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5 Interactions found for:

Norco
Interactions Summary
  • 3 Major
  • 0 Moderate
  • 2 Minor
  • Norco

Drug Interactions

A total of 635 medications are known to interact with Norco. Add another medication to view potential interactions with this medication.

Common Interactions Checks

Drug and Food Interactions

Major
Norco + Food

The following applies to the ingredients: Hydrocodone (found in Norco)

GENERALLY AVOID: Alcohol may potentiate the central nervous system (CNS) depressant effects of opioid analgesics including hydrocodone. Concomitant use may result in additive CNS depression and impairment of judgment, thinking, and psychomotor skills. In more severe cases, hypotension, respiratory depression, profound sedation, coma, or even death may occur.

GENERALLY AVOID: Consumption of alcohol while taking some sustained-release formulations of hydrocodone may cause rapid release of the drug, resulting in high systemic levels of hydrocodone that may be potentially lethal. Alcohol apparently can disrupt the release mechanism of some sustained-release formulations. In study subjects, the rate of absorption of hydrocodone from an extended-release formulation was found to be affected by coadministration with 40% alcohol in the fasted state, as demonstrated by an average 2.4-fold (up to 3.9-fold in one subject) increase in hydrocodone peak plasma concentration and a decrease in the time to peak concentration. Alcohol also increased the extent of absorption by an average of 1.2-fold (up to 1.7-fold in one subject).

GENERALLY AVOID: Grapefruit juice may increase the plasma concentrations of hydrocodone. The proposed mechanism is inhibition of CYP450 3A4-mediated metabolism of hydrocodone by certain compounds present in grapefruit. Increased hydrocodone concentrations could conceivably increase or prolong adverse drug effects and may cause potentially fatal respiratory depression.

MANAGEMENT: Patients taking sustained-release formulations of hydrocodone should not consume alcohol or use medications that contain alcohol. In general, potent narcotics such as hydrocodone should not be combined with alcohol. Patients should also avoid consumption of grapefruit or grapefruit juice during treatment with hydrocodone.

References

  1. "Product Information. Zohydro ER (hydrocodone)." Zogenix, Inc (2013):

The following applies to the ingredients: Acetaminophen (found in Norco)

GENERALLY AVOID: Chronic, excessive consumption of alcohol may increase the risk of acetaminophen-induced hepatotoxicity, which has included rare cases of fatal hepatitis and frank hepatic failure requiring liver transplantation. The proposed mechanism is induction of hepatic microsomal enzymes during chronic alcohol use, which may result in accelerated metabolism of acetaminophen and increased production of potentially hepatotoxic metabolites.

MANAGEMENT: In general, chronic alcoholics should avoid regular or excessive use of acetaminophen. Alternative analgesic/antipyretic therapy may be appropriate in patients who consume three or more alcoholic drinks per day. However, if acetaminophen is used, these patients should be cautioned not to exceed the recommended dosage (maximum 4 g/day in adults and children 12 years of age or older).

References

  1. Kaysen GA, Pond SM, Roper MH, Menke DJ, Marrama MA "Combined hepatic and renal injury in alcoholics during therapeutic use of acetaminophen." Arch Intern Med 145 (1985): 2019-23
  2. O'Dell JR, Zetterman RK, Burnett DA "Centrilobular hepatic fibrosis following acetaminophen-induced hepatic necrosis in an alcoholic." JAMA 255 (1986): 2636-7
  3. Seeff LB, Cuccherini BA, Zimmerman HJ, Adler E, Benjamin SB "Acetaminophen hepatotoxicity in alcoholics." Ann Intern Med 104 (1986): 399-404
  4. Thummel KE, Slattery JT, Nelson SD "Mechanism by which ethanol diminishes the hepatotoxicity of acetaminophen." J Pharmacol Exp Ther 245 (1988): 129-36
  5. McClain CJ, Kromhout JP, Peterson FJ, Holtzman JL "Potentiation of acetaminophen hepatotoxicity by alcohol." JAMA 244 (1980): 251-3
  6. Kartsonis A, Reddy KR, Schiff ER "Alcohol, acetaminophen, and hepatic necrosis." Ann Intern Med 105 (1986): 138-9
  7. Prescott LF, Critchley JA "Drug interactions affecting analgesic toxicity." Am J Med 75 (1983): 113-6
  8. "Product Information. Tylenol (acetaminophen)." McNeil Pharmaceutical PROD (2002):
  9. Whitcomb DC, Block GD "Association of acetaminopphen hepatotoxicity with fasting and ethanol use." JAMA 272 (1994): 1845-50
  10. Bonkovsky HL "Acetaminophen hepatotoxicity, fasting, and ethanol." JAMA 274 (1995): 301
  11. Nelson EB, Temple AR "Acetaminophen hepatotoxicity, fasting, and ethanol." JAMA 274 (1995): 301
  12. Zimmerman HJ, Maddrey WC "Acetaminophen (paracetamol) hepatotoxicity with regular intake of alcohol: analysis of instances of therapeutic misadventure." Hepatology 22 (1995): 767-73

