Oxycodone vs. Hydrocodone: Which Is Better for Pain?

  • Medical Editor: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

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Oxycodone vs. hydrocodone comparison

  • Oxycodone (OxyContin) and hydrocodone (Zohydro ER) are strong prescription opioid (narcotic) pain relievers similar to morphine, fentanyl, and methadone.
  • These narcotics are prescribed to manage acute or chronic, moderate to severe pain in people who need to take pain medication over a long period of time, and other pain treatments haven't been effective in managing their pain.
  • They are available in combination with other pain medication, for example, they each can be combined with acetaminophen (for example, Percocet, Roxicet, Oxycet, Vicodin, Lortab, Norco) to treat moderately severe pain, fever, and inflammation.
  • One difference between these two narcotics is that hydrocodone also can be combined with ibuprofen to manage pain, fever, and inflammation. It also can be combined with an expectorant and decongestant (for example, guaifenesin and pseudoephedrine) to treat nasal congestion, cough, and to the loosen mucus people tend to get with the common cold.
  • Most narcotics have the same common side effects, for example:
  • The main differences between oxycodone are the more serious effects and adverse reactions.
  • Both of these pain medications are opioids, and increase the effects of other medication that slows brain function, for example, alcohol, barbiturates, benzodiazepines, and skeletal muscle relaxants. If you combine opioids with other medication that slows brain function, it may lead to dangerous impairment of breathing or death.
  • Narcotics also are highly addictive, even if you take the correct dosage your doctor prescribed for you.
  • If you are an addict or have an addiction problem and you don't take the medication as prescribed; if you crush or snort pills, or inject opioids such as oxycodone, hydrocodone, morphine, or fentanyl; you at a higher risk of overdose, and possibly death.
  • Interactions are similar between these two opioids.

What are oxycodone and hydrocodone?

Oxycodone and hydrocodone are strong narcotic pain medications similar to morphine and other opioids (narcotics). Doctors prescribe them to manage chronic to severe pain in people who need long-term pain medicine, and haven't responded to other treatments for pain.

Researchers don't know exactly how oxycodone works in decreasing discomfort and increasing pain tolerance. But on the other hand, we do know how hydrocodone works. It works like other opioid narcotics by stimulating the receptors in the brain to increase a person's threshold to pain (the amount of stimulation it takes to feel pain) and reduce how painful it feel it feels (the perception of pain).

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What are the differences between how these narcotics are used for pain?

One difference between these two narcotics is how they are prescribed. Hydrocodone can be combined with other medicine, for example, ibuprofen (a nonsteroidal anti-inflammatory drug or NSAID), to relieve pain, decrease inflammation, and reduce a fever (brand name Vicoprofen). Or it can be combined with homatropine (Hycodan) or chlorpheniramine (Tussionex) to relieve pain and suppresses cough.

A similarity between these narcotics is that they both can be combined with other non-narcotic pain medication like acetaminophen to relieve pain, inflammation, and reduce fever (for example, brand names Percocet and Vicodin).

Can I become addicted to these pain medications?

Both of these medications are habit forming (addictive), misused, and abused; as can all strong pain killers. You can become mentally and physically dependent on them when you take them for pain over a long period of time, even at the dosage your doctor has prescribed. Take them as your doctor has prescribed and don't crush or snort pills, or inject the product.

They also react with alcohol and benzodiazepines, for example, alprazolam (Xanax), lorazepam (Ativan), diazepam (Valium), clonazepam (Klonopin), and may cause the patient to become extremely sedated, suffer respiratory depression, coma, and even death.

What are the withdrawal symptoms of narcotics?

If you suddenly stop taking either pain medication you may experience withdrawal symptoms like:

People who abuse narcotics and those with addiction disorders misuse strong narcotics to get “high” by crushing, snorting, or injecting them, which results in uncontrolled delivery of the medicine and can lead to overdose and death.

Are these narcotics a controlled substance?

