Hydrocodone vs. oxycodone: Differences, similarities, and which is better for you

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

Hydrocodone and oxycodone are two opioid prescription drugs indicated for the treatment of moderate to severe pain, often for acute pain. Both drugs are classified as narcotics, which means they are addictive and have a high potential for abuse. Both drugs work by binding to pain receptors, called mu receptors, in the brain, which weakens or blocks pain signals, and results in pain relief. Because both drugs are very powerful, they are generally used after surgery, or in situations where a more mild pain reliever would not be effective or cannot be tolerated.

What are the main differences between hydrocodone and oxycodone?

There are many different formulations of both hydrocodone and oxycodone. Both drugs are Schedule II pain medications; this means that the drug may have a high potential for abuse.

Hydrocodone (Hydrocodone coupons | What is Hydrocodone?) is most commonly found as brand names Norco or Vicodin, which contains hydrocodone in combination with generic Tylenol (acetaminophen, often abbreviated as APAP). Hydrocodone/APAP can be found in pill form as well as liquid form. Hydrocodone can also be found in combination with ibuprofen, and in combination cough medications, such as Hycodan syrup or tablets (hydrocodone/homatropine) or Tussionex suspension (hydrocodone/chlorpheniramine). Alone, hydrocodone can be found in the extended-release drugs Zohydro ER (extended-release) or Hysingla ER.

Oxycodone (Oxycodone coupons | What is Oxycodone?) is commonly prescribed alone, as a generic for OxyIR (immediate-release). It is also found alone in a long-acting drug called OxyContin. Oxycodone is also commonly found in combination, such as in Percocet, which contains oxycodone and APAP.

Both drugs vary in dosage by age and condition and generally are prescribed in the lowest dose for the shortest duration possible. All states have laws regarding opioid prescriptions, because of their strong potential for abuse.

Conditions treated by hydrocodone and oxycodone

Hydrocodone and oxycodone are both indicated for the management of pain that is severe enough to require an opioid, where other treatments (non-opioids) are not adequate or tolerated

Is hydrocodone or oxycodone more effective?

In a double-blind, placebo-controlled study of hydrocodone vs oxycodone in an emergency room setting, pain relief was similar, at 30 minutes and at 60 minutes for both hydrocodone or oxycodone. Both drugs had similar side effects, with hydrocodone causing slightly more constipation than oxycodone.

Another study showed hydrocodone/APAP and oxycodone/APAP to have similar effects in terms of pain relief, but that oxycodone/APAP was 1.5 times more potent than hydrocodone/APAP.

Both hydrocodone and oxycodone are strong painkillers with a high potential for abuse, used when milder painkillers have not provided effective pain relief, or cannot be tolerated. The most effective medication should only be determined by your doctor, who will look at the whole picture of your medical condition(s), history, and other medications you are taking.

Coverage and cost comparison of hydrocodone vs. oxycodone

Due to various state laws, if you are receiving an opioid for the first time, it is likely that you will receive a small quantity.

A typical prescription of 20 tablets of generic hydrocodone-acetaminophen can cost over $100. With a SingleCare coupon, generic Vicodin or Norco can run $26-$41. A typical prescription of oxycodone-acetaminophen 20 tablets is $25-$50. The out-of-pocket price is $10-$15 with a SingleCare coupon.

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Common side effects of hydrocodone vs. oxycodone

The most common side effects of hydrocodone are light-headedness, dizziness, sedation, nausea, and vomiting. Other side effects may include constipation, anxiety, skin rash, lethargy, and dependence.

The most common side effects of oxycodone are nausea, constipation, vomiting, headache, pruritus (itching), insomnia, dizziness, weakness, and drowsiness. Other side effects may include palpitations, dry mouth, anxiety, skin rash, and dependence.

Other side effects may occur. Consult your healthcare provider for more information regarding adverse effects.

Drug interactions of hydrocodone vs. oxycodone

Taking hydrocodone or oxycodone with certain medications that are metabolized by an enzyme called CYP3A4 or CYP2D6 may result in a drug interaction. These drugs are known as enzyme inhibitors and include macrolide antibiotics, azole antifungals, and protease inhibitors. Using them together with hydrocodone or oxycodone can result in higher levels of the opioid, which can be very dangerous.

Other drugs, known as inducers, have the opposite effect, lowering the opioid level so that it is not effective or can cause withdrawal symptoms.

Using benzodiazepines or other CNS depressants (including other opioid medications) in combination with hydrocodone or oxycodone can lead to hypotension, respiratory depression, profound sedation, coma, and death.

Taking hydrocodone or oxycodone with drugs that increase serotonin can also increase the risk of serotonin syndrome. These drugs include SSRI and SNRI antidepressants, tricyclic antidepressants, muscle relaxants, MAO inhibitors (MAO inhibitors should not be used within 14 days of hydrocodone or oxycodone), and triptans for migraine. Consult your healthcare provider for a full list of drug interactions.