Drug and Pregnancy Interactions

The following applies to the ingredients: Hydrocodone (found in Norco)

Benefit should outweigh risk

US FDA pregnancy category: Not assigned

Risk Summary: Based on animal data, may cause fetal harm; prolonged maternal use of opioids during pregnancy may cause neonatal opioid withdrawal syndrome.

Comments:
-Women should be advised of the risk of neonatal abstinence syndrome and ensure that appropriate treatment will be available.
-Long-acting opioids should not be used during and immediately prior to labor, when short acting analgesics or other analgesic techniques are more appropriate.

Rats administered this drug during gestation and lactation showed increases in stillborn pups and decreases in pup survival at doses equivalent to the human dose of 100 mg/day. Reduced nursing behavior and decreased body weights were observed at 2 times the human dose. Reduced fetal weights were observed in rabbits given this drug during the period of organogenesis at doses equivalent to 5 times the human dose of 100 mg/day. Additionally, increases in the number of umbilical hernias, irregularly shaped bones, and delays in fetal skeletal maturation were observed in the study at doses 15 times the human dose of 100 mg/day. No fetal malformations were observed in rats and rabbits at doses approximately 2 (rats) and 10 (rabbits) times a human dose of 100 mg/day. Prolonged use of opioid analgesics during pregnancy for medical or nonmedical purposes may cause neonatal opioid withdrawal syndrome. There are no controlled data in human pregnancy.

Chronic opioid use may cause reduced fertility in males and females; it is unknown whether these effects on fertility are reversible.

US FDA pregnancy category Not Assigned: The US FDA has amended the pregnancy labeling rule for prescription drug products to require labeling that includes a summary of risk, a discussion of the data supporting that summary, and relevant information to help health care providers make prescribing decisions and counsel women about the use of drugs during pregnancy. Pregnancy categories A, B, C, D, and X are being phased out.

References

  1. "Product Information. Zohydro ER (hydrocodone)." Zogenix, Inc (2013):
  2. "Product Information. Hysingla ER (hydrocodone)." Purdue Pharma LP (2014):

The following applies to the ingredients: Acetaminophen-Hydrocodone (found in Norco)

Benefit should outweigh risk

US FDA pregnancy category: C

Comments:
-Prolonged use of opioids during pregnancy can result in physical dependence in the neonate; women should be advised of the risk of neonatal abstinence syndrome and ensure that appropriate treatment will be available.
-Monitor neonates exposed to opioid analgesics for signs of excess sedation and respiratory depression.

Opioid analgesics cross the placenta. Hydrocodone use during labor may cause respiratory depression in the newborn infant. Prolonged use of opioids during pregnancy can result in physical dependence in the neonate and neonatal opioid withdrawal syndrome shortly after birth. The onset, duration, and severity of the condition will vary based on maternal use (duration of use, timing, and amount of last use) and rate of elimination in the newborn. Acetaminophen has not been associated with major congenital malformations, although animal studies have identified adverse effects at clinically relevant doses. Epidemiologic data do not clearly report an association with oral acetaminophen and major birth defects, miscarriage, or adverse maternal or fetal outcomes when this drug is used during pregnancy, but due to methodological limitations cannot definitively establish the absence of any risk. In pregnant rats receiving oral drug at doses up to 0.88 times maximum human daily dose (MHDD) during organogenesis, fetotoxicity (reduced fetal weight and length) and dose-related increases in bone variations (reduced ossification and rudimentary rib changes) were observed. Areas of necrosis in both the liver and kidney of pregnant rats and fetuses were observed when pregnant rats were given oral drug throughout gestation at doses 1.2 times the maximum human daily dose. There are no controlled data in human pregnancy.

Chronic use of opioids may cause reduced fertility; it is unknown whether these effects are reversible.

