Vicodin vs. Lortab vs. Norco for Pain

As a pharmacist I probably receive more questions about "pain" than about any other symptom or condition. In this article I want to provide a brief comparison of 3 useful and widely-prescribed prescription medications for short-term or breakthrough pain: Vicodin, Lortab and Norco.

One would think that practical information on these important medications would abound. It doesn't. There is no official "Vicodin" or "Lortab" or "Norco" website maintained by the manufacturers to help patients obtain answers to commonly asked questions. This is mostly due to the fact that all these products are available generically, and therefore the brand manufacturers receive very little revenue from them any longer.

In this article I intend to try and fill in this information gap by providing relevant and accurate information about Vicodin, Lortab and Norco.

Below you will find the following information about these commonly prescribed prescription pain killers:

1. The Ingredients: Hydrocodone and Acetaminophen

2. A Comparison: How Do These Products Compare?

3. Frequently Asked Questions Answered

IMPORTANT: Part of the reason I am writing this article is because these medications, although very useful, have been involved in more drug-related fatalities than any other medications on the market. When used appropriately, these medications can be a valuable resource in regaining a reasonable quality of life for those who suffer from acute or chronic pain. But when abused or misused they are very dangerous. 

All 3 of these pain relievers contain the same 2 ingredients in varying amounts: hydrocodone and acetaminophen.

A) HYDROCODONE: Hydrocodone is a synthetic narcotic pain reliever, similar to codeine. It was first discovered in the 1920's and has been used in the U.S. since 1943. Hydrocodone is a "controlled substance" and is regulated by the DEA. This means, among other things, that it has some potential for addiction and abuse. Patients should always carefully follow the advice and directions of their physician and not use more than prescribed. Hydrocodone is generally considered to be "less" potent and addictive than oxycodone (the ingredient found in Oxycontin).

B) ACETAMINOPHEN: Acetaminophen in varying amounts (also commonly known by the brand name Tylenol) is included to help treat pain in Vicodin, Norco and Lortab. The inclusion of acetaminophen makes it ESPECIALLY important that daily dosages are NOT exceeded. Too much of this ingredient will create serious problems for your liver. Additionally, NEVER use any alcohol while taking these medications, as this makes the possibility of liver damage far more likely.

Why 2 Ingredients? Together these 2 ingredients create a synergy in which combined they are more effective than either are alone. Also, the combination deters the abuse of hydrocodone as it cannot safely be taken at higher doses (due to the acetaminophen component).

So which is best? As mentioned above, they all contain the same 2 ingredients. The differences between them are the AMOUNTS and the RATIO of hydrocodone to acetaminophen.

Look at the chart below:

As you can see from the above chart, all of these products are NOT CREATED EQUAL.

• Vicodin comes in 3 different varieties known as Vicodin, Vicodin ES and Vicodin HP. If a prescriber just writes "Vicodin" then they are referring to the 5mg/500mg strength.
• Lortab comes in 3 strengths and the strength must be indicated on the prescription.
• Norco comes in 2 strengths and, like Lortab, the strength must be written on the prescription to be valid.

Let's compare them in this way:

THE STRONGEST: The product from the above chart with the HIGHEST amount of Hydrocodone AND acetaminophen is Vicodin HP.

THE WEAKEST: Norco 5/325 has the lowest amount of hydrocodone and acetaminophen per tablet.

THE BEST: For serious pain, my opinion is that Norco 10mg/325mg is the best. Because it has the highest amount of hydrocodone and lowest amount of acetaminophen it will allow for a slightly higher total daily tablet count.

THE MOST POPULAR: By far, the most frequently prescribed version of these products is Vicodin.

WHAT ABOUT COST? Another way to compare them is by cost. Typically Vicodin (the generic form) is the least expensive of the bunch. Why? Because it is prescribed so much pharmacies buy it in BULK and thus get better pricing than on the other varieties. However, if you have an insurance and pay the same amount for ANY generic...your copay should be the same for any of these.

QUESTION: How are Vicodin, Norco or Lortab typically taken?

ANSWER: These products are usually taken as a single tablet every 4-6 hours as needed for pain. For severe pain, and only under the direction of your physician, 2 tablets are used in some instances. NEVER take more than prescribed.

QUESTION: How often can these products be refilled?

ANSWER: Sometimes a doctor will allow 1 or more refills. However, be sure to have a talk with your doctor about how often he/she expects this prescription to be refilled. Just because you are allowed to take 1 or 2 tablets ever 4-6 hours as needed does NOT mean the doctor expects you will use THAT MANY every single day. Sometimes you will, but this must be discussed, especially if you find yourself needing them that often.

QUESTION: What side effects do these medications have?

ANSWER: The most common side effects associated with Vicodin, Norco and Lortab are nausea, vomiting, dizziness and drowsiness. Taking them with food will help reduce stomach upset. More serious side effects which require medical attention would be things like a rash or hives or difficulty breathing (very rare).

QUESTION: Are these products addictive?

ANSWER: Many patients are concerned about addiction while using Vicodin, Norco or Lortab. Continual daily use over a prolonged period will typically create some dependence, meaning a "weening" process will be required. This is not usually needed for short-term use (meaning 1-2 weeks of treatment). "Addiction" however tends to also vary by patients and personalities, and many people use these products without creating long-term dependence.

QUESTION: Do YOU have a question? Feel free to ask it below and I will do my best to give you a helpful answer.