Percocet vs. Norco

Introduction

Percocet (generic name oxycodone) and Norco (generic name hydrocodone) are both opioid prescription drugs used for managing moderate to severe pain. Opioids, also known as opiates, narcotics, and painkillers, include prescription and illegal drugs derived from or mimic the natural substances found in the opium poppy plant. Opioids are addictive, and many drug abusers use them for the euphoric feeling they provide.

Percocet and Norco are in the same drug class and designated as schedule II drugs by the U.S. Drug Enforcement Administration (DEA) due to a high potential for abuse and addiction. Percocet and narco have multiple similarities and differentiate only on their sources. For instance, Percocet is derived from thebaine, while Norco is derived from codeine.

About Percocet and Norco

What is Percocet?

Percocet or oxycodone is a semisynthetic opioid analgesic derived from thebaine and produced in a lab. The first oxycodone containing-drug, Percodan, was approved by the FDA in 1950. It is used for managing moderate to severe pain. It is sold as an immediate-release product for moderate to severe pain. In the case of chronic pain that requires continued use of analgesics for a long-term period, Percocet is indicated as an extended-release product.

Percocet is a combination medication for treating pain when non-opioid medications aren’t effective. It is available in tablet and liquid form and works by interacting with the opioid receptors in the body and causing multiple changes to reduce pain.

What conditions is Percocet approved to treat?

Oxycodone is sold under multiple brands, such as Percocet, Percodan, Tylox, and Roxicet. Since this is a controlled substance with a high potential for drug abuse, doctors prescribe this medication when non-opioid treatments are ineffective. Percocet is generally used for treating severe pain associated with cancer, dental procedures, surgeries, and injuries.

Percocet is approved to treat the following conditions:

• Moderate to severe pain
• Severe pain in combination with Acetaminophen
• Acute pain
• Chronic pain (extended-release formulation for long-term use)

How does Percocet work for Pain?

The mechanism of action of Percocet is not fully known. General understanding supports that Percocet interacts with opioid receptors in the body, located in the heart, lungs, liver, reproductive system, and gastrointestinal tract, causing multiple body changes. For instance, Percocet’s effect on the lungs leads to respiratory depression, suppresses the cough reflex by acting on the cough center, decreases pupil size, and slows down the peristalsis of the gastrointestinal tract. The opioid receptors are activated in case of inflammation and pain. Percocet or oxycodone and its metabolites bind to specific receptors and help reduce moderate to severe pain. The N-type voltage-operated calcium channels are inhibited by binding and activating the mu-opioid receptors, and as a result, the body stops responding to pain signals.

What is Norco?

Norco is an opioid agonist that is derived from codeine and is used for treating mild to severe pain. It was first approved by the FDA in 1943 as part of cough syrup but has now been replaced by dextromethorphan in current cough suppressant formulations. It is used in combination with other drugs, such as acetaminophen, to treat mild to moderate pain. Norco is also available in a more potent form, hydromorphone, which is used frequently in cases of severe/extreme pain.

Doctors recommend Norco for terminally ill patients or those who have undergone surgeries or dental procedures. It is also used in combination with expectorants, decongestants, and antihistamines for treating the common cold and allergic rhinitis.

What conditions is Norco approved to treat?

In terms of functionality, Norco is similar to Percocet and is used for managing moderate to severe pain. Since it is an opioid, a structured long-term treatment program and medical detox are required for recovery. Thus, it is only recommended when non-opioid treatments are ineffective.

Percocet is approved to treat the following conditions:

• Management of acute pain (in combination with acetaminophen and ibuprofen)
• Common cold and allergic rhinitis (in combination with expectorants, decongestants, and antihistamines)
• Moderate pain

How does Norco work for Pain?

Hydrocodone works by binding to the mu-opioid and delta-opioid receptors and preventing pain signals from reaching the brain and spinal cord. Norco’s analgesic effects are mostly attributed to its binding to mu-opioid receptors. Activation of mu-opioid receptors inhibits the calcium channel opening and GIRK channel activity which hyperpolarizes the neurons and inhibits the release of neurotransmitters.

Similarly, hydrocodone also causes multiple brain actions, like other opioids. It activates neurons in the reward system and inhibits neurons in the periaqueductal gray (PAG). This inhibition causes cough suppression, respiratory depression, and sedation, reducing pain signals.

Effectiveness

How effective are Percocet and Norco for treating Pain?

