What is the effect of Norco (hydrocodone and acetaminophen) on systolic blood pressure (SBP)?

Effect of Norco 5 on Systolic Blood Pressure

Norco (hydrocodone/acetaminophen) can cause hypotension, including orthostatic hypotension and syncope, rather than elevating systolic blood pressure. 1

Primary Blood Pressure Effects from Hydrocodone Component

The opioid component (hydrocodone) in Norco has well-documented hypotensive effects:

• Hydrocodone may cause severe hypotension including orthostatic hypotension and syncope in ambulatory patients 1
• The risk is increased in patients with already compromised blood pressure from reduced blood volume or concurrent CNS depressant use 1
• Vasodilation can further reduce cardiac output and blood pressure, particularly in patients with circulatory shock 1
• Patients should be monitored for signs of hypotension after initiating or titrating dosage 1

Acetaminophen Component Effects on Blood Pressure

The acetaminophen component shows more complex effects depending on route and dosing:

Oral Acetaminophen in Hypertensive Patients

• Regular acetaminophen use (4g daily) increases systolic blood pressure by approximately 4.7 mmHg in hypertensive patients compared to placebo 2
• This effect was demonstrated in a high-quality randomized, double-blind, placebo-controlled crossover trial 2
• Diastolic blood pressure increased by 1.6 mmHg with regular use 2
• However, a large observational study using verified prescription data found no sustained rise in blood pressure from acetaminophen in treated hypertensive patients 3

Intravenous Acetaminophen

• IV acetaminophen causes statistically significant drops in systolic blood pressure, diastolic blood pressure, and mean arterial pressure 4
• This hypotensive effect is most pronounced in critically ill patients 4
• Increased vasopressor requirements have been documented following IV acetaminophen administration 4

Net Clinical Effect in Norco Users

The dominant effect of Norco on systolic blood pressure is hypotension from the hydrocodone component, not hypertension. 1

Key Clinical Considerations:

• The FDA labeling explicitly warns about severe hypotension as a significant adverse effect of hydrocodone/acetaminophen combinations 1
• Patients should be counseled to recognize symptoms of low blood pressure (dizziness, lightheadedness) and reduce risk by rising slowly from sitting or lying positions 1
• The acetaminophen component at typical Norco 5 dosing (325mg per tablet) is unlikely to cause clinically significant blood pressure elevation, especially given the opposing hypotensive effect of hydrocodone 1

Special Populations at Higher Risk

Elderly, cachectic, or debilitated patients are at increased risk for hypotensive effects due to altered pharmacokinetics 1

Additional high-risk groups include:

• Patients with reduced blood volume 1
• Those taking concurrent CNS depressants (benzodiazepines, phenothiazines, general anesthetics) 1
• Patients with circulatory shock (Norco should be avoided in this population) 1

Monitoring Recommendations

• Monitor blood pressure after initiating or titrating Norco dosage 1
• Assess for orthostatic changes by checking blood pressure in both seated and standing positions 1
• Educate patients about recognizing hypotension symptoms and appropriate responses 1