Norco and Vicodin are two brand-name medications used in the management of moderate to severe pain. Norco and Vicodin are both a combination of two drugs—hydrocodone and acetaminophen—and are classified as opioid pain relievers. In 2014, the Drug Enforcement Administration (DEA) changed its classification from Schedule III to Schedule II due to the high potential for addiction, abuse, and misuse. Schedule II is the most dangerous schedule of drugs available with an accepted medicinal use.
What are the main differences between Norco and Vicodin?
Norco is a prescription medication that contains a combination of 325 mg of acetaminophen with either 5 mg, 7.5 mg, or 10 mg of hydrocodone. Hydrocodone, a derivative of codeine, works to decrease pain perception by binding to opioid receptors in the central nervous system. In doing so, it is thought to alter our perception of pain, though the exact mechanism is not known. Acetaminophen, which is the active ingredient in over-the-counter Tylenol formulations, also achieves its analgesic effects through the central nervous system by activating the descending serotonergic pathways.
Vicodin is also a prescription drug that is a combination of hydrocodone and acetaminophen. The primary difference between Norco and Vicodin is that Vicodin only contains 300 mg of acetaminophen, instead of 325 mg. Vicodin combines 300 mg of acetaminophen with either 5 mg, 7.5 mg, or 10 mg of hydrocodone.
Both Norco and Vicodin are oral tablets and have generic forms available. Norco and Vicodin are metabolized by the liver and excreted by the kidneys.
|Main differences between Norco and Vicodin|
|Drug class||Opiate analgesic||Opiate analgesic|
|Brand/generic status||Brand and generic available||Brand and generic available|
|What is the generic name?||Hydrocodone/acetaminophen||Hydrocodone/acetaminophen|
|What form(s) does the drug come in?||Oral tablet||Oral tablet|
|What is the standard dosage?||5 mg/325 mg every 4 to 6 hours||5 mg/300 mg every 4 to 6 hours|
|How long is the typical treatment?||7 days or less||7 days or less|
|Who typically uses the medication?||Children 2 years of age and older, adults||Children 2 years of age and older, adults|
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Conditions treated by Norco and Vicodin
Norco and Vicodin are each indicated in the treatment of moderate to severe pain for which other non-opioid options have been inadequate. Due to the potential for abuse and misuse of the drug, it is important that the use of Norco and Vicodin be limited to patients who have tried other pain-relieving options and have inadequate or no relief of symptoms. If the use of opiate pain relievers is deemed necessary, every attempt should be made to limit use to as short-term as possible.
|Moderate to severe pain||Yes||Yes|
Is Norco or Vicodin more effective?
Norco and Vicodin are a combination of the same two drugs and vary only by 25 mg in acetaminophen content. Their efficacy is best understood when compared to other pain management options as their expected efficacy is similar due to content similarities.
Prescribers are encouraged to utilize non-opiate or less addictive options prior to prescribing opiates. A study was conducted comparing the efficacy of tramadol, a Schedule IV controlled substance and the active ingredient in Ultram, to the combination of hydrocodone/acetaminophen.
These drugs were randomized to patients who had mild to moderate pain following a musculoskeletal trauma. The study concluded that pain relief was superior in patients who received hydrocodone/acetaminophen compared to those who received tramadol. This study also found that side effects such as dizziness, nausea, and vomiting were reported at a higher rate in the tramadol group.
A more recent study compared the combination of oxycodone/acetaminophen to hydrocodone/acetaminophen in acute musculoskeletal pain. The combination of oxycodone/acetaminophen has been a Schedule II controlled substance for much longer than hydrocodone/acetaminophen. The results found that oxycodone/acetaminophen was not superior to hydrocodone/acetaminophen in pain relief. Both drugs displayed an ability to decrease pain by approximately 50%.
Only your physician can determine which pain medication is appropriate for you. Oftentimes, physicians will select a drug based on experience and make dose adjustments or drug changes after observing patient response.
Coverage and cost comparison of Norco vs. Vicodin
Norco and Vicodin are typically covered by both commercial and Medicare prescription plans, though some limitations may apply. The DEA and Centers for Medicare Services recognize the opiate abuse epidemic and its potential effects on our society. In response, on Jan. 1, 2019, many prescribing limitations and guidelines went into effect.
There are many facets to this effort to control opiate prescribing and abuse. Medicare Part D beneficiaries who are opiate naive are limited to a seven-day prescription upon an initial fill of an opiate. A patient’s need must be reassessed at the end of the seven days in order to receive more medication. (Opiate naive is defined as not having taken an opiate in the past 60 days.) After seven days, if additional medication is needed, prescribers may prescribe longer term. There are exceptions to these rules, such as hospice and cancer-related care. Some chronic pain diagnoses qualify for prescribing exceptions as well. Many commercial insurance plans have adopted similar limitations for their beneficiaries. Pharmacies may also have specific policies for the filling of opiate medications.
The average retail cost of generic Norco can be as much as $100 for 90 tablets of the 10 mg/325 mg strength. You can purchase the generic version with a coupon from SingleCare, and get it for less than $30.
Vicodin is usually covered in its generic form by most insurance companies, and by some Medicare Part D plans. An average prescription of Vicodin can cost about $400. A SingleCare coupon can reduce the price of generic Vicodin to less than $100 depending on which pharmacy you use.
|Typically covered by insurance?||Yes, with limitations||Yes, with limitations|
|Typically covered by Medicare?||Yes, with limitations||Yes, with limitations|
|Standard dosage||10 mg/325 mg tablets||5/300 mg tablets|
|Typical Medicare copay||Typically less than $20||Typically less than $20|
Common side effects of Norco vs. Vicodin
Norco and Vicodin have the potential to cause the same side effects due to their similar content. Side effects related to their effect on the central nervous system include drowsiness, dizziness, and headache. Each patient may experience these adverse effects in varying degrees and it may depend on dose.
