impotence, erectile dysfunction, amenorrhea, or infertility. Accidental ingestion of NORCO, especially by children, can result in a fatal overdose of NORCO see WARNINGS. Note that this list is not all-inclusive and includes only common medications that may interact with Norco. You should refer to the prescribing information for Norco for a complete list of interactions. Medicines that interact with Norco may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with Norco. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does.