Herbal interactions with norco
Executive summary
Herbal and supplement products can interact with Norco (hydrocodone/acetaminophen); authoritative patient resources and prescribing information warn patients to tell providers about "herbal supplements" and list specific herbal agents such as St. John’s wort and tryptophan as potential interactants, while cannabis is flagged separately for major interaction risks with Norco [1] [2] [3] [4]. Drug information databases note that many nonprescription products — vitamins, herbal remedies and cannabis — may change hydrocodone effects, breathing risk, or acetaminophen safety and that clinicians should assess all supplements before prescribing Norco [5] [6] [7].
1. Why clinicians warn about "herbal" products with Norco
Professional labels for Norco and major drug information sites explicitly instruct patients to disclose any prescription medicines, over‑the‑counter drugs, vitamins or herbal supplements because those products can alter hydrocodone or acetaminophen metabolism and safety [1] [8]. Drugs.com and Mayo Clinic patient pages reiterate that herbal products are part of that warning and that interactions may necessitate dose changes or extra monitoring [5] [6]. The label also emphasizes risk when Norco is combined with other central nervous system depressants — a category that includes some herbal sedatives — which can amplify sedation and breathing suppression [1].
2. Specific herbs flagged in patient resources
MedlinePlus and its hydrocodone‑combination entry call out St. John’s wort and tryptophan as nonprescription or herbal products that may interact with hydrocodone or hydrocodone combinations; both sources advise telling your doctor and pharmacist if you take them [3] [2]. The presence of those two names is concrete in public patient guidance even though comprehensive lists of all possible herbs are not provided in these sources [3] [2].
3. Cannabis: a major and studied interaction
Drugs.com’s interaction checker categorizes cannabis as a "Major Drug Interaction" with Norco, noting that combining opioids and other CNS depressants (including cannabis) can cause profound sedation, respiratory distress, coma and death — a very serious caution [4]. A case‑report style study discussed in the literature examined smoked cannabis added to oral hydrocodone/acetaminophen and found pharmacokinetic and pharmacodynamic differences, and laboratory data suggest THC may inhibit enzymes (CYP2D6, UGT2B7) relevant to hydrocodone metabolism — a mechanistic reason further study is needed [9].
4. How herbs might change Norco's effects — mechanisms cited
Regulatory and pharmacology summaries stress CYP3A4 and other metabolic pathways can change opioid exposure; Norco labeling warns that co‑use with CYP3A4 inhibitors or inducers can alter hydrocodone concentrations and that monitoring or dose adjustments may be required [1] [10]. The cannabis study similarly points to possible inhibition of CYP2D6 and UGT2B7 by cannabinoids, which could change opioid metabolism and effects [9]. Available sources do not list every herb that affects these enzymes; they instead emphasize that many supplements could be relevant and providers should assess them [1] [5].
5. The chief clinical risks to watch for
Across prescribing information and drug resources, the principal dangers are increased sedation and respiratory depression when Norco is combined with other CNS depressants (including some herbal sedatives and cannabis), and hepatotoxicity risk when acetaminophen is combined with other products that affect the liver — all reasons clinicians require a full list of patient supplements [1] [7] [5]. Drugs.com quantifies that Norco interacts with hundreds of drugs and flags alcohol as a specifically dangerous combination [11] [8].
6. What patients should do — practical steps from the sources
All sources consistently advise: tell your prescriber and pharmacist about every prescription, OTC medicine, vitamin, and herbal supplement before starting Norco; expect clinicians to monitor, adjust dosing, or recommend alternatives if there is risk of interaction [8] [1] [6]. Use an interaction checker with a clinician’s guidance for complex cases — Drugs.com and other databases offer checkers but the label remains the primary clinical directive [5] [1].
Limitations and disagreements in reporting
Sources converge on the core warnings (disclose supplements; watch for CNS depression, enzyme‑mediated changes, and acetaminophen risks) and identify St. John’s wort, tryptophan and cannabis specifically [3] [2] [4]. Available sources do not provide an exhaustive list of herbal interactions or definitive evidence for every herb — many entries explicitly say the lists are incomplete and larger clinical studies are needed, particularly for cannabis‑opioid pharmacology [5] [9].
Bottom line
Treat herbal supplements and cannabis as clinically relevant when you or a clinician considers Norco: disclose them, expect monitoring or dose changes, and avoid unsupervised combinations that raise sedation, respiratory depression, or liver‑injury risks [1] [4] [7].