What is a suitable second pain medication to use in conjunction with Norco (hydrocodone and acetaminophen) 5?

From the Guidelines

Gabapentin is the recommended second pain medication to take alongside Norco 5, as it has been shown to have additive effects with opioids and can provide better pain relief at lower doses. When considering a second pain medication, it's essential to prioritize morbidity, mortality, and quality of life as the outcome. According to the study by 1, a combination regimen of morphine and gabapentin should be considered in patients with neuropathic pain for their possible additive effects and lower individual doses required of the 2 medications when combined. This is supported by the study by 1, which found that the combination of gabapentin and extended-release morphine titrated together required lower dosages of both medications and resulted in better pain relief than when either medication was administered alone in patients with PHN or painful DPN.

• Key considerations when adding gabapentin to Norco 5 include:
  • Starting with the smallest effective dose and titrating as needed
  • Monitoring for potential side effects, such as dizziness or drowsiness
  • Adjusting the dose of Norco 5 as needed to minimize the risk of adverse effects
  • Regularly assessing the patient's pain relief and quality of life to determine the effectiveness of the combination therapy
• It's crucial to consult with a healthcare provider before combining medications to ensure safety and minimize the risk of adverse interactions.

From the FDA Drug Label

Naproxen has been studied in patients with mild to moderate pain secondary to postoperative, orthopedic, postpartumepisiotomy and uterine contraction pain and dysmenorrhea. Onset of pain relief can begin within 1 hour in patients taking naproxen and within 30 minutes in patients taking naproxen sodium Analgesic effect was shown by such measures as reduction of pain intensity scores, increase in pain relief scores, decrease in numbers of patients requiring additional analgesic medication, and delay in time to remedication.

Naproxen can be considered as a second pain medication to Norco 5 for patients with mild to moderate pain.

• Key benefits:
  • Onset of pain relief within 1 hour
  • Analgesic effect lasting up to 12 hours
  • Less gastrointestinal adverse effects compared to aspirin or indomethacin 2

From the Research

Second Pain Medication to Norco 5

• Norco 5 is a combination of hydrocodone and acetaminophen, commonly used to treat moderate to severe pain.
• When considering a second pain medication to use in conjunction with Norco 5, it's essential to look at studies that have evaluated combination therapies for pain management.
• A study from 2012 3 found that combining two or more different drugs may improve analgesic efficacy and, in some situations, reduce overall side effects.
• The study also noted that the majority of combinations evaluated involved drugs that shared some element of central nervous system (CNS) depression, which may limit the utility of such combinations.
• Another study from 2021 4 recommended that pharmacologic management of acute pain should be tailored for each patient, including a review of treatment expectations and a plan for the time course of prescriptions.
• The study suggested that for severe or refractory acute pain, treatment can be briefly escalated with the use of medications that work on opioid and monoamine receptors or with the use of acetaminophen/opioid or NSAID/opioid combinations.
• A study from 2002 5 compared the efficacy and tolerability of combination hydrocodone and ibuprofen versus combination oxycodone and acetaminophen in the treatment of moderate or severe acute low back pain.
• The study found that both combinations were similarly effective and tolerable in relieving moderate or severe acute low back pain.
• Another study from 2003 6 found that the combination of hydrocodone and ibuprofen produced a synergistic analgesic interaction, with ibuprofen enhancing the analgesic response of hydrocodone.
• Based on these studies, potential second pain medications to consider in conjunction with Norco 5 could include:
  • Ibuprofen, which has been shown to have a synergistic interaction with hydrocodone 6
  • Other NSAIDs, such as naproxen or diclofenac, which may also have a synergistic effect with opioids
  • Alternative opioids, such as oxycodone or tramadol, which may be used in combination with Norco 5 for severe or refractory pain 4