Alcohol and Norco is one drug combination that should always be avoided.

Norco is the brand name of the combination of hydrocodone bitartrate and acetaminophen and is a commonly prescribed opioid pain reliever. This drug combination was the most frequently prescribed drug in ten American states in 2017.

Given how commonly Norco is used, many people wonder if Norco can be combined with alcohol. In short, mixing Norco and alcohol is not safe and should be avoided.

Article at a Glance:

Important points to remember about Norco and alcohol use include:

  • Mixing Norco and alcohol can dangerously lower breathing rate, causing coma, brain failure or death
  • Mixing Norco and alcohol can also cause liver damage
  • Signs of an overdose of Norco and alcohol include loss of consciousness, erratic breathing, choking and blue fingertips or lips
  • Contact help immediately if an overdose is suspected

Mixing Norco and Alcohol

The Food and Drug Administration (FDA) requires that the manufacturer of Norco includes a boxed warning, the most serious type of warning on a drug label, noting that use of Norco with alcohol can cause respiratory depression, coma or death.

How Norco and Alcohol Affect the Brain

The hydrocodone component of Norco is a semi-synthetic opioid used to treat severe pain. The pain-relieving effects of Norco are primarily due to how the drug binds to opioid receptors in the brain. However, hydrocodone affects other parts of the brain including the medullary respiratory center. Hydrocodone inhibits the respiratory center in the brain, causing slow and ineffective breathing.

Alcohol affects the brain in a slightly different way than Norco does. It mimics the effects of gamma-Aminobutyric acid, or GABA, the primary inhibitory neurotransmitter. Mimicking GABA at the GABA receptor is how alcohol causes relaxation and sedation.

Alcohol also inhibits the primary excitatory neurotransmitter in the brain, glutamate. Both GABA and glutamate help control the body’s breathing. By increasing the inhibitory effects of GABA and decreasing the excitatory effects of glutamate, alcohol can slow down breathing.

Alcohol and Norco Can Lead to Respiratory Depression

Because both alcohol and Norco affect breathing rate on their own, they have a strong and dangerous effect when mixed. The rate of respiratory depression, or slow and ineffective breathing, is dramatically higher when alcohol and Norco are combined. A recent study shows that as little as one tablet of an opioid medication combined with modest alcohol intake can increase the risk of respiratory depression.

Alcohol and Norco Can Lead to Liver Damage

While respiratory depression is the main danger of combining Norco and alcohol, this drug combination can also affect the liver. Each Norco tablet contains 325 mg of acetaminophen. The FDA recommends a maximum daily dose of 3,000 mg of acetaminophen, which is the equivalent of nine Norco tablets.

However, the daily maximum is even lower if alcohol is consumed at the same time. Too much acetaminophen, or the combination of alcohol and acetaminophen, can cause liver failure.

Side Effects of Mixing Norco and Alcohol

Short-term side effects of mixing Norco and alcohol include:

  • Sedation
  • Dizziness
  • Nausea or vomiting
  • Lightheadedness

Long-term effects of using both Norco and alcohol include:

  • Liver damage or failure
  • Brain damage
  • Increased overdose risk
  • Irritability
  • Potential for withdrawal effects

The combination of Norco and alcohol can also lead to a drug overdose. An overdose can occur soon after ingesting the two substances.

Signs of a Norco and alcohol overdose may include:

  • Inability to walk
  • Excessive sedation
  • Unconscious
  • Slow or erratic breathing
  • Choking or gurgling sounds
  • Blue fingertips or lips

An overdose with Norco and alcohol is a medical emergency. Medical help should be contacted immediately if an overdose is suspected.

Treatment for Norco and Alcohol Addiction

Norco and alcohol are highly addictive substances. Due to the nature of these two drugs, it is best to treat addiction to both substances at the same time.

When stopping one or both of these substances, a person may experience withdrawal symptoms. These are potentially dangerous and should be supervised by a health care provider or under the management of a doctor in a medical detox program.

Medication is available to help with opioid and alcohol addiction, as well as reversing an opioid overdose, but the most comprehensive care will come from an addiction treatment program.

Treatment methods, managed by both medical and mental health care providers, should follow a protocol that includes the following:

  • Medically assisted detox care
  • Individual or group counseling
  • Behavioral therapy
  • Medications for mental health issues or physical conditions, if necessary
  • Post-detox treatment consideration, including transitioning to inpatient or outpatient programs

If you are struggling from addiction to Norco or alcohol, you are not alone. Help is available. Contact a representative of The Recovery Village today to begin your path to recovery.

Norco and alcohol are both addictive substances. If you struggle with these substances, you may need professional help. The Recovery Village offers treatment programs that can help you or a loved one overcome addiction in a safe, supportive setting. To learn more about treatment at one of our accredited facilities, call The Recovery Village today.

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Editor – Camille Renzoni
Cami Renzoni is a creative writer and editor for The Recovery Village. As an advocate for behavioral health, Cami is certified in mental health first aid and encourages people who face substance use disorders to ask for the help they deserve. Read more
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Medically Reviewed By – Nathan Jakowski, PharmD
Nate Jakowski is a clinical pharmacist specializing in drug information and managed care. He completed his Doctor of Pharmacy degree at the University of Wisconsin. Read more

Goetz, Thomas. “The most prescribed drugs in America, state by state.” GoodRx, 2018. Accessed March 25, 2019.

Gudin, Jeffrey et al. “Risks, Management, and Monitoring of Com[…], and/or Alcohol Use.” U.S. National Library of Medicine, 2013. Accessed March 25, 2019.

American Society of Anesthesiology. “Mixing Opioids and Alcohol May Increase […]Elderly, Study Finds.” Published on February 7, 2017. Accessed March 25, 2019

DailyMed. “Norco Package Insert.” Allergan Inc., 2018. Accessed March 25, 2019.

U.S. Food and Drug Administration. “Acetaminophen Information.” Published on November 24, 2017. Accessed on March 25, 2019.

National Institute on Drug Abuse. “Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).” Updated in January 2018. Accessed March 25, 2019.

Medical Disclaimer

The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.