Warnings of hydrocodone and oxycodone

There is a boxed warning on hydrocodone and oxycodone, which is the strongest warning required by the FDA. Other warnings include:

• Opioids have a risk of addiction, abuse, and misuse, which can lead to overdose and death. Patients should be assessed for risk before taking an opioid and should be monitored regularly.
• To ensure that the benefits of opioids outweigh the risk of addiction, drug abuse, and misuse, drug companies must educate healthcare providers. Healthcare providers must complete a REMS (Risk Evaluation and Mitigation Strategy)-compliant education program, thoroughly counsel patients and caregivers with each prescription, and emphasize the importance of reading the medication guide, which is provided with each prescription.
• Opioids may cause serious, life-threatening, or fatal respiratory depression. Patients should be monitored, especially in the beginning of treatment and following a dosage change.
• Accidental ingestion, especially by children, can result in a fatal overdose. Patients should be instructed to secure opioids out of the reach of children.
• Neonatal opioid withdrawal syndrome can result in prolonged opioid use during pregnancy and can be life-threatening if not recognized and treated.
• Using opioids with certain medications that are metabolized by the enzyme cytochrome P 450 3A4 may increase opioid levels and cause increased side effects and potentially fatal respiratory depression.
• Using benzodiazepine drugs such as Xanax (alprazolam), Valium (diazepam), or other CNS depressants, such as other opioids (or alcohol), can result in profound sedation, respiratory depression, coma, and death, and should be avoided if possible. Patients who do take this combination due to other alternatives not working must be closely monitored.

Other warnings and contraindications include:

• Hydrocodone or oxycodone should not be used in patients with significant respiratory depression, acute or severe bronchial asthma in an unmonitored setting, gastrointestinal obstruction, or hypersensitivity to any of the ingredients.
• Hydrocodone or oxycodone should not be used in patients with chronic pulmonary disease or elderly or debilitated patients.
• Adrenal insufficiency may occur, usually after one month. Seek treatment if any of these symptoms occur: nausea, vomiting, anorexia, fatigue, weakness, dizziness, and low blood pressure.
• Hydrocodone or oxycodone may cause severe low blood pressure.
• Do not use hydrocodone or oxycodone in patients that have impaired consciousness or are in a coma.
• Hydrocodone or oxycodone can increase the risk of seizures in patients with seizure disorders.
• Hydrocodone or oxycodone should not be withdrawn abruptly but should be tapered slowly.
• Do not drive or operate machinery until you know how the medication affects you.
• Unsecured opioids can be a deadly risk to anyone else in the home, including visitors. Store securely, out of sight and reach of children, and in a location not accessible by others. Ask your healthcare professional how to dispose of unused opioids in your area.

Because there are no well-controlled studies in women, hydrocodone or oxycodone should not be used in pregnancy unless benefits outweigh risks. Prolonged use of opioids during pregnancy, whether for medical or nonmedical use, can cause physical dependence in the baby, leading to neonatal opioid withdrawal syndrome shortly after birth.

Warnings specific to acetaminophen (APAP) which is often found in combination with hydrocodone or oxycodone are:

• Acetaminophen may cause serious skin reactions such as acute generalized exanthematous pustulosis (AGEP), Stevens-Johnson Syndrome (SJS), and toxic epidermal necrolysis (TEN), which could be fatal. Patients should seek urgent treatment if skin reaction occurs.
• There is a risk of liver failure due to APAP. Your doctor should tell you the maximum daily dose of APAP that you can take, and you should check other medications you take for APAP (such as NyQuil).
• Hypersensitivity or anaphylaxis may occur. Seek emergency treatment if any of these signs and symptoms occur: swelling of the face, mouth, and throat, respiratory distress, urticaria, rash, pruritus, and vomiting.

Frequently asked questions about hydrocodone vs. oxycodone

What is hydrocodone?

Hydrocodone is an opioid painkiller used to treat pain that does not respond to milder painkillers. It is available in a variety of formulations, most commonly with acetaminophen in the form of Norco.

What is oxycodone?

Oxycodone is an opioid pain reliever used to treat pain that does not respond to milder painkillers. It is available in a variety of formulations, often by itself  (in both immediate-release and extended-release forms) and also commonly with acetaminophen in the form of Percocet.

Are hydrocodone and oxycodone the same?

Both drugs are strong opioid analgesics. While they are very similar, they do have some differences, such as in the dosing, outlined above.

Is hydrocodone or oxycodone better?

In studies, both drugs have shown to provide effective pain relief. However, both drugs are very strong with a high potential for abuse. Consult your healthcare provider for personalized advice.

Can I use hydrocodone or oxycodone while pregnant?

You should not use hydrocodone or oxycodone while pregnant unless your doctor determines that the benefit to you outweighs the risk to the fetus. Also, using opioids for too long during pregnancy can cause dependence in the fetus, and can lead to neonatal opioid withdrawal syndrome.

Can I use hydrocodone or oxycodone with alcohol?

No. Hydrocodone or oxycodone should never be used with alcohol. The combination could lead to profound sedation, respiratory depression, coma, or death.

Can you take hydrocodone and oxycodone together?

No. Hydrocodone and oxycodone should not be used together. The combination can be very dangerous and lead to respiratory depression or death. This is one reason why it is very important to dispose of old prescription opioids when they are no longer needed. Ask your pharmacist how to dispose of medications at a location near you.

Why do some people use hydrocodone for recreational effects?

While reducing pain, opioids such as hydrocodone or oxycodone may also produce a euphoric effect. Opioids have a high potential for drug abuse. When taking an opioid medication, only use as prescribed. Do not take additional doses, and do not mix with alcohol. Ask your doctor or pharmacist about drug interactions. Dispose of the medication when you no longer need it; do not save it for another time. It can be dangerous to anyone in the home.