What Are the Health Risks of Mixing Norco and Alcohol?

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

Alcohol Abuse

Alcohol is one of the most well-known drugs in the world. According to a survey done by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) in 2015, more than 85 percent of people over the age of 18 reported consuming alcohol at some time in life. Heavy drinking is a problem in the United States, as the same survey found more than 25 percent of people reported binge drinking in the month prior to being surveyed.

Alcohol use disorders (AUDs) are issues with alcohol that arise due to excessive consumption of the substance. In 2015, approximately 15 million adults in the country had AUD, showing just how problematic alcohol can become on a large scale. More than 600,000 youths from age 12 to 17 had AUD in 2015, according to the same survey. It is estimated that nearly 90,000 people in the US die each year from alcohol-related causes, making it the fourth-highest preventable cause in the nation.

What Is Norco?

While alcohol is a well-known substance, Norco may not be to the same extent. Norco is the brand name of a combination of two substances, hydrocodone and acetaminophen, and the drug was approved by the Food and Drug Administration (FDA) in 1997. Acetaminophen is a mild painkilling substance, available over the counter, while hydrocodone is a narcotic opioid. The combination of the two drugs classifies it as an opioid analgesic, as it can block some of the brain’s nerve receptors. It is commonly used to treat moderate to moderate-severe pain.

According to Everyday Health, common side effects of Norco include dizzy spells, increased drowsiness, constipation, and nausea. There is also the potential for more serious side effects, such as:

  • Breathing problems
  • Slowed heart rate
  • Confusing thoughts
  • Anxiety
  • Depression
  • Mood swings
  • Convulsions
  • Abdominal pain

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 in regard to breathing problems and kidney or liver diseases.

According to the Drug Enforcement Administration (DEA), hydrocodone is the most frequently prescribed opioid medication in the United States. It sees more abuse than any other opioid, legal or illegal. The potential to induce euphoria and provide a sedative effect make it popular for recreational use, and the effects can last for a few hours.

With prolonged use of Norco, physical dependence will form, signified by withdrawal symptoms when the person goes without the medication. As a person’s tolerance to the drug rises, more of it is needed to experience the same effects. The person may then begin to increase their dosage or alter the method in which it is taken (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 be very risky for a multitude of reasons. First, as with any medication containing acetaminophen, drinking alcohol in conjunction with it can cause serious liver damage. Norco is packaged with warning labels regarding its acetaminophen content. According to Columbia University, if alcohol and acetaminophen are mixed, it can result in the aptly named alcohol-acetaminophen syndrome. This condition results in increased levels of transaminase, a liver protein that aids in metabolism in the organ. This is often a sign that the liver is working too hard to metabolize both the acetaminophen and the alcohol, which can result in serious liver damage and even liver failure. Usually alcohol is metabolized first, which leaves the highly toxic materials in acetaminophen in the liver. It has been speculated that this hepatoxicity could be the leading cause of acute liver failure in the country, though this has not been proven.

According to RxList, individuals should disclose any personal or family history regarding alcohol or substance abuse to their doctor before taking Norco. Assessing an individual’s drinking behavior is important in deciding whether to take the drug for legitimate medical reasons. It is even recommended that an individual abstain from consumption of alcohol for about a week after taking any drug with acetaminophen in it.

Dangers of Mixing the Substances

While acetaminophen presents serious dangers when combined with alcohol, the effects of hydrocodone often lead to polydrug use with alcohol. Alcohol can increase the dizzying effects of Norco, as well as increase the level of drowsiness that accompanies use.

Concurrent use can result in the following symptoms:

  • Impaired judgement
  • Impaired motor skills
  • Confusion
  • Respiratory problems
  • Excessive sedation
  • Coma

According to Medline Plus, consuming alcohol while taking any drug containing hydrocodone can result in life-threatening effects. Alcohol enhances and quickens the release of hydrocodone into the system, which can cause levels of the substance in the body to become dangerously high. It has been found that alcohol can increase the concentration of hydrocodone in the system more than twofold. It also increases the extent of absorption of the drug.

While people often intentionally abuse the combination of hydrocodone and alcohol, it can happen by accident. Those taking Norco should be vigilant in checking the alcohol content of anything they consume. For example, something as easily obtainable as over-the-counter cough syrup contains alcohol, and even a standard dosage can cause a very serious reaction when mixed with Norco.


Operating a motor vehicle or any kind of machinery can be dangerous after consuming either alcohol or Norco, but doing so after taking a combination of both substances can be especially hazardous. Mixing the two drugs can result in impaired judgement, which can lead to the decision to get behind the wheel. Furthermore, impairment of motor functions can make it extremely difficult for an individual to safely operate the vehicle once the person is on the road.


Since both alcohol and hydrocodone are easily obtainable in the US, this specific combination is particularly common in instances of polysubstance abuse. Alcohol is the most readily available drug in the US, and as noted earlier, hydrocodone is the most frequently abused opioid in the country. From 1991 to 2013, the number of opioid prescriptions in the country nearly tripled, rising from about 76 million to more than 200 million, according to the National Institute on Drug Abuse (NIDA).  This has resulted in more problems due to the availability of such opioids. Deaths due to prescription opioid overdose have tripled in the last two decades, and 2010 alone saw more than 16,000. It is now more common to overdose on a prescription opioid than on heroin or cocaine, showing the great danger of prescription drug abuse.

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


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