Oxycodone vs. Vicodin (hydrocodone/acetaminophen) for Pain

  • Medical Reviewer: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

Oxycodone vs. Vicodin (hydrocodone/acetaminophen) for pain review

  • Oxycodone is a strong opioid narcotic pain reliever (analgesic), and Vicodin is a combination of two drugs, hydrocodone (a strong narcotic pain reliever) and acetaminophen (Tylenol).
  • Oxycodone and hydrocodone are similar to other drugs that are opioid narcotics, for example, methadone, fentanyl, and morphine.
  • Both oxycodone and Vicodin are prescribed to treat moderate to severe pain. However, hydrocodone also may prescribed to treat fever, inflammation, and cough.
  • Oxycodone also is available in combination with acetaminophen (Percocet, Roxicet, Tylox, Oxycet).
  • Other brand names for hydrocodone and acetaminophen, for example, include Vicodin ES, Vicodin HP, Lortab, Lorcet, and Norco.
  • Common side effects of both oxycodone and Vicodin include:
  • The dosages for oxycodone and Vicodin are not the same and should be reviewed prior to taking either medication.
  • Oxycodone and Vicodin interact with several other medications, for example, neither drug should be taken with monoamine oxidase inhibitors (MAOI), a class of antidepressants. Combining oxycodone or Vicodin with alcohol or other drugs may lead to increased sedation and cause confusion.
  • Acetaminophen taken in large doses or when used with other drugs like alcohol may lead to liver toxicity or liver damage.
  • Oxycodone and Vicodin are listed as schedule II drugs by the Controlled Substances Act because their use may lead to addiction and withdrawal symptoms.

What are oxycodone and Vicodin (hydrocodone/acetaminophen), and how do they work?

  • Oxycodone: Oxycodone is prescribed strong narcotic pain-reliever and cough suppressant similar to morphine, codeine, and hydrocodone. The precise mechanism of action is not known but may involve stimulation of opioid receptors in the brain. Oxycodone does not eliminate the sensation of pain but decreases discomfort by increasing the tolerance to pain. In addition to tolerance to pain, oxycodone also causes sedation and depression of respiration.
  • Vicodin is a prescribed combination of hydrocodone and acetaminophen. Hydrocodone is a strong narcotic pain-reliever (analgesic) and a cough suppressant, similar to codeine. Hydrocodone blocks the receptors on nerve cells in the brain that give rise to the sensation of pain. Acetaminophen is a non-narcotic analgesic (pain reliever) and antipyretic (fever reducer). Acetaminophen works by elevating the threshold to pain, that is, in order for pain to be felt, greater stimulation of the nerves responsible for the sensation of pain is necessary. It reduces fever through its action on the temperature-regulating center of the brain. Frequently, hydrocodone and acetaminophen are combined to achieve pain relief, as in Vicodin.

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What brand names are available for oxycodone and hydrocodone/acetaminophen?

Oxycodone brand names

Examples of brands of oxycodone available in the US include:

  • OxyContin
  • Roxicodone
  • Oxecta

There are many other brand name for oxycodone to include combinations with other drugs, for example:

  • Endocet
  • Percodan
  • Percocet
  • Oxycet

Hydrocodone and acetaminophen brand names

Brand names available for hydrocodone and acetaminophen in the US include:

  • Vicodin
  • Vicodin ES
  • Vicodin HP
  • Lortab
  • Lorcet
  • Lorcet Plus
  • Norco
  • Zydone
  • Hycet
  • Maxidone
  • Stagesic
  • Verdrocet
  • Xodol
  • Zamicet
  • Zolvit
  • Anexsia is a discontinued brand and is no longer available in the US.

What are the uses for oxycodone vs. Vicodin (hydrocodone/acetaminophen)?

Oxycodone uses

  • Oxycodone is prescribed for the management of pain severe enough to require daily, around-the-clock, long-term treatment with a narcotic, and for which alternative treatment options are inadequate for the relief of moderate to severe pain.

Vicodin uses

  • Vicodin (hydrocodone/acetaminophen) is prescribed for the relief of moderate to moderately severe pain. It also may be used as a cough suppressant.

What are the side effects of oxycodone vs. Vicodin (hydrocodone/acetaminophen)?

Oxycodone side effects

The most frequent side effects of oxycodone oxycodone include:

Other side effects of oxycodone include:

Oxycodone can depress breathing and is used with caution in elderly, debilitated patients and in patients with serious lung disease.

Oxycodone can impair thinking and the physical abilities required for driving or operating machinery.

Is oxycodone additive?

Oxycodone is habit forming. Mental and physical dependence can occur but are unlikely when used for short-term pain relief. If oxycodone is suddenly withdrawn after prolonged use, symptoms of withdrawal may develop. The dose of oxycodone should be gradually reduced in order to avoid withdrawal symptoms.

Vicodin side effects

Common side effects of Vicodin are:

  • lightheadedness,
  • dizziness,
  • sedation,
  • nausea, and
  • vomiting.

Other important side effects of Vicodin include:

  • drowsiness,
  • constipation, and
  • spasm of the ureter, which can lead to difficulty in urinating.

Hydrocodone can impair thinking and the physical abilities required for driving or operating machinery. Hydrocodone can depress breathing, and should be used with caution in elderly, debilitated patients and in patients with serious lung disease.

Acetaminophen can cause severe liver failure if excessive amounts are used and when combined with chronic alcohol use or other drugs that also impair liver function.

Is Vicodin addictive?

Hydrocodone may be habit forming. Mental and physical dependence can occur but are unlikely when used for short-term pain relief.

How should oxycodone vs. Vicodin (hydrocodone/acetaminophen) be taken (dosage)?

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 of time. Extended release tablets should not be broken, crushed or chewed but should be swallowed whole. Braking, crushing or chewing extended release tablets may lead to rapid absorption of the medication and dangerous levels of oxycodone.
  • The 60 and 80 tablets or single doses greater than 40 mg should only be used by patients who have been using opioids and have become tolerant to opioid therapy. Administration of large doses to opioid-naïve patients may lead to profound depression of breathing.
  • The usual adult dose of the oral concentrate (20 mg/ml) is 5 mg every 6 hours.
  • The usual adult dose for the oral solution (5 mg/5 ml) is 10-30 mg every 4 hours.

Vicodin dosage

  • The usual dose of Vicodin (hydrocodone/acetaminophen) for adults is 1 to 2 tablets or capsules (hydrocodone 2.5 to 10 mg; acetaminophen) 300 to 750 mg) every 4 to 6 hours or 15 mL of liquid every 4 to 6 hours as needed.

Which drugs interact with oxycodone vs. Vicodin (hydrocodone/acetaminophen)?

Oxycodone drug interactions

  • Oxycodone, like other narcotic pain-relievers, