Hydrocodone and oxycodone are prescription pain relievers classified as opioids or narcotics. Both drugs are derived from the opium poppy. Oxycodone is synthesized from the opium alkaloid thebaine, while hydrocodone is derived from codeine. These medications are typically prescribed to patients requiring long-term pain management for mild to severe pain. They are usually prescribed when other pain medications have proven ineffective in alleviating the patient’s discomfort.
What is the classification of oxycodone and hydrocodone?
Hydrocodone: Hydrocodone affects the central nervous system, blocking pain signals from reaching the brain. It is available as a standalone medication or in combination with other drugs, with hydrocodone and acetaminophen being a commonly prescribed combination. It is the active ingredient in medications such as Vicodin, Norco, and Lortab, and can be used in combination with ibuprofen to manage pain, fever, and inflammation.
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Oxycodone: Oxycodone alters the brain and body’s responses to pain and perception of pain. It is available as a standalone medication or in combination with other drugs, similar to hydrocodone. OxyContin and Percocet are examples of medications containing oxycodone as the active ingredient. Common side effects of oxycodone include muscle twitching, anxiety, confusion, insomnia, depression, restlessness, and seizures.
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What are the common forms and strengths of hydrocodone and oxycodone?
- Oxycodone is offered in extended-release dosages of 10, 20, 40, and 80 mg. Immediate-release capsules are also available in 5 mg strength. Oxycodone comes in oval-shaped pills of various colors, and it can also be administered through liquid injection.
- Hydrocodone is available in tablet form with strengths of 2.5, 5, 7.5, and 10 mg. The tablets come in white, yellow, or orange colors. Hydrocodone is also available as a liquid and in transdermal patches.
What is the difference between oxycodone and hydrocodone?
| Hydrocodone | Oxycodone | |
| Active ingredient | Hydrocodone | Oxycodone |
| 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 |
| (Other) brand names | Lortab, Lorcet, Maxidone, Norco, Vicodin, Xodol, Zydone, Ibudone, Reprexain, Vicoporfen, Zohydro ER | Dazidox, Endocodone, ETH-Oxydose, Oxecta, OxyContin, Oxyfast, OxyIR, Percolone, Roxicodone |
| Dependence liability | Moderate | Moderate–high |
| Excretion | Renal | Urine (19% unchanged) |
| Bioavailability | High (80% +) | 100% (IV); Up to 87% (oral) |
| Metabolism | Hepatic | Hepatic: primarily CYP3A, secondarily CYP2D6 |
| Formula | C18H21NO3 | C18H21NO4 |
| 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 |
| Pregnancy | Drugs in category C shouldn’t be used during pregnancy or while nursing. | In the US, category B medications may be administered if the benefit to the mother outweighs the risk to the fetus; nursing is not advised while taking these prescriptions. |
What are the drug interactions of hydrocodone and oxycodone?
- When hydrocodone or oxycodone is taken together with certain drugs that are metabolized by the CYP3A4 or CYP2D6 enzymes, there can be drug interactions. Examples of enzyme inhibitors include macrolide antibiotics, azole antifungals, and protease inhibitors. When combined with hydrocodone or oxycodone, these inhibitors can increase the levels of opioids in the body, which can be extremely dangerous.
- Conversely, enzyme inducers have the opposite effect, reducing the levels of opioids to the extent that they may no longer be effective or may cause withdrawal symptoms.
- Combining hydrocodone or oxycodone with benzodiazepines or other central nervous system depressants, including other opioid medications, can result in low blood pressure, respiratory depression, excessive drowsiness, coma, and even death.
- Taking hydrocodone or oxycodone with medications that enhance serotonin can worsen serotonin syndrome. These medications include antidepressants such as SSRIs and SNRIs, tricyclic antidepressants, muscle relaxants, MAO inhibitors (which should not be taken within 14 days of hydrocodone or oxycodone), and migraine triptans. It is important to consult your doctor for a comprehensive list of drug interactions.
Which is stronger oxycodone and hydrocodone?
In a clinical study comparing hydrocodone and oxycodone, it was found that both drugs provided similar pain relief after 30 minutes and 60 minutes. The side effects of both medications were also similar, with hydrocodone causing slightly more constipation compared to oxycodone. Another study indicated that hydrocodone and oxycodone had comparable pain-relieving effects. However, certain clinical studies have suggested that oxycodone maybe 1.5 times more effective than hydrocodone in some cases.
It is important to note that both hydrocodone and oxycodone are potent opioids with a high risk of misuse. They are typically prescribed when milder pain medications are ineffective or not well-tolerated. The choice of the most suitable and effective drug for an individual depends on factors such as their medical condition(s), medical history, and other medications they may be taking. Your doctor is the best person to determine the appropriate medication for you based on these considerations.
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What are the warnings and precautions for oxycodone and hydrocodone?
- If you experience symptoms such as nausea, vomiting, loss of appetite, fatigue, weakness, dizziness, or low blood pressure, it is important to seek immediate medical assistance.
- Individuals with chronic lung disease, the elderly, or those with impairments should consult their doctor before using hydrocodone or oxycodone.
- The use of hydrocodone or oxycodone can lead to abnormally low blood pressure.
- Hydrocodone or oxycodone should not be used in individuals who have lost consciousness or are in a coma.
- Ensure the safe storage of these medications, keeping them out of sight and reach of minors and in a secure location inaccessible to others.
- Consult your healthcare provider for proper disposal methods of unused opioids in your area.
- In individuals with seizure disorders, hydrocodone or oxycodone may increase the risk of seizures.
- Patients with severe respiratory depression, acute or severe bronchial asthma in an unmonitored setting, gastrointestinal obstruction, or hypersensitivity to any of the components should not take hydrocodone or oxycodone without consulting their doctor.
- The discontinuation of hydrocodone or oxycodone should be done gradually rather than abruptly. Until you understand how the medication may affect you, refrain from driving or operating machinery.
Conclusion
Both Hydrocodone and Oxycodone function in a similar way, working to increase pain tolerance and diminish pain perception by stimulating pain receptors in the brain. Oxycodone is a potent analgesic that is available in immediate-release as well as extended-release formulations. On the other hand, hydrocodone is commonly prescribed as an immediate-release pain reliever, often combined with acetaminophen. However, when used alone, it can also have a time-release formulation. In terms of efficacy in providing pain relief or inducing sensations of euphoria, both medications are highly comparable. The choice between the two should be based on individual factors and determined by a healthcare