Opiate pain relievers are known to cause constipation, especially when given for longer periods of time. Increasing water intake or taking stool softeners may help mitigate this side effect.
The following list is not intended to be an all-inclusive list of potential side effects. You should consult with your doctor, pharmacist, or healthcare provider for a complete list of adverse events and medical advice.
|Drowsiness||Yes||Not defined||Yes||Not defined|
|Lethargy||Yes||Not defined||Yes||Not defined|
|Headache||Yes||Not defined||Yes||Not defined|
|Dizziness/ Lightheadedness||Yes||Not defined||Yes||Not defined|
|Mood changes||Yes||Not defined||Yes||Not defined|
|Constipation||Yes||Not defined||Yes||Not defined|
|Nausea||Yes||Not defined||Yes||Not defined|
|Vomiting||Yes||Not defined||Yes||Not defined|
|Pruritus||Yes||Not defined||Yes||Not defined|
|Skin rash||Yes||Not defined||Yes||Not defined|
Drug interactions of Norco vs. Vicodin
The drug interaction profiles for Norco and Vicodin are similar due to the fact that they contain the same active ingredients.
The concomitant use of opiates such as Norco and Vicodin with other CNS depressants should be avoided whenever possible. Examples of other CNS depressants include benzodiazepines, other opiate painkillers, and cannabinoid drugs. The use of these medications together can lead to severe respiratory depression, profound sedation, low blood pressure, coma, or death.
The use of serotonergic agents, such as selective serotonin reuptake inhibitors (SSRIs), with Norco or Vicodin, can increase the risk of serotonin syndrome. Serotonin syndrome is characterized by increased heart rate, high blood pressure, confusion, and tremors.
Opioid pain relievers may decrease the effects of diuretics through the release of antidiuretic hormone. This can lead to changes in fluid status and blood pressure.
The following table is not intended to be a complete list of potential drug interactions. Consult a medical professional for a complete list and advice on interactions.
|Monoamine oxidase inhibitors||Yes||Yes|
|Selective serotonin reuptake inhibitors||Yes||Yes|
Warnings of Norco and Vicodin
Alcohol use should be avoided in patients who take Norco or Vicodin. Alcohol could increase the serum concentration of hydrocodone and therefore enhance the CNS depressant effects.
Norco and Vicodin are metabolized by the liver and excreted by the kidneys. Prescribers may need to adjust the dose in patients who have liver damage or impaired kidney function.
Norco and Vicodin are pregnancy category C, meaning there are no human studies proving harm or safety in pregnant patients. The use of these drugs should be limited to only absolutely necessary use. Both hydrocodone and acetaminophen are present in the breast milk of lactating mothers. The use of Norco and Vicodin in breastfeeding mothers should only be done when the benefit clearly outweighs the risk.
It is important to note that both Norco and Vicodin are highly addictive drugs. They each have high potential for abuse, misuse, physical dependence, and addiction. They should only be used when all other non-opiate treatment options have been exhausted. Their use should be limited to as short of a term as possible. If a patient has been taking hydrocodone products for an extended period of time, they may be prone to withdrawal symptoms if they stop abruptly. Discontinuation after high dose and long-term use of opioid analgesics should be done with physician oversight.
Frequently asked questions about Norco vs. Vicodin
What is Norco? / Is Norco an opioid?
Norco is an opioid pain reliever that contains a combination of hydrocodone and acetaminophen. It is available by prescription only as an oral tablet and is classified by the DEA as a Schedule II narcotic. Norco is approved in the treatment of moderate to severe pain.
What is Vicodin?
Vicodin is an opioid pain reliever that contains a combination of hydrocodone and acetaminophen. It is available by prescription only as an oral tablet and is classified by the DEA as a Schedule II narcotic. Vicodin is intended to be used in the treatment of moderate to severe pain.
Are Norco and Vicodin the same?
Norco and Vicodin both contain hydrocodone and acetaminophen, but are not exactly the same. While each comes in strengths containing 5 mg, 7.5 mg, or 10 mg of hydrocodone, their acetaminophen content is slightly different. Norco contains 325 mg of acetaminophen, while Vicodin contains 300 mg.
Is Norco or Vicodin better?
It is reasonable to expect the efficacy of Norco and Vicodin to be very similar to each other given that they only vary by 25 mg of acetaminophen. Studies have shown (see above) the combination of hydrocodone and acetaminophen to be superior to tramadol, and at least equal to the combination of oxycodone and acetaminophen.
Can I use Norco or Vicodin while pregnant?
There are no good studies in humans proving safety in pregnancy. Based on studies in animals, the use of Norco or Vicodin in pregnancy should only be if the perceived benefit outweighs the risk.
Can I use Norco or Vicodin with alcohol?
Alcohol may increase the blood concentration of hydrocodone and enhance the CNS depressive effects. Patients taking Norco or Vicodin should avoid alcohol.
Is it easy to get addicted to hydrocodone?
Hydrocodone is highly addictive. The DEA reclassified it to a Schedule II narcotic in 2014 due to patterns of abuse and misuse. Hydrocodone products should only be used in moderate to severe pain in which other non-opiate options have proven unsuccessful.