Hydrocodone, the active ingredient in drugs like Norco and Vicodin, and oxycodone, the active ingredient in Percocet and OxyContin, are two of the most popular opioid — or narcotic — analgesics prescribed for pain relief. Both medications' standard-release versions take effect in 30 minutes to an hour, while oxycodone's immediate release version provides pain relief within 10 to 15 minutes. Both drugs manage pain for 4 to 6 hours on average. While hydrocodone does not have an immediate-release version, it does offer a controlled-release formula, as does oxycodone, that lasts up to 12 hours for severe pain management. Oxycodone may be somewhat safer during pregnancy than hydrocodone, but neither is an ideal pain reliever for pregnant women.
|Use||Relief of moderate to severe pain||Relief of moderate to severe pain|
|Form||Oral tablet, capsule with sustained release option, or liquid||Liquid, tablet (both controlled release and immediate release), capsule|
|Dosage||2.5mg to 10mg orally every 4 to 6 hours, extended release brands available||2.5mg to 10mg orally every 4 to 6 hours, except 12-hour controlled release|
|Cost||120 tablets of generic Vicodin (5mg hydrocodone + 325mg acetaminophen) falls between $12 and $25.||120 tablets of generic Percocet (5mg oxycodone + 325mg acetaminophen) is between $23 and $73.|
|Side effects||Drowsiness, vomiting, nausea, itching, dizziness, headache, loss of appetite, stomach pain, dry mouth, swelling of hands and/or feet, back and muscle pain, cold-like symptoms, mild to severe constipation||Nausea, vomiting, constipation, loss of appetite, dizziness, headache, tiredness, dry mouth, sweating and itching|
|Overdose||Potentially fatal. Warning signs may include light-headedness, confusion, sever drowsiness, tremors, slow heart rate, shallow breathing, painful urination||Potentially fatal. Symptoms include extreme drowsiness, muscle weakness, confusion, clammy skin, shallow breathing, fainting and coma|
|Pregnancy||Category C drug — not recommended for pregnancy or breastfeeding. Animal reproduction studies have found adverse effects.||Category B drug in U.S. — may be prescribed if benefit to mother outweighs risk to fetus; not recommended while breastfeeding. Animal reproduction studies have not found adverse effects. Category C drug in Australia.|
|(Other) brand names||Lortab, Lorcet, Maxidone, Norco, Vicodin, Xodol, Zydone, Ibudone, Repraxain, Vicoporfen, Zohydro ER||Dazidox, Endocodone, ETH-Oxydose, Oxecta, OxyContin, Oxyfast, OxyIR, Percolone, Roxicodone|
|Addiction||Highly addictive||Highly addictive, most popular opioid among abusers|
|Excretion||Renal||Urine (19% unchanged)|
|Bioavailability||High (80% +)||100% (IV); Up to 87% (oral)|
|Metabolism||Hepatic||Hepatic: primarily CYP3A, secondarily CYP2D6|
|Half-life||3.8–6 hours||3–4.5 hr|
|Generic name||Hydrocodone is the generic name||Oxycodone is the generic name|
|Class of Drugs||Schedule II controlled substance||Schedule II controlled substance|
|Prescription/OTC||Prescription only||Prescription only|
Oral application of both hydrocodone and oxycodone manages moderate to acute pain within 30 to 60 minutes of ingestion, for 4 to 6 hours on average. Oxycodone's time-released and hydrocodone's extended-release formulas both treat acute pain and manage pain for longer periods; they are not used for on-demand, as-needed, or emergency immediacy pain relief. Oxycodon also offers a quick-release formula giving relief in 10-15 minutes.
The primary reason one narcotic may be prescribed over the other is to avoid negative side effects. The secondary difference between which medication doctors prescribe and when, is based on what the active ingredient--oxycodone vs. hydrocodone--is mixed with. For example, most of the hydrocodone products are mixed with ibuprofen or acetaminophen. Ibuprofen, like all NSAIDs, can cause gastrointestinal damage if taken in large quantities and for long periods of time. Recently, one of the extended release hydrocodones, Zohydro ER, was developed not to be combined with any acetaminophen-based product. Conversely, all doses of oxycodone are and have been available as a stand-alone medication.
Hydrocodone vs. Oxycodone Dosage
For adults, initial doses of 10mgs of oral oxycodone or hydrocodone over each 12-hour period may be adjusted to 5 to 15mgs every 4 to 6 hours. The majority of branded pharmaceuticals with these opioids contain 2.5 to 7.5mgs in combination with other painkillers such as acetaminophen and ibuprofen.
Geriatric dosage of oxycodone is 2.5mgs every 6 hours. Neither drug is prescribed to children under 12 months of age. For older children, dosage depends on weight, with children who weigh less than 110 pounds receiving .05 to .15mgs every 4 to 6 hours, and children who weigh over 110 pounds receiving 5 to 10mgs every 4 to 6 hours.
The maximum dosage daily for hydrocodone is 40mg per day, 80mg for oxycodone. If narcotic tolerance has been established in a medically-controlled environment, additional doses may be prescribed.
