From the Guidelines
No, you should not take Norco (hydrocodone) and buprenorphine at the same time, as this combination can lead to serious health consequences, including reduced pain control and an increased risk of respiratory depression, which can be life-threatening 1. Buprenorphine is a partial opioid agonist that binds strongly to opioid receptors, while hydrocodone (in Norco) is a full opioid agonist. When taken together, buprenorphine can block the effects of hydrocodone, potentially leading to inadequate pain management.
If you're currently taking buprenorphine, adding Norco could either trigger withdrawal symptoms or cause overdose effects depending on the timing and dosages 1. The high affinity of buprenorphine for the μ receptor risks displacement of, or competition with, full opioid agonist analgesics when buprenorphine is administered concurrently or sequentially.
For patients on buprenorphine maintenance therapy, alternative approaches for managing acute pain include continuing buprenorphine maintenance therapy and titrating a short-acting opioid analgesic to effect, or dividing the daily dose of buprenorphine and administering it every 6 to 8 hours to take advantage of its analgesic properties 1. However, these approaches should only be undertaken under the guidance of a healthcare provider, as they require careful monitoring and adjustment of medication dosages to avoid adverse effects.
In all cases, it is essential to consult with your healthcare provider about all medications you're taking and to develop a specialized pain management plan that accounts for your buprenorphine use 1. Never adjust medication dosages or combine these medications on your own, as this can lead to serious health consequences.
Key considerations for managing pain in patients on buprenorphine therapy include:
- The potential for buprenorphine to block the effects of full opioid agonists, leading to reduced pain control
- The risk of respiratory depression, which can be life-threatening
- The need for careful monitoring and adjustment of medication dosages to avoid adverse effects
- The importance of developing a specialized pain management plan that accounts for buprenorphine use 1.
From the FDA Drug Label
Avoid the use of mixed agonist/antagonist (e.g, pentazocine, nalbuphine, and butorphanol) or partial agonist (e.g., buprenorphine) analgesics in patients who are receiving a full opioid agonist analgesic, including Hydrocodone Bitartrate and Acetaminophen Tablets. In these patients, mixed agonist/antagonist and partial analgesics may reduce the analgesic effect and/or precipitate withdrawal symptoms
Do not take Norco (hydrocodone) and buprenorphine at the same time, as this can reduce the analgesic effect and/or precipitate withdrawal symptoms 2.
From the Research
Medication Interactions
- The use of Norco (hydrocodone) and buprenorphine at the same time is a complex issue, and there is limited direct evidence to support or refute this combination 3, 4.
- Buprenorphine is a partial mu-opioid agonist commonly used to treat opioid-use disorders, and it has a unique pharmacological profile that allows it to provide adequate analgesia with less abuse potential 3.
- However, studies have shown that a substantial proportion of patients fill prescriptions for non-buprenorphine opioids, such as Norco, during and following buprenorphine treatment 5.
Safety and Efficacy
- There is evidence to suggest that the use of non-buprenorphine opioids, including Norco, may be associated with increased risks of opioid overdose and other complications 4, 6.
- On the other hand, some studies have found that the use of buprenorphine, even in combination with non-prescribed opioids, may be associated with improved treatment outcomes and reduced risks of discontinuation 7.
Clinical Considerations
- The decision to use Norco and buprenorphine at the same time should be made on a case-by-case basis, taking into account the individual patient's medical history, treatment goals, and risk factors 3, 4.
- Clinicians should carefully monitor patients for signs of opioid overdose, respiratory depression, and other potential complications when using this combination 4, 6.