Oxycodone vs. Hydrocodone

• Oxycodone (OxyContin, Oxaydo, Xtampza ER, Roxybond) 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:
  • Lightheadedness
  • Dizziness
  • Sedation
  • Nausea
  • Vomiting
• 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 oxycodone and hyrocodone.

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).

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).

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:

• Loss of energy or strength (asthenia)
• Gastritis
• Twitching
• Anxiety
• Confusion
• Hiccups
• Insomnia
• Tinnitus
• Gas or flatulence
• Depression
• Impotence
• Dry skin
• Dermatitis
• Agitation
• Seizures
• Urinary retension

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

• Peripheral edema (swelling)
• Upper respiratory tract infections
• Muscle spasms
• Urinary tract infections (URIs)
• Back pain
• Tremor
• Tachycardia
• Chills
• Hot flashes
• Both opioids can impair thinking and the physical abilities to drive or operate machinery. It can slow (depress) the breathing in the elderly, disabled, and people with serious lung disease.

Both of these medications are habit forming (addictive), misused, and abused; as can all strong painkillers. 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.

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

• Anxiety
• Insomnia
• Muscle pain
• Vomiting
• Goosebumps
• Sweating

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.

Controlled substances

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 healthcare providers office. Your doctor can't call it into your pharmacy; not even for refills.

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 dosage

• The usual starting dose using immediate release oxycodone tablets is 5 to 30 mg every 4 to 6 hours. Patients who have never received opioids should start with 5-15 mg every 4 to 6 hours. Some patients may require 30 mg or more every 4 hours.
• The usual starting dose using extended release tablets is 10 mg every 12 hours. Extended release tablets are used when around-the-clock treatment is required for an extended period. Extended release tablets should be swallowed whole, broken, crushed, or chewed. Breaking, crushing, or chewing extended release tablets may lead to rapid absorption of the drug and dangerous levels of oxycodone.
• Patients who have been using opioids and have become tolerant to opioid therapy should only use the 60 and 80 tablets or single doses greater than 40 mg. Administration of large doses to opioid-naïve patients may lead to profound depressed breathing. The usual adult dose for the oral solution (5 mg/5 ml) is 10-30 mg every 4 hours.

Hydrocodone dosage

• 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 5 mg 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.

Oxycodone interactions 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%

Hydrocodone interactions include:

• Alcohol can result in an increase of hydrocodone plasma levels and cause a potentially fatal overdose of hydrocodone.
• CYP3A4 inhibitors can increase the plasma concentration of hydrocodone, resulting in increased or prolonged opioid effects. 
  • These effects could be more pronounced with concomitant use of hydrocodone and CYP2D6 and CYP3A4 inhibitors, particularly when an inhibitor is added after a stable dose of hydrocodone is achieved
• CYP3A4 inducers can decrease the plasma concentration of hydrocodone, resulting in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence to hydrocodone
• Serotonergic drugs—The concomitant use of opioids with other drugs that affect the serotonergic neurotransmitter system has resulted in serotonin syndrome.
• Mixed agonist/antagonist and partial agonist opioid analgesics may reduce the analgesic effect of hydrocodone and/or precipitate withdrawal symptoms.
• Muscle relaxants—Hydrocodone may enhance the neuromuscular blocking action of skeletal muscle relaxants and produce an increased degree of respiratory depression.
• Diuretics—Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone.
• Anticholinergic drugs—The concomitant use of anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus.

The other drug interactions, warnings and precautions that are similar 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.

Is hydrocodone safe to take if I'm pregnant or breastfeeding?

• The safety of taking hydrocodone during pregnancy or while breastfeeding is not known.

Is oxycodone safe to take if I'm pregnant or breastfeeding?

• Safety during pregnancy has not been established. Children born to mothers who were taking oxycodone for a prolonged period may exhibit respiratory depression or withdrawal symptoms.
• Small amounts of oxycodone are secreted in breast milk, which may cause side effects in the newborn.

Oxycodone warnings and contraindications

• Oxycodone is used with caution in the elderly, debilitated patients, and in patients with serious lung disease because it can depress breathing.
• Oxycodone can impair thinking and the physical abilities required for driving or operating machinery.