What Are The Health Risks of Mixing Norco & Alcohol?

Both alcohol and prescription painkillers are widely abused in the United States. The risks of abusing either substance alone are great, but when the substances are combined, these risks are compounded even further.

Alcohol Abuse

In 2019, one survey revealed that more than 85 percent of people over the age of 18 reported consuming alcohol at some time in their life.1 In addition, binge and heavy drinking continues to be a problem. The same survey found that more than 25 percent of the respondents reported binge drinking in the month prior to being surveyed.1

Alcohol use disorder (AUD), a medical condition defined by uncontrollable alcohol use despite negative consequences, affects millions of Americans. In 2019, approximately 15 million adults in the United States had an AUD, including more than 400,000 youths ages 12 to 17.1 In addition, an estimated 95,000 people die each year from alcohol-related causes, making it the third-leading preventable cause of death in the nation.1

What Is Norco?

Historically, Norco was one of several branded formulations of hydrocodone available in combination with acetaminophen. The drug was discontinued in the U.S. market.

While acetaminophen is an over-the-counter pain and fever medicine, hydrocodone is a prescription-only opioid. Opioid painkillers like hydrocodone work by altering the perception of pain signaling. It is commonly used to treat moderate to moderate-severe pain.2

Side Effects of Norco

The most common side effects of Norco include dizzy spells, increased drowsiness, nausea, and vomiting. There is also the potential for Norco to induce other adverse reactions, including:2

  • Slowed breathing.
  • Anxiety.
  • Mood changes.
  • Over-sedation.
  • Confusion.
  • Constipation.
  • Urinary retention.
  • Itchy skin.

These severe side effects of Norco can occur without mixing it with any other substances. Patients are instructed to share the details of their medical history with their doctor before taking this drug, especially breathing issues and kidney or liver diseases.2

Hydrocodone is the most frequently prescribed opioid medication in the United States.3 Consequently, it’s also one of the most commonly abused opioids.4 The potential to induce euphoria and sedative effects that last for a few hours make it popular for recreational use.

With prolonged use, however, Norco—like other opioids—can result in tolerance, physical dependence, and addiction.3 As a person’s tolerance to the drug increases, more of the drug is needed to experience the same effects. The person may then begin to increase their dosage or alter the method in which they take it (e.g., crushing the pills and snorting the powder), beginning a pattern of abuse that rapidly leads to addiction.

How Norco and Alcohol Affect the Liver

Mixing Norco and alcohol can lead to liver injury. On its own, acetaminophen can be safely taken in low doses, but when taken in high doses, it can cause acute liver injury, even death from acute liver failure.5 Drinking alcohol in conjunction with the acetaminophen found in a medication like Norco can result in acetaminophen-induced hepatotoxicity (toxic liver disease).6

Chronic alcohol consumption can lower the threshold for acetaminophen-mediated liver toxicity, even at prescribed doses.7 That’s why it’s important for individuals to discuss any personal or family history regarding alcohol or substance abuse with their health care provider before taking any medication containing acetaminophen or hydrocodone.

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Dangers of Mixing the Substances

While acetaminophen presents serious dangers when combined with alcohol, the effects of the hydrocodone component of Norco in combination with alcohol can also be problematic. Combined symptoms can include increased dizziness and drowsiness or, more seriously, dangerous respiratory depression—which can increase the risk of coma and death.2,9 Other effects associated with the concurrent use of hydrocodone and alcohol include: 6

  • Impaired motor skills.
  • Memory issues.
  • Unusual behavior.
  • Increased risk of overdose.

Despite the risks, hydrocodone is often abused in conjunction with alcohol and other forms of polysubstance abuse.3 The relative ease of obtaining both hydrocodone and alcohol means that addiction issues affect a range of age groups—from school-age children to older adults.3 In 2017, for instance, hydrocodone-containing drugs were prescribed to 93.7 million patients; in 2013, 83.6 million people received prescriptions for medications with hydrocodone as an ingredient.3

More prescriptions lead to more problems. Deaths due to prescription opioid overdose have quadrupled in the last two decades.8 In 2019, more than 14,000 people died as a result of prescription opioid-related overdoses.8

Overdose is a serious danger with hydrocodone misuse. Some potential signs and symptoms of an opioid overdose include:2, 10

  • Pinpoint pupils.
  • Cold, clammy skin.
  • Severely slowed or stopped breathing (respiratory arrest).
  • Slowed heart rate or low blood pressure.
  • Profound over-sedation and loss of consciousness.
  • Coma.

When alcohol is added to the equation, the risk of overdose increases, as are all potential side effects of both substances.6 It may seem harmless to take a few pills and have a few drinks, but that simply is not the case. Alcohol should be avoided completely if a person is taking Norco or any other drug that contains hydrocodone or acetaminophen.

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  1. National Institute on Alcohol Abuse and Alcoholism. (June 2021). Alcohol Facts and Statistics
  2. DailyMed. Norco.
  3. Drug Enforcement Administration. (October 2019). Hydrocodone.
  4. Jones, Christopher M., Pharm.D., M.P.H., Lurie, Peter G., M.D., M.P.H., and Throckmorton, Douglas C., M.D. (March 2016). Effect of the US Drug Enforcement Administration’s Rescheduling of Hydrocodone Combination Analgesic Products on Opioid Analgesic PrescribingJAMA Internal Medicine, 176(3), 399-402.
  5. PubChem. Acetaminophen.
  6. National Institute on Alcohol Abuse and Alcoholism. (2014). Harmful Interactions
  7. National Institute on Alcohol Abuse and Alcoholism. (January 1995). Alcohol Alert.
  8. Centers for Disease Control and Prevention. (March 2021). Opioids: Understanding the Epidemic.
  9. National Institute on Drug Abuse. (August 20, 2020). Commonly Used Drug Charts.
  10. Schiller, Elizabeth Y., Goyal, Amandeep, and Mechanic, Oren J. (September 20, 2021). Opioid Overdose. StatPearls.
Last Updated on Sep 14, 2022
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