The US Drug Enforcement Agency classifies certain substances, chemicals, and drugs into five (5) classified categories. They are classified by their potential abuse by a patient. Oxycodone and hydrocodone are both Schedule II drugs, which means they have a high potential for physical and psychological addiction, and are considered dangerous to the patient. Both drugs, and any other combinations of these drugs, for example when they are combined with either acetaminophen or ibuprofen (Percocet, Vicodin, Lortab, etc.) are classified as Schedule II drugs. This means that they are considered dangerous, addictive, and are regulated by the DEA and your doctor. It also means that you have to pick up your prescription for pain at your health-care providers office. Your doctor can't call it into your pharmacy; not even for refills.

The only drugs classified as more dangerous by the DEA than opioids are Schedule I drugs. These are illegal drugs, and they are highly addictive like heroin, LSD, ecstasy, and peyote. Schedule III includes drugs have a moderate to low potential for addiction. Examples include Tylenol with codeine, anabolic steroids, and testosterone. Schedule IV medicine has a low potential for abuse and addition. Examples include alprazolam (Xanax), Soma, diazepam (Valium), lorazepam (Ativan), tramadol (Ultram), and zolpidem (Ambien). Schedule V drugs have the lowest potential for addition. Examples include some cough suppressants, pain medication, and antidiarrheals. Schedule III-V drugs can be called into your pharmacist, including refills.

What are the differences between the side effects of oxycodone and hydrocodone?

Both medications have common side effects like dizziness, nausea, vomiting, constipation, dry mouth, and sweating. The more dangerous side effects and adverse reactions are the main differences between these narcotics.

Oxycodone may cause more serious side effects and adverse reactions like:

Hydrocodone also may cause more serious side effects and adverse reactions like:

What are the differences between the dosage of these pain medications?

Your doctor or other health care professional will tailor your initial dose based on your past history with prescription narcotic pain medication, risks for addiction, abuse, or misuse.

Oxycodone dosing

  • You should be monitored closely for respiratory depression in the first 24-72 hours of taking oxycodone.
  • Take the tablets water and swallow them whole after putting the pill in your mouth. Don't lick or presoak the tablets.
  • The usual starting dose of immediate release tablets is 5mg to 30mg every 4 to 6 hours. Some people may need 30 mg or more every 4 hours.
  • The usual starting dose for the extended release tablets (is 10mg every 12 hours). These tablets are prescribed by your doctor if you need treatment 24 hours a day for a long period of time. Extended release pills are made to release the medication into your system slowly over an extended period of time. Extended release tablets also have fewer effects and adverse reactions.
  • You should only use the 60mg and 80mg tablets or single doses greater than 40mg if you have been using other opioids and have become tolerant of therapy with narcotics.
  • The usual adult dosage for oxycodone oral concentrate is 20mg/ml (5mg) every 6 hours.
  • The usual adult dosage for the oral solution is 5mg/5ml (10mg to30 mg) every 4 hours.

Hydrocodone dosing

  • You should be monitored closely for respiratory depression in the first 24-72 hours of taking it.
  • Capsules should be taken with water and swallowed whole after putting it in your mouth. Don't lick or presoak the capsules.
  • The initial dose of is 5mg every 4 to 6 hours as needed for pain.
  • The initial dose for extended release tablets (ER) is one 10mg capsule twice a day (every 12 hours). This also is the starting dose if you can't tolerate opioid medication. It can be dangerous if it's taken in larger doses in the beginning because it may cause fatal respiratory depression (death).
  • You should stop taking all other opioids when you start treatment to avoid overdose. Talk to your doctor before you begin taking it if you are currently taking other narcotic pain medication.

What are the differences between the drug interactions?

The differences between these two opioids is oxycodone interacts, and include:

  • It may cause constipation. Talk to your doctor about medications and lifestyle changes to prevent and relieve constipation.
  • If you combine oxycodone with drugs that affect activity of particular liver enzymes or discontinuing such drugs may result in a fatal overdose.
  • A fatty meal may increase the absorption of oxycodone by 27%

The other drug interactions, warnings and precautions are similar, and include:

Combining these narcotics with other medicine that suppresses the central nervous system (CNS), for example, tranquilizers (Valium), hypnotics (Ambien, Intermezzo), benzodiazepines (Ativan, Xanax, Restoril), other narcotics (morphine, fentanyl or other opium based products), and alcohol can increase the risk of respiratory depression (your system is so sedated that your lungs aren't able to take in enough oxygen to breath), which can lead to coma and death.

Combining oxycodone or hydrocodone with other medicine that suppresses the central nervous system (CNS), for example, tranquilizers (Valium), hypnotics (Ambien, Intermezzo), benzodiazepines (Ativan, Xanax, Restoril), other narcotics (morphine, fentanyl or other opium based drugs), and alcohol can increase the risk of respiratory depression (your system is so sedated that your lungs aren’t able to take in enough oxygen to breath), which can lead to coma and death.

You shouldn't take these opioids with a type of antidepressant called monoamine oxidase inhibitors or MAOIs (for example, isocarboxazid [Marplan], phenelzine [Nardil], and tranylcypromine [Parnate]) or other drugs that inhibit monoamine oxidase, (for example, linezolid [Zyvox]), because combining these drugs with narcotics can lead to confusion, tremor, hyperactivity, high blood pressure, coma, and even death. If you are taking an MAOI, talk to your doctor before you start taking opium products because you should stop taking MAOIs 14 days before you begin treatment with opioids.

Acetaminophen can cause liver damage when taken in large doses or combined with alcohol. Tylenol liver damage can be avoided if you don't drink alcohol while taking these products, and pay careful attention to the dosage of acetaminophen in combined products, for example, Percocet or Vicodin.

Are these drugs safe to take if I'm pregnant or breastfeeding?

  • The safety of taking hydrocodone during pregnancy or while breastfeeding is not known.
  • The safety of taking oxycodone during pregnancy has not been established.
  • Small amounts of oxycodone are secreted into breast milk, and may have serious effects in a nursing newborn.
  • Infants born to women who were taking any narcotic for a long period of time may have life-threatening signs of respiratory depression or withdrawal symptoms.

REFERENCE:

FDA. "HYSLINGA® ER."
<http://www.accessdata.fda.gov/drugsatfda_docs/label/2014/206627s000lbl.pdf>

FDA Prescribing Information. "Zohydro® ER
<http://www.accessdata.fda.gov/drugsatfda_docs/label/2013/202880s000lbl.pdf>

FDA. "Medication Guide; OXYCONTIN®."
<http://www.fda.gov/downloads/drugs/drugsafety/ucm208530.pdf>

Jarzyna, D. et al. "American Society for Pain Management Nursing Guidelines on Monitoring for Opioid-Induced Sedation and Respiratory Depression." Medscape.
<http://www.medscape.com/viewarticle/749754_9>

United States Drug Enforcement Administration. "Drug Scheduling."
<https://www.dea.gov/druginfo/ds.shtml>

Last Editorial Review: 2/6/2017

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Reviewed on 2/6/2017
References
REFERENCE:

FDA. "HYSLINGA® ER."
<http://www.accessdata.fda.gov/drugsatfda_docs/label/2014/206627s000lbl.pdf>

FDA Prescribing Information. "Zohydro® ER
<http://www.accessdata.fda.gov/drugsatfda_docs/label/2013/202880s000lbl.pdf>

FDA. "Medication Guide; OXYCONTIN®."
<http://www.fda.gov/downloads/drugs/drugsafety/ucm208530.pdf>

Jarzyna, D. et al. "American Society for Pain Management Nursing Guidelines on Monitoring for Opioid-Induced Sedation and Respiratory Depression." Medscape.
<http://www.medscape.com/viewarticle/749754_9>

United States Drug Enforcement Administration. "Drug Scheduling."
<https://www.dea.gov/druginfo/ds.shtml>

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