Percocet vs. Vicodin: 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

Percocet and Vicodin are two FDA-approved prescription drugs used for the treatment of severe pain. These drugs are classified in a group of medications called opioids, or narcotics, analgesics. Opioid analgesics work by binding to mu-opioid receptors in the brain, weakening and blocking pain signals. By doing this, they relieve severe pain (hence the nickname painkillers). Percocet and Vicodin are classified by the DEA as Schedule II drugs because they have a high potential for substance abuse and may lead to psychological or physical dependence/opioid addiction. Percocet and Vicodin have many similarities, but they also have some differences, which we will discuss below.

What are the main differences between Percocet and Vicodin?

Percocet and Vicodin are combination drugs (each pill contains two drugs) used for pain management (severe, acute pain). Percocet contains oxycodone and acetaminophen. Acetaminophen is the generic of Tylenol and is also referred to as APAP, so the drug name often appears as oxycodone/APAP. Percocet contains 325 mg of acetaminophen, and 2.5 mg, 5 mg, 7.5 mg, or 10 mg of oxycodone.

Vicodin contains both hydrocodone and APAP. Vicodin contains hydrocodone/APAP 5/300 mg. Vicodin ES contains hydrocodone/APAP 7.5/300 mg. Vicodin HP contains hydrocodone/APAP 10/300 mg.

Both Percocet and Vicodin are available in brand name and generic form. Percocet and Vicodin are intended to be used for short-term pain relief; however, some patients with chronic pain continue taking Percocet or Vicodin for longer, depending on the healthcare provider’s instruction. All patients who take Percocet or Vicodin should be closely monitored.

Conditions treated by Percocet and Vicodin

Percocet and Vicodin both have one indication—for the management of pain that is severe enough to require an opioid analgesic, when other treatments (non-opioids) are not tolerated or not adequate to control the pain.

Is Percocet or Vicodin more effective?

In a study of emergency room patients who had acute fractures and were treated with Percocet or Vicodin, pain relief was the same at 30 and 60 minutes with either drug. The study authors concluded that both Percocet and Vicodin provided similar effects in terms of pain relief.

Another study compared oxycodone/APAP (5/325 mg) to hydrocodone/APAP (5/325 mg). Note: The dose of APAP (Tylenol) was 325 mg, as opposed to 300 mg that Vicodin contains. The study looked at patients who had acute pain and compared how the two drugs worked after discharge from the emergency room. Both drugs were similarly effective in reducing pain (by about 50%).

The best drug for you can be determined by your healthcare provider, who can take into account your medical condition(s) and history, as well as any other medications you take that can potentially interact with Percocet or Vicodin.

Coverage and cost comparison of Percocet vs. Vicodin

State laws often limit the first fill of a narcotic prescription to a small quantity. Percocet is covered in its generic form by most insurance and Medicare Part D plans. A typical prescription of generic Percocet could cost over $50 but starts at $11 with a SingleCare discount coupons at participating pharmacies.

Vicodin is usually covered in its generic form by most insurance companies, and by some Medicare Part D plans. (Some plans prefer Norco, which contains 5, 7.5, or 10 mg of hydrocodone, and 325 mg of APAP.) A typical prescription of generic Vicodin runs about $200. A SingleCare coupon can reduce the price to less than $100.

Common side effects of Percocet vs. Vicodin

Serious adverse effects that can occur with Percocet or Vicodin are respiratory depression (slowed breathing and not getting enough oxygen), apnea, respiratory arrest, low blood pressure, and shock.

The most common side effects of Percocet are lightheadedness, dizziness, drowsiness, sedation, nausea, and vomiting. Other side effects include euphoria, dysphoria (feeling unwell or unhappy), constipation, and itching.

The most common side effects of Vicodin are lightheadedness, dizziness, sedation, nausea, and vomiting. Other side effects include lethargy, mental cloudiness, constipation, mood changes, and itching.

Serotonin syndrome is a serious, life-threatening reaction that could occur with Percocet or Vicodin, especially when taken with other drugs that increase serotonin.

This is not a full list of side effects. Consult your healthcare provider for a complete list of side effects of Percocet or Vicodin.

Drug interactions of Percocet vs. Vicodin

Taking Percocet or Vicodin with medications that are metabolized by enzymes called  CYP3A4 or CYP2D6 may result in a drug interaction. These drugs are enzyme inhibitors and include certain antibiotics, antifungals, and protease inhibitors. Using one of these drugs with Percocet or Vicodin can result in a buildup of opioids in your body, which can be very dangerous.

Other drugs are enzyme inducers, and have the opposite effect—they lower the opioid level so that it is not as effective or can cause withdrawal symptoms.

Benzodiazepines or other CNS depressants (including other opioids) in combination with Percocet or Vicodin can cause low blood pressure, slowed breathing, profound sedation, coma, or even death.

Taking Percocet or Vicodin with medications that increase serotonin levels increases the risk of serotonin syndrome, a very serious or even life-threatening condition. These drugs include certain antidepressants, muscle relaxants, MAO inhibitors (MAO inhibitors should not be used within 14 days of Percocet or Vicodin), and triptans.

If you are taking Percocet or Vicodin, remember that they contain Tylenol (APAP), and many over-the-counter cough and cold medications and pain relievers contain APAP as well. Check with your pharmacist, who can help you select an OTC medication that does not contain APAP.

Other drug interactions may occur. Consult your healthcare provider for a full list of drug interactions of Percocet and Vicodin.

