From the Guidelines
Combining Norco (hydrocodone/acetaminophen) and duloxetine (Cymbalta) is a potentially hazardous mix that requires close medical supervision due to the risk of serotonin syndrome and central nervous system depression. When considering the combination of these medications, it's crucial to weigh the benefits against the risks, as they can interact to increase the risk of serotonin syndrome, a potentially serious condition characterized by agitation, hallucinations, rapid heart rate, fever, excessive sweating, shivering, tremors, muscle stiffness, and coordination problems 1. Additionally, both medications can cause central nervous system depression, potentially leading to increased drowsiness, dizziness, and impaired coordination when taken together. The combination may also reduce the effectiveness of hydrocodone for pain relief. Some key points to consider when combining these medications include:
- Monitoring for signs of serotonin syndrome, such as agitation, hallucinations, and rapid heart rate
- Watching for increased drowsiness, dizziness, and impaired coordination
- Potential reduction in the effectiveness of hydrocodone for pain relief
- Importance of medical supervision and potential need for dosage adjustments It's essential to note that duloxetine has been associated with severe skin reactions, including erythema multiforme and Stevens-Johnson syndrome, and should be discontinued at the first appearance of blisters, peeling rash, mucosal erosions, or other signs of hypersensitivity 1. If you're prescribed both medications, your healthcare provider has likely determined that the benefits outweigh the risks for your specific situation. Never adjust dosages or stop either medication without consulting your doctor. Be sure to report any unusual symptoms like confusion, severe drowsiness, or coordination problems immediately. Your doctor may need to monitor you more closely or adjust dosages if both medications are deemed necessary for your treatment.
From the Research
Interaction between Norco and Duloxetine
- Norco, a combination of acetaminophen and hydrocodone, is an opioid analgesic used for pain management [ 2, 3 ].
- Duloxetine, a serotonin-norepinephrine reuptake inhibitor, is used to treat major depressive disorder, generalized anxiety disorder, neuropathic pain, fibromyalgia, and stress urinary incontinence [ 4, 5 ].
- The combination of Norco and Duloxetine may increase the risk of serotonin toxicity, as both medications can affect serotonin levels in the body [ 2, 3 ].
Risks associated with the combination
- Serotonin toxicity, also known as serotonin syndrome, can occur when multiple serotonergic medications are taken together, including opioids and serotonin-norepinephrine reuptake inhibitors [ 2, 3 ].
- Opioid-induced respiratory depression is a potentially life-threatening side effect of opioid use, and the combination with Duloxetine may increase this risk [ 3, 6 ].
- Histamine release and hemodynamic changes are also possible side effects of opioid use, which may be affected by the combination with Duloxetine [ 3 ].
Mechanisms and effects
- The mechanisms underlying opioid-induced respiratory depression are not well understood, but research suggests that opioid μ receptors expressed on respiratory neurons in the CNS play a key role [ 6 ].
- Duloxetine's dual mechanism of action, inhibiting both serotonin and norepinephrine reuptake, may contribute to its efficacy in treating various clinical conditions, but also increases the risk of serotonin toxicity when combined with opioids [ 4, 5 ].