Percocet vs. Norco: The Similarities & Differences of These 2 Pain Medications

Percocet is a combination of two active ingredients, acetaminophen and an opiate called oxycodone. There are different strengths available for this prescription medication, they are typically prescribed to individuals who are experiencing moderate, severe, and chronic pain. After taking this medication, it can be present in the urine for about 48 hours and in a hair sample for up to 3 months.

Norco is another opioid painkiller, prescribed for severe discomfort when non-opioids are not providing enough relief or are not tolerated. It is made up of a combination of hydrocodone and acetaminophen. 

Percocet (combination of oxycodone and acetaminophen) and Norco (combination of hydrocodone and acetaminophen) are two prescription medications used for the treatment of moderate to severe pain, and may also be used to treat chronic cancer pain. They work by binding with mu receptors in the brain. As well as, weakening and blocking pain signals, which makes them effective for treating chronic discomfort. They effectively provide relief by reducing inflammation. They’re both classified as Schedule II drugs by the DEA. They’re highly addictive and can lead to psychological and physical dependence. Percocet and Norco are both opioid analgesics and while they do have many similarities, they also do have some notable differences.

The biggest difference between these two opioid drugs is what they are composed of. Both of them contain acetaminophen; however, the opioid component differs between the two. Percocet contains oxycodone, while Norco contains hydrocodone.

Side Effects & Drug Interactions (of Oxycodone, Hydrocodone, and Acetaminophen)

Serious adverse effects that may occur with Percocet or Norco are respiratory depression or decreased breathing rate, sleep apnea, respiratory arrest, decreased heart rate, decreased blood pressure, and shock.  Although uncommon, some people may also experience an allergic reaction to either of these medications.

The most common side effects of Percocet are lightheadedness, dizziness, drowsiness/sedation, stomach pain, nausea, and vomiting; usually followed by euphoria, dysphoria, constipation, and pruritus itching. 

The most common side effects of Norco are similar to those of Percocet; lightheadedness, dizziness, sedation, nausea, and vomiting.

Along with those listed above, serotonin syndrome could also occur with either of these two substances. Serotonin syndrome is a serious, life-threatening adverse reaction to these substances, especially occurring when either one is taken in combination with any other substance that increases serotonin levels. These can include tricyclic antidepressants, muscle relaxants or muscle relaxers, ibuprofen, triptans for migraine, SSRI, SNRI, and MAO inhibitors. It is important to note that monoamine oxidase inhibitors should not be used within 14 days of Percocet or Norco. 

Taking Percocet or Norco in combination with certain medications that are metabolized by the CYP3A4 or CYP2D6 enzyme can result in a drug interaction, these are also known as enzyme inhibitors. They include other substances such as macrolide antibiotics, azole antifungals, and protease inhibitors. When combined with Percocet or Norco it can result in a buildup of the opioid in your body, this is very dangerous.

On the other hand, enzyme inducers have the opposite effect as inhibitors, they lower the opioid level so that it is not as effective. An enzyme inducer can even cause withdrawal symptoms. 

Using benzodiazepines or other CNS depressants (which includes other opioids) in combination with Percocet or Norco can lead to low blood pressure, respiratory depression, sedation, coma, and even death.

If you are taking Percocet or Norco, remember that the medication contains APAP, and should not be taken in combination with many over-the-counter cough suppressant & cold medications and NSAIDS, as they contain APAP as well. Check with your pharmacist to be sure that you select an over-the-counter medication that does not contain APAP.  You can also reach out to your healthcare provider for further information on interactions. 

Risks & Warnings of Dependence on Oxycodone, Hydrocodone, and Acetaminophen (Including Overdose)

Both come with a black box warning, which is the strongest warning, as required by the FDA.  There is a high potential for misuse and addiction, which could result in overdose and sometimes even death. Taking your medication as prescribed is essential for avoiding these outcomes. 

Serious, life-threatening respiratory depression may occur and patients taking these medications should be monitored closely. Especially during the beginning of therapy, treatment, or any time that the dosage is changed. Elderly people and any patient with lung disease are at higher risk of experiencing respiratory depression. 

The use of opioids, like hydrocodone and oxycodone during pregnancy can result in neonatal opioid withdrawal syndrome, especially when used for prolonged periods of time. 

Acetaminophen has been associated with liver damage or failure after long-term use or when not used as suggested. This could result in the need for a liver transplant or death. It is important to be aware of the maximum daily dose of acetaminophen (ask your doctor) and you should avoid using more than one medication containing acetaminophen at a time. 

Abuse, Misuse, Addiction, and Withdrawal

Percocet and Norco can be very addictive for some people. These medications are often initially prescribed to treat discomfort, but the medication contains chemical properties that can also lead to abuse and addiction. 

The DEA considers both of these substances to be Schedule II drugs. This means that they have a high potential for addiction as well as a high potential for abuse. Breaking the addiction to these substances can be very challenging for most due to withdrawal symptoms. Percocet withdrawal symptoms may appear when tapering off or undergoing detoxification. Both medications are very likely to result in overdose when not used exactly as prescribed. When one uses these painkillers, it can become really hard to know how much is too much. 

Because they contain oxycodone and hydrocodone, these two medications can be especially dangerous for someone with an addictive past. National survey done in 2014 on the Drug Use and Health, showed that about 2.1 million Americans had used some prescription medication for a nonmedical reason within the last year and 20% of people have done so at one point in their life, according to this double-blind, randomized, controlled trial. Opioids are among the most common substances to be abused, and more than 97 percent of them come from medication prescribed by a doctor.

While the above statistics show the severity of prescription abuse and more specifically opioid medication, the problem continues. It is very important to be able to recognize prescription medication addiction and substance use disorder. It is also important to understand how to get help for yourself or someone you love.

Frequently Asked Questions

Percocet is an opioid pain medication, containing oxycodone and acetaminophen. This combination drug is typically prescribed by a healthcare professional to treat acute or chronic pain. However, it is extremely addictive when not used as recommended.
Percocet and Norco are similar; they are both opioid painkillers used to treat pain. Percocet contains oxycodone and APAP, while Norco contains hydrocodone and APAP. There are other differences, but this is the most significant. It is important to note that both Percocet and Norco are immediate-release tablet forms.
These substances have been proven to provide similar relief for individuals. One very small study was performed, only looking at 20 people, l found that Percocet was 1.5 times stronger than Norco due to the efficacy of oxycodone. You can consult with your physician to determine which one would be a better fit for you.
No, these substances should not be used while consuming alcohol. This combination is very dangerous and greatly increases the risk of adverse reactions. Such as severe respiratory depression, sedation, coma or even death.
No, it is not safe to consume these substances or the generic versions while pregnant. They can cause harm to the fetus if taken while pregnant. The use of opioids, such as oxycodone or hydrocodone, for a prolonged period of time during pregnancy can cause a life-threatening condition in the baby. This is known as neonatal opioid withdrawal syndrome. If you are already taking Percocet or Norco and you find out that you are pregnant, it is important that you contact your healthcare provider immediately for help and medical advice on stopping the drug.

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