Vicodin / Norco

Combination product

Pronunciation: hye-droe-KOE-doen and a-set-a-MEE-noe-fen

Combination of Hydrocodone and Acetaminophen.

Each component keeps its own pharmacology page; the combination itself adds no new mechanism.

Vicodin / Norco mascot — mnemonic cartoon — Visual mnemonic: Vicodin / Norco mascot
**“Viking Hydrant code”**

Components (2)

Hydrocodone ballicule — decagon mechanism diagram — Hydrocodone

Acetaminophen ballicule — decagon mechanism diagram — Acetaminophen

FDA label

Read the full label on DailyMed ↗

BOXED WARNING Opioid addiction/abuse/misuse risk (assess before and during); life-threatening respiratory depression (esp. at initiation/dose increase); accidental ingestion of one dose can be fatal in children; concomitant benzodiazepines/CNS depressants → profound sedation, respiratory depression, coma, death; prolonged in-utero exposure → neonatal opioid withdrawal syndrome; CYP3A4 inhibitor use (or inducer discontinuation) can raise hydrocodone levels → fatal respiratory depression; acetaminophen hepatotoxicity — acute liver failure, mostly at >4,000 mg/day APAP or multiple APAP products; opioid REMS.

FDA dosing	Population	Start	Target	Max
Pain severe enough to require an opioid, alternatives inadequate (5/325 mg)	Adults	1–2 tabs q4–6h PRN	Lowest dose achieving adequate analgesia	8 tabs/day
Same (7.5/325 mg or 10/325 mg)	Adults	1 tab q4–6h PRN	Lowest dose achieving adequate analgesia	6 tabs/day

Renal Severe renal disease: follow therapy with serial renal function tests (label gives no dose adjustment)

Hepatic Severe hepatic disease: follow therapy with serial liver function tests (label gives no dose adjustment); APAP hepatotoxicity risk >4,000 mg/day

Total daily acetaminophen from ALL sources — hepatotoxicity mostly at >4,000 mg/day APAP

Instructions

Use lowest effective dose for shortest duration; many acute pain conditions need no more than a few days
Converting from other opioids: underestimate the 24-h dose (conservative conversion)
Do not abruptly stop in physically dependent patients: taper ≤10–25% of total daily dose every 2–4 weeks; pause or slow taper if withdrawal emerges
Discuss access to an opioid overdose reversal agent (naloxone/nalmefene) with all patients
Store securely out of reach of children; dispose of unused tablets promptly (flush if no take-back available)

Available strengths

tab 5/325, 7.5/325, 10/325 mg

Contraindications

Significant respiratory depression
Acute or severe bronchial asthma in unmonitored setting or without resuscitative equipment
Known or suspected GI obstruction, including paralytic ileus

Cautions

Life-threatening respiratory depression — greatest risk at initiation/dose increase; elderly, cachectic, debilitated, and chronic pulmonary disease patients at higher risk
Concomitant benzodiazepines/CNS depressants/alcohol: reserve for inadequate alternatives
Adrenal insufficiency (usually >1 month of use)
Severe hypotension incl. orthostatic; caution with circulatory shock
Serotonin syndrome with concomitant serotonergic drugs
Opioid-induced hyperalgesia/allodynia
May impair driving/machinery operation

Adverse reactions

Most frequent: light-headedness, dizziness, sedation, nausea, vomiting
Constipation; drowsiness, mental clouding, dysphoria, mood changes
Urinary retention/ureteral spasm
Hearing impairment or permanent loss (chronic overdose)
SJS/TEN, rash, pruritus; thrombocytopenia, agranulocytosis
Hypoglycemia; androgen deficiency (long-term); anaphylaxis

Pregnancy Prolonged use during pregnancy → neonatal opioid withdrawal syndrome (life-threatening if not recognized/treated; ensure neonatology management at delivery); can cause fetal harm

Lactation Advise nursing mothers to watch infant for increased sleepiness, breathing difficulty, or limpness and seek immediate care

Cost

Vicodin / Norco

What pharmacies pay · NADAC 9/30/26

Strength		#/mo	generic $/unit	CostPlus
5/325 mg	tab	per unit	$0.14/ea	not offered
7.5/325 mg	tab	per unit	$0.14/ea	not offered
10/325 mg	tab	per unit	$0.15/ea	not offered

Part D rank #26.

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