Both Percocet and Norco are opioids used for treating moderate to severe pain. Both follow a similar mechanism of action and have more similarities than dissimilarities when it comes to function and outcomes. In a 2017 randomized clinical trial, the effect of a single dose of opioids and non-opioids was compared to the reduction of moderate to severe acute extremity pain in the emergency department. The trial included 416 patients (divided into four groups), reach receiving the following 4 oral analgesics in the following combinations; 400 mg of ibuprofen and 1000 mg of acetaminophen; 5 mg of oxycodone and 325 mg of acetaminophen; 5 mg of hydrocodone and 300 mg of acetaminophen; or 30 mg of codeine and 300 mg of acetaminophen. For outcome measurement, pain intensity was assessed using an 11-point numerical rating scale (NRS), in which 0 indicates no pain and 10 indicates the worst possible pain. At 2 hours, the mean NRS pain score decreased by 4.3 in the ibuprofen and acetaminophen group; by 4.4 in the oxycodone and acetaminophen group; by 3.5 in the hydrocodone and acetaminophen group; and by 3.9 in the codeine and acetaminophen group.

It is important to note that Percocet and Norco have a high potential for abuse due to their euphoric effects and prominence. Addiction to these drugs leads to frequent emergency department visits, dependence on the drug, and even death due to overdose. A 2022 study analyzes the effect of first-time prescriptions of oxycodone and hydrocodone on opioid-naive patients to determine the risk of opioid-related adverse events. After index prescription, 2.8% (n = 14,458) of individuals developed chronic use, and 0.3% (n = 1,480) experienced overdose. It was observed that the risk of overdose was higher after oxycodone, whereas drug abuse or chronic use was higher after hydrocodone. When combined with acetaminophen or monotherapy, hydrocodone can be a favorable agent for reducing moderate to severe pain.

Moreover, hydrocodone was also found to be more effective in suppressing the development of burn-induced mechanical allodynia than morphine and oxycodone.

Dosage information

How is Percocet administered for Pain?

Oral treatment for Percocet usually starts at a dosage of 2.5 mg tablets, taken every 4 to 6 hours, depending on the severity of the pain. The total acetaminophen limit should not exceed 4 grams in adults. Moreover, conversion from tablet to extended-release oxycodone requires close monitoring for signs of excessive respiratory depression or sedation.

How is Norco administered for Pain?

The oral dosage of Norco for adults starts at 5 mg and can go up to 10 mg depending on the severity of the pain. Due to the addictive nature, the prescription should be initiated on the lowest effective dose, and the patient should be closely monitored for signs of respiratory depression within 24-72 of starting therapy.

Side Effects

Please note that these are not exhaustive lists of side effects; always read the package inserts and speak with your doctor or a healthcare professional to understand the potential side effects of your treatment with Percocet or Norco.

What are the most common side effects of Percocet?

• Nausea
• Unpleasant breath odor
• Skin rash and itching
• Fever
• Headache
• Dizziness
• Chills
• Dark urine
• Respiratory depression
• Black, tarry stools
• Vomiting of blood
• Tiredness and weakness
• Loss of appetite
• Hypotension
• Bradycardia
• Constricted pupils

Rare symptoms include cough, unusual bleeding, and bruising, fever (with or without chills), sore throat, mouth ulcers, and lower back or side pain.

Are there any potentially serious side effects of Percocet?

* If you experience any of these serious side effects, seek medical help immediately

• Cold and clammy skin
• Bluish lips or skin
• Slowed breathing
• Loss of consciousness or change in consciousness
• Extreme sleepiness
• Low blood pressure or pulse
• Feeling of discomfort or illness
• What are the most common side effects of Norco?
• Difficulty breathing
• Feeling drowsy or sleepy
• Nausea
• Nosebleeds
• Respiratory depression
• Stupor or coma
• Skeletal muscle flaccidity
• Cold sweat
• Constricted pupils
• Indigestion
• Feeling of nervousness
• Bradycardia
• Hypotension
• Partial or complete airway obstruction
• Atypical snoring
• Edemia

Are there any potentially serious side effects of Norco?

* If you experience any of these serious side effects, seek medical help immediately

• Bloody and cloudy urine
• Changes in consciousness
• Decreased awareness of the surroundings and unresponsiveness
• Feeling of discomfort or illness
• Slowed or irregular heartbeat
• Severe cough sometimes resulting in pink frothy sputum
• Sudden decrease in urine amount
• Swelling in the legs or ankles
• Cold and clammy skin
• Increased sweating

Contraindications and interactions

Warnings and general precautions for Percocet and Norco

Percocet and Norco follow the same mechanism of action and have a high potential for drug abuse or adverse side effects. Thus, they should only be prescribed if non-opioid treatments are ineffective. Percocet and Norco can result in life-threatening respiratory depression even at recommended dosages; thus, patients should be educated about the warning signs and seek immediate medical help if breathing difficulty occurs.

