Drug Interaction Between Norco And Tramadol

In our latest question and answer, the pharmacist discusses the drug interaction between Norco (hydrocodone/acetaminophen) and tramadol.


I took a Norco 7.5 (hydrocodone/acetaminophen) four hours ago. Can I take a tramadol 50 mg now?

Asked by Wanda On Jul 14, 2018

Answered by
Medical Content Reviewed By PharmacistAnswers Staff

On Jul 14, 2018

Tramadol and Norco (hydrocodone/acetaminophen) should not be taken at the same time but generally can be taken in the same day as long as they are separated by at least four to six hours.

Why To Avoid Taking Norco And Tramadol Together

Tramadol may cause additive sedative, CNS, and/or respiratory-depressant effects with combined with Hydrocodone. In addition, concomitant use of tramadol increases the seizure risk in patients taking other opiate agonists, like hydrocodone. Also, tramadol can cause additive CNS depression and respiratory depression when used with opiate agonists. Therefore, it is recommended to avoid concurrent use whenever possible. If used together, extreme caution is needed, and a reduced tramadol dose may be needed.

Taking Norco And Tramadol The Same Day

As mentioned above it generally is okay to take Norco and tramadol the same day, as long as they are separated by an appropriate amount of time (~4-6 hours). In fact, your doctor may prescribe both to you and recommend to take tramadol for more moderate pain symptoms, and reserve Norco for times when your pain symptoms are more severe as Norco is considered a stronger pain medication.

In your case, 7.5 hours hours between doses of Norco and tramadol should be safe, however, you should discuss with your doctor a specific dosing schedule. There may be a small number of individuals susceptible to uncommon side effects like respiratory depression, even when doses are separated by more than 6 hours.

About the Pharmacist

Dr. Brian Staiger Pharm.D

Dr. Brian Staiger is a licensed pharmacist in New York State and the founder of PharmacistAnswers.com. He graduated from the University At Buffalo with a Doctor of Pharmacy degree in 2010. He has been featured in numerous publications including the Huffington Post as well as a variety of health and pharmacy-related blogs. Please feel free to reach out to him directly if you have any inquiries or want to connect! He's answered thousands of medication and pharmacy-related questions and he's ready to answer yours! Brian.Staiger@PharmacistAnswers.com Office: 716-389-3076

About Tramadol

Tramadol is a centrally-acting analgesic with a unique, dual mechanism of action. It is both a mu-opioid receptor agonist and a weak inhibitor of norepinephrine and serotonin reuptake. Tramadol is a synthetic analog of codeine but has less potential for abuse or respiratory depression than other opiate agonists, but both may occur nonetheless. The onset of action of immediate release tramadol products is within 1 hour of administration, with effects lasting around 4 to 6 hours. The FDA approved oral, immediate-release tramadol (Ultram) in March 1995; an orally disintegrating tablet (Rybix) in May 2005; a once-daily, oral, extended-release tablet (Ultram ER) in September 2005; a second once-daily, oral, extended-release tablet with a different release formulation (Ryzolt) in December 2008; and a once-daily, extended-release capsule (ConZip) in May 2010; the ConZip product provides an immediate release component of tramadol, along with an extended-release component.

About Hydrocodone

Hydrocodone is an oral semisynthetic opioid agonist and is most commonly prescribed in combination with acetaminophen, although it is available as a single ingredient in products such as Zohydro ER. Hydrocodone works by acting as a mu-receptor opioid agonist, which causes changes in the perception of pain in the central nervous system. Hydrocodone may be taken with or without food, and has an onset of action within 10-30 minutes after taking a dose by mouth. The duration of action is around 4 to 8 hours,

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