FDA pregnancy category C: Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

References

  1. "Product Information. Norco (acetaminophen-hydrocodone)." Allergan Inc (2017):
  2. "Product Information. Lortab (acetaminophen-hydrocodone)." Akorn Inc (2017):
  3. "Product Information. Acetaminophen-Hydrocodone Bitartrate (acetaminophen-hydrocodone)." Mikart Inc (2017):

The following applies to the ingredients: Acetaminophen (found in Norco)

Benefit should outweigh risk

AU TGA pregnancy category: A
US FDA pregnancy category: Not Assigned

Risk Summary: A clear association of drug use and birth defects, miscarriage, or adverse maternal or fetal outcomes has not been shown with human use; animal studies have demonstrated adverse events at clinically relevant doses.

In pregnant rats receiving oral drug at doses up to 0.85 times maximum human daily dose (MHDD) during organogenesis, fetotoxicity and dose-related increases in bone variations (reduced ossification and rudimentary rib changes) were observed. Areas of necrosis in both the liver and kidney of pregnant rats and fetuses were observed when pregnant rats were given oral drug throughout gestation at doses 1.2 times the maximum human daily dose. Animal studies using the IV formulation have not been performed. In humans, this drug and its metabolites cross the placental barrier. Large cohort studies have not found an association between maternal use in the first trimester and either adverse pregnancy outcomes or congenital malformations. Some evidence of increased risk of neurodevelopmental disorders (e.g., attention deficit hyperactivity disorder [ADHD]), respiratory illness (e.g., asthma) and reproductive toxicity (e.g., androgen disruption) has been suggested in epidemiologic studies. However, extrapolating causation from pharmaco-epidemiological studies to humans is tricky considering various confounders and biases inherent in the study design. Associations seen in clinical cohort studies need clarification with randomized clinical trials (RCTs), which would be difficult to perform ethically in pregnant populations. The mechanism by which this drug or its metabolites affect neurological development, asthma, or endocrine/reproductive toxicity is poorly understood. It is important to factor in the risk of untreated febrile illness in mother and child when evaluating risks and benefits of using this drug. There are no controlled data in human pregnancy.

Epidemiologic data, including a population based case-control study from the National Birth Defects Prevention Study (n= 11,610) and data from 26,424 live singleton births have shown no increased risk of major birth defects in children with first trimester prenatal exposure. In 2015, the US Food and Drug Administration released results of their evaluation on published research studies looking at mothers who took this drug as either an over the counter or prescription product at any time during their pregnancy and the risk of attention deficit hyperactivity (ADHD) in their babies. They found all studies reviewed had potential limitations in their designs that prevented drawing reliable conclusions. In a prospective birth cohort study (Avon Longitudinal Study or Parents and Children [ALSPAC]) maternal drug exposure was assessed by questionnaire at 18 and 32 weeks, children were assessed at 61 months. Mothers were questioned about behavioral problems in their children at 7 years old; children's behavioral problems were assessed using the Strengths and Difficulties Questionnaire (SDQ). A number of confounders were evaluated although a limitation of the study was lack of information for drug use. The authors suggest there may be an association between drug use during pregnancy and behavioral problems in childhood that may be due to an intrauterine mechanism. Further studies are needed to test alternatives to a causal explanation.

According to published animal studies, this drug may cause reduced fertility in both males and females described as decreased testicular weights, reduced spermatogenesis, reduced fertility; and reduced implantation sites, respectively.

AU TGA pregnancy category A: Drugs which have been taken by a large number of pregnant women and women of childbearing age without any proven increase in the frequency of malformations or other direct or indirect harmful effects on the fetus having been observed.

US FDA pregnancy category Not Assigned: The US FDA has amended the pregnancy labeling rule for prescription drug products to require labeling that includes a summary of risk, a discussion of the data supporting that summary, and relevant information to help health care providers make prescribing decisions and counsel women about the use of drugs during pregnancy. Pregnancy categories A, B, C, D, and X are being phased out.

References

  1. Cerner Multum, Inc. "Australian Product Information." O 0
  2. U.S. Food and Drug Administration U.S. Food and Drug Administration U.S. Food and Drug Administration U.S. Food and Drug Administration "FDA Drug Safety Communication: FDA has reviewed possible risks of pain medicine use during pregnancy http://www.fda.gov/Drugs/DrugSafety/ucm429117.htm" (2015):
  3. "Product Information. Ofirmev (acetaminophen)." Cadence Pharmaceuticals Inc (2016):
  4. Stergaikoulie E, Thapar A, Davey Smith G "Association of acetaminophen use during pregnancy with behavioral problems in childhood: evidence against confounding." JAMA Pediatr 170 (2016): 964-70
  5. McCrae JC, Morrison EE, MacIntyre IM, Dear JW, Webb DJ "Long-term adverse effects of paracetamol - a review." Br J Clin Pharmacol 84 (2018): 2218-2230

Drug and Breastfeeding Interactions

The following applies to the ingredients: Hydrocodone (found in Norco)

Use is not recommended and a decision should be made to discontinue breastfeeding or discontinue the drug, taking into account the importance of the drug to the mother.