A double-blind, randomized, controlled study evaluating 5mg doses of both opioids (coupled with acetaminophen) found that hydrocodone+acetaminophen and oxycodone+acetaminophen deliver equal pain relief over the course of an hour. The study compared 65,000 people with acute fractures in an urban trauma care facility and revealed the drugs have few side effects, but that hydrocodone+acetaminophen was more likely to cause constipation than oxycodone+acetaminophen.
Additional studies addressing severe and chronic pain, as well as pain management for cancer patients and the elderly agree that both oxycodone and hydrocodone, when properly and similarly prescribed, deliver the same level and duration of pain relief.
Some studies have analyzed the effects of combining these drugs with other pain relief medications, the two most common being acetaminophen, mentioned above, and ibuprofen. In an NIH study that focused on pain management following gynecological surgeries, 7.5mg of hydrocodone combined with 200mg of ibuprofen was just as effective as a 10mg oxycodone / 325mg acetaminophen combination. As these drugs do come with a risk of dependency, finding lower-dose alternatives or combination therapies is sometimes preferable.
Brand names and the combination of these drugs with other pharmaceuticals influence pricing. Cost also sometimes determines which medication is prescribed. GoodRx.com compares retail drug prices across six or more major pharmacy chains nationwide. On average, the cash price for 120 tablets of generic Vicodin (5mg hydrocodone + 325mg acetaminophen) falls between $12 and $25. The average cash price for 120 tablets of generic Percocet (5mg oxycodone + 325mg acetaminophen) is between $23 and $73.
Generally, hydrocodone users may experience drowsiness, vomiting, nausea, itching, dizziness, headache, loss of appetite, stomach pain, dry mouth, swelling of hands and/or feet, back and muscle pain, cold-like symptoms, and mild to severe constipation.
Oxycodone-using patients experience less overall side effects but may endure drowsiness, vomiting, nausea, itching, dizziness, headache, loss of appetite, stomach pain, dry mouth and mild to moderate constipation.
The efficacy comparison studies also compared side effects like nausea and dizziness. There was no significant indication that one drug delivered worse effects than the other; however constipation was elevated somewhat in the hydrocodone test group. For both drugs, extreme nausea and vomiting can cause additional problems such as dehydration.
Combining oxycodone or hydrocodone with alcohol may cause serious injury or death. Both may impair driving and equipment operation, and result in falls from dizziness. Both medications are known to react negatively to some herbal and vitamin supplements, depression and anxiety medications, sleeping pills, muscle relaxants, and various other pain meds. Oxycodone efficacy may be hindered by grapefruit products.
Oxycodone is a category B drug in the U.S., meaning that currently no animal reproduction studies have found a risk to fetal development when administering the drug, but that no good studies on pregnant humans have been carried out. Many doctors will prescribe oxycodone to pregnant women only in cases where the benefit to mother outweighs the potential risk to the fetus. It is worth noting that Australia lists oxycodone as a category C drug in its healthcare system, meaning there oxycodone is "suspected of causing harmful effects," though these may be reversible — as in the case of potential withdrawal symptoms — and do not include malformations.
Hydrocodone is a category C pain reliever in the U.S. and is less likely to be prescribed to pregnant women, accordingly. Category C drugs are those which have produced adverse effects in animal reproduction studies.
These drugs are also not to be used during breastfeeding because in vitro and milk-delivered effects to the child may include side effects (e.g., extreme drowsiness) and dependency followed by withdrawal symptoms; they can even result in death. Most doctors will recommend discontinuing breastfeeding if one of these drugs is needed.
Dependency and Abuse
Abuse and addiction for both opioids are extremely high, but oxycodone is the more popular drug of choice among opioid abusers.
NIH-compiled studies indicate that more than 4.7 million Americans use opioids that are obtained or taken illicitly, and an average of 1 million people in the country are addicted to prescription narcotics. This abuse and addiction begins as early as the 8th grade. Since 1998, hydrocodone production has increased almost three-fold from 10 years prior, and oxycodone has increased 6-fold. The Drug Abuse Warning Network (DAWN) has suggested these statistics are indicative of high rates of abuse and addiction.
- Choosing an Opioid - Michigan State University
- Combination hydrocodone and ibuprofen versus combination oxycodone and acetaminophen in the treatment of postoperative obstetric or gynecologic pain - NIH.gov
- Comparison of oxycodone and hydrocodone for the treatment of acute pain associated with fractures - NIH.gov
- Current aproach to cancer pain management - NIH.gov
- Hydrocodone Information - Drugs.com
- Opioid Analgesic Comparison Chart (PDF) - Medical University of South Carolina
- Oxycodone Information - Drugs.com
- The Relative Abuse Liability of Oral Oxycodone, Hydrocodone and Hydromorphone Assessed in Prescription Opioid Abusers - NIH.gov
- Percocet Prices - GoodRx.com
- Vicodin Prices - GoodRx.com