Can blood pressure drop after taking Norco (hydrocodone) and marijuana?

Blood Pressure Effects of Norco and Marijuana Combination

Yes, blood pressure can drop after taking Norco (hydrocodone) and marijuana together, potentially causing dangerous hypotension due to their combined cardiovascular effects.

Cardiovascular Effects of Individual Substances

Hydrocodone (Norco)

• Hydrocodone can cause severe hypotension including orthostatic hypotension and syncope in ambulatory patients 1
• The risk is increased in patients whose blood pressure regulation is already compromised by reduced blood volume or concurrent use of certain CNS depressants 1
• In patients with circulatory shock, hydrocodone may cause vasodilation that can further reduce cardiac output and blood pressure 1

Marijuana

• Cannabis use may be associated with adverse cardiovascular events including orthostatic hypotension with acute use 2
• Marijuana increases heart rate and can slightly increase supine blood pressure, but often produces marked orthostatic hypotension 3
• The cardiovascular effects of marijuana include decreased peripheral vascular resistance, which can contribute to hypotension 3
• A recent study found that cannabis treatment for 3 months was associated with a reduction in 24-hour systolic and diastolic blood pressure values with the lowest point occurring at 3 hours after cannabis administration 4

Combined Effects and Risks

• When opioids like hydrocodone are used with other CNS depressants (including marijuana), there is an increased risk of hypotension, respiratory depression, and sedation 1
• The FDA specifically warns about the risks when combining opioids with other CNS depressants, including illicit drugs 1
• Both substances can independently cause orthostatic hypotension, and their combination may potentiate this effect 1, 3
• Heavy marijuana users have 1.80 higher odds of elevated blood pressure than never users, but acute use, especially when combined with other substances, can cause hypotension 5

Mechanism of Interaction

• Hydrocodone produces peripheral vasodilation which may result in orthostatic hypotension or syncope 1
• Marijuana affects the cardiovascular system through the endocannabinoid system and autonomic nervous system modulation 3
• When used together, both substances can:
  • Suppress the central nervous system 1
  • Cause vasodilation 1, 3
  • Alter autonomic nervous system function 3
  • Reduce the body's ability to maintain normal blood pressure, especially with positional changes 1, 3

Clinical Considerations and Precautions

• Patients should be advised not to drive or operate heavy machinery when using this combination due to the risk of hypotension and sedation 1
• The risk of severe hypotension is higher in:
  • Elderly, cachectic, or debilitated patients 1
  • Patients with pre-existing cardiovascular conditions 3
  • Patients taking other medications that affect blood pressure 6
• Signs of hypotension to monitor for include dizziness, lightheadedness, feeling faint, and syncope 1
• Patients should be advised to change positions slowly (from lying to sitting, sitting to standing) to minimize orthostatic effects 1

Important Warnings

• This combination can be particularly dangerous for patients with cardiovascular disease 3
• The 2024 AHA/ASA guidelines recommend screening for substance use to inform stroke risk, as both substances can contribute to cardiovascular events 6
• Patients should be counseled about the risks of combining these substances and the potential for dangerous drops in blood pressure 6