Comparative Pharmacology
Head-to-head clinical analysis: NORCO versus ULTRAM.
Peer-Reviewed Evidence
Head-to-head clinical analysis: NORCO versus ULTRAM.
NORCO vs ULTRAM
Comparing the clinical profiles, pharmacokinetic behaviors, and safety indices of these two therapeutic agents.
NORCO is a combination of hydrocodone, a mu-opioid receptor agonist that inhibits ascending pain pathways and alters pain perception, and acetaminophen, which inhibits cyclooxygenase (COX) enzymes, particularly in the CNS, leading to decreased prostaglandin synthesis and antipyresis.
Tramadol is a centrally acting synthetic opioid analgesic that binds to μ-opioid receptors and inhibits norepinephrine and serotonin reuptake.
One tablet (5 mg hydrocodone/325 mg acetaminophen, 7.5 mg/325 mg, 10 mg/325 mg) orally every 4-6 hours as needed for pain. Maximum acetaminophen dose 4000 mg/day; maximum hydrocodone dose 60 mg/day.
50-100 mg orally every 4-6 hours as needed for pain; maximum 400 mg/day (for extended-release: 100 mg once daily, titrated up to 300 mg once daily).
None Documented
None Documented
Hydrocodone: terminal elimination half-life is 3.8 to 6.0 hours (mean 4.5 hours) in adults; prolonged in hepatic or renal impairment. Acetaminophen: half-life 1.5–3 hours.
Tramadol: ~6 hours; M1 metabolite (O-desmethyltramadol): ~7 hours; prolonged in renal/hepatic impairment
Hydrocodone: primarily renal (approximately 60% as unchanged drug and metabolites, including norhydrocodone, hydromorphone, and conjugated metabolites). Biliary/fecal excretion accounts for <10%.
Renal: ~90% (tramadol and metabolites; conjugated metabolites are major), Fecal: ~10%
Category C
Category C
Opioid Analgesic
Opioid Analgesic