Excreted into human milk: Yes

Comments: Infants exposed to this drug through breast milk should be closely monitored for excess sedation and respiratory depression; withdrawal symptoms can occur when maternal administration of hydrocodone is stopped or breastfeeding is stopped.

Maternal use of oral narcotics during breastfeeding can cause infant drowsiness, central nervous system depression, and even death. Newborns are particularly sensitive. Once a mother's milk comes in, it is best to provide pain control with a nonnarcotic analgesic. There are no studies describing drug levels of extended-release hydrocodone or its metabolites in breast milk. Hydrocodone is metabolized to 6 active metabolites including hydromorphone.

References

  1. United States National Library of Medicine "Toxnet. Toxicology Data Network. http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT" (2013):
  2. "Product Information. Zohydro ER (hydrocodone)." Zogenix, Inc (2013):
  3. "Product Information. Hysingla ER (hydrocodone)." Purdue Pharma LP (2014):

The following applies to the ingredients: Acetaminophen-Hydrocodone (found in Norco)

A decision should be made to discontinue breast-feeding or discontinue this drug, considering the importance of the drug to the mother

Excreted into human milk: Yes (acetaminophen) Yes (hydrocodone)

Comments:
-Breastfed infants should be monitored for excess sedation and respiratory depression; immediate medical attention should be sought if infant develops breathing difficulties or limpness.
-Withdrawal symptoms can occur in breastfed infants when maternal drug use or breastfeeding are stopped.

Breastfed infants of mothers who receive opioids, especially newborns, can experience drowsiness and CNS depression, even death. A study in 30 breastfeeding women found mean and median hydrocodone infant daily doses of 3.9 and 2.1 mcg/kg, respectively, which calculates to 2.4% and 1.6% of weight-adjusted maternal doses. Hydrocodone is metabolized to 6 active metabolites including hydromorphone. Mean and median hydromorphone daily doses of 2.1 and 0.3 mcg/kg, respectively, were found. Of interest was that 2 women excreted much more hydromorphone than others which might represent ultrarapid CYP450 2D6 metabolizers.

References

  1. United States National Library of Medicine "Toxnet. Toxicology Data Network. http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT" (2013):
  2. "Product Information. Norco (acetaminophen-hydrocodone)." Allergan Inc (2017):
  3. "Product Information. Lortab (acetaminophen-hydrocodone)." Akorn Inc (2017):
  4. "Product Information. Acetaminophen-Hydrocodone Bitartrate (acetaminophen-hydrocodone)." Mikart Inc (2017):

The following applies to the ingredients: Acetaminophen (found in Norco)

Caution is recommended.

Excreted into human milk: Yes

Comments;
-This drug has been used without apparent harmful effects.
-This drug is considered compatible with breastfeeding by the American Academy of Pediatrics.

This drug is excreted into breast milk in very small amounts. Published reports reveal peak levels occur 1 to 2 hours after dosing and are undetectable after 12 hours. Reports have also shown infants ingesting 90 mL of breast milk every 3 hours would receive an average of 0.14% (range 0.04% to 0.23%) of the mother's dose; calculated to be a maximum maternal weight-adjusted dose of around 2%. Other studies have shown similar calculated maximal maternal weight adjusted doses (1.1% to 3.6%); these doses are about 0.5% of the lowest recommended infant dose of this drug. A single case of a maculopapular rash has been reported in a 2-month old nursing infant; the rash recurred on rechallenge.

References

  1. Committee on Drugs, 1992 to 1993 "The transfer of drugs and other chemicals into human milk." Pediatrics 93 (1994): 137-50
  2. Cerner Multum, Inc. "Australian Product Information." O 0
  3. United States National Library of Medicine "Toxnet. Toxicology Data Network. http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT" (2013):
  4. "Product Information. Ofirmev (acetaminophen)." Cadence Pharmaceuticals Inc (2016):

Therapeutic Duplication Warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

Switch to: Consumer Interactions

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

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