Patients should also be informed not to take over 4,000 milligrams of acetaminophen daily.

Contraindications and important interactions for Percocet and Norco

Contraindications

Percocet

Percocet should not be given to pregnant women unless advised by a physician.

Nursing mothers should avoid taking Percocet while breastfeeding because of the possibility of sedation or respiratory depression in the infant.

Do not take Percocet if you have acute or severe bronchial asthma.

Do not take Percocet if you have or suspect gastrointestinal obstruction, including paralytic ileus.

Norco

Norco should not be given to pregnant or nursing women.

Do not take Norco if you are hypersensitive to hydrocodone or acetaminophen.

Do not take Norco if you have acute or severe bronchial asthma.

Do not take Norco if you have or suspect gastrointestinal obstruction, including paralytic ileus.

Drug/Medication Interactions

Percocet

(only major/potentially severe interactions listed here; further information on Percocet interactions)

• Axitinib
• Astemizole
• Azelastine
• Cabazitaxel
• Carbamazepine

Norco

(only major/potentially severe interactions listed here; further information on Norco interactions)

• Astemizole
• Azelastine
• Cyclophosphamide
• Enasidenib
• Eluxadoline

Food/Beverage/Supplement Interactions

Percocet

Limit or avoid alcohol consumption while taking Percocet as it can result in additive CNS depression, and impairment of judgment, thinking, and psychomotor skills.

Avoid grapefruit juice as it can increase plasma concentrations of oxycodone.

Norco

Limit or avoid alcohol consumption while taking Norco, as it can result in additive CNS depression, and impairment of judgment, thinking, and psychomotor skills.

Avoid grapefruit juice as it can increase plasma concentrations of hydrocodone.

Cost Comparison

How much do Percocet and Norco cost?

Both Percocet and Norco have generic forms available, which offer significant cost savings.

For the brand name versions of these drugs:

• The price of 90 tablets of Percocet (10 mg/325 mg) averages around $200, which works out to $2–6/day, depending on your dose.
• The price of 90 tablets of Norco (10 mg/325 mg) averages about $120, working out to approximately $2-4/day, depending on your dose.

Thus, if you are in the higher dosage range for oxycodone (i.e., 300 mg/day or higher), then brand-name Percocet is more expensive on a per-day treatment basis. Please note that cost should not be a primary consideration in determining which drugs are right for you.

For the generic versions of Percocet (oxycodone) and Norco (hydrocodone), costs are significantly lower:

• Oxycodone (5 mg tablets) is available in packs of 90 tablets with approximate costs of $0.5 to $1.66 per day for dosages of 5 mg/day, or more if you are taking more typical dosages of 7.5 to 10 mg/day.
• Hydrocodone (10 mg tablets) is available in packs of 90-100 tablets for around $19. The approximate cost per day for dosages of 10 mg/day is around $0.19, or more if you are taking more typical dosages of 7.5 to 10 mg/day.

Popularity of Percocet and Norco

Oxycodone, in generic form as well as brand names such as Percocet, was estimated to have been prescribed to approximately 10,086,467 people in the US in 2020. On the other hand, hydrocodone was prescribed to around 30,100,356 people in the US and was ranked #16 in 2020. According to a 2021 report, oxycodone and hydrocodone are among the most commonly prescribed opioids for pain. Both have similar side effects, although oxycodone is associated with increased overdose risk and, thus, hydrocodone has a significant advantage.

Conclusion

Takeaway

Both Percocet (oxycodone) and Norco (hydrocodone) are effective in treating moderate to severe pain and have multiple clinical trials and studies that indicate they are more effective than placebo treatments. However, the prominence and euphoric effect generated by these drugs have a high potential for misuse and drug abuse. It can lead to drug dependence, and addiction and withdrawal would require a structured recovery plan. Thus, Percocet and Norco are only recommended when non-opioid treatments are ineffective, and even then, initial therapy should involve the lowest effective dose.

Both Percocet and Norco have similar side effects profiles. Although, some clinical studies show that oxycodone results in a higher risk of overdose, whereas hydrocodone can lead to chronic use. Management with acetaminophen and monotherapy can make them both favorable agents. Moreover, patients should be educated about overdosing symptoms and seek immediate medical help if such symptoms occur.

Both drugs are available in generic forms and offer significant cost savings to patients who pay out of pocket.