Warnings of Percocet and Vicodin

Both Percocet and Vicodin come with a boxed (black box) warning, which is the strongest warning required by the FDA. Here are other warnings:

• Potential for abuse, misuse, and addiction, which can result in overdose and death. Take your medication as prescribed, and only for the purpose it was prescribed.
• Serious, life-threatening respiratory depression can occur. Patients should be monitored, especially during the beginning of treatment and with any change in dose. Elderly patients and patients who have lung problems are at higher risk for respiratory depression.
• Accidental ingestion by anyone, especially children, may cause a fatal overdose.
• The use of opioids for a prolonged time during pregnancy can cause neonatal opioid withdrawal syndrome, which can be life-threatening.
• Tylenol (acetaminophen) has been associated with liver problems, which could result in the need for a liver transplant or death. Patients should be aware of the maximum daily dose of acetaminophen (ask your healthcare provider) and should not use other products that contain acetaminophen.
• Using opioids with benzodiazepines (such as Xanax) or other central nervous system (CNS) depressants can cause serious respiratory depression, profound sedation, coma, or even death. If the combination of an opioid and a benzodiazepine cannot be avoided, the lowest dose should be prescribed, and the medication should be used for the shortest duration possible. The patient should be closely monitored.

Other warnings include:

• Low blood pressure may occur—monitor blood pressure.
• In rare cases, acetaminophen can cause serious skin reactions, including acute generalized exanthematous pustulosis (AGEP), Stevens-Johnson Syndrome (SJS), and toxic epidermal necrolysis (TEN), which may be fatal. If a skin reaction occurs, stop the drug immediately and seek emergency treatment. Acetaminophen can also cause hypersensitivity reactions, which may include swelling around the lips and face, or skin reactions. If this occurs, seek emergency treatment.
• Opioid pain relievers should not be used in patients who have a head injury, or in a patient with impaired consciousness. Also, patients with gastrointestinal obstruction should not use opioids.
• Patients with seizure disorders have an increased risk of seizures when taking opioids.
• When discontinuing an opioid, taper the medication gradually (as directed by your healthcare provider) to avoid symptoms of withdrawal. Never stop taking the medication abruptly.
• Do not drive or operate machinery until you know how you will react to the medication.
• Do not drink alcohol while taking Percocet or Vicodin.
• Keep your medication out of the reach of children and others, preferably in a locked cabinet or drawer. When you are finished with your course of treatment, do not save the medication. The CDC has resources on how to safely dispose of your opioid medication.
• Opioids should not be taken during pregnancy, because they can cause harm to the fetus. Using opioids for a prolonged time during pregnancy can lead to a life-threatening condition called neonatal opioid withdrawal syndrome.

Frequently asked questions about Percocet vs. Vicodin

What is Percocet?

Percocet is an opioid pain reliever and contains oxycodone and acetaminophen. It should only be used for severe, acute pain, for a short period of time, unless otherwise instructed by your healthcare provider.

What is Vicodin?

Vicodin is also an opioid pain reliever. It contains hydrocodone and acetaminophen. It is used for severe, acute pain, and should only be used for a short period of time unless otherwise instructed by your healthcare provider.

Are Percocet and Vicodin the same? / Which is more powerful, Percocet or Vicodin?

They are similar, but not the same. Both contain Tylenol or acetaminophen. Percocet also contains oxycodone, a strong painkiller. Vicodin also contains hydrocodone, which is a strong painkiller.

Is Percocet or Vicodin better?

Both drugs seem to be similarly effective, as seen in the studies described above. If you have severe, acute pain, that is not controlled with a non-opioid medication, your doctor may recommend trying Percocet or Vicodin on a short-term basis. Consult your healthcare provider for more information.

Can I use Percocet or Vicodin while pregnant?

No. Taking Percocet or Vicodin can cause harm to the baby, and taking it for a prolonged period of time can cause neonatal opioid withdrawal syndrome (also known as neonatal abstinence syndrome), which can be life-threatening.

Can I use Percocet or Vicodin with alcohol?

No, you should not use Percocet or Vicodin with alcohol. The combination could increase the risk of CNS and respiratory depression, which could lead to a coma or death. Also, the combination of alcohol and acetaminophen can increase the risk for liver problems.

Can you take oxycodone with Vicodin?

Generally, no. If you are taking an opioid for acute pain, you would not take another opioid. For example, patients should not take oxycodone with Vicodin because the combination increases the risk of CNS and respiratory depression, psychomotor impairment, low blood pressure, and severe constipation.

However, some patients with chronic pain, who are carefully monitored under the care of a pain management specialist take a different, long-acting form of oxycodone, called Oxycontin, and take Vicodin for breakthrough pain if needed.

If you are taking an opioid pain reliever for acute pain, you would not take another opioid.

Is tramadol stronger than Percocet?

Ultram (tramadol) is a strong painkiller. Tramadol is in the DEA Schedule IV, which means it has a low potential for abuse and low risk of dependence. Percocet is in Schedule II, which means it has a high potential for abuse, and could potentially lead to severe psychological or physical dependence. Although Percocet is placed in a higher schedule, both drugs have similar side effects. Consult your healthcare provider for more information.

Is Percocet an opiate or opioid?

Often, we see these terms used interchangeably, but they are not exactly the same.

An opiate is a drug that comes from opium, as in the poppy plant. An opioid can be natural or synthetic. Percocet is an opioid—it is synthetic and not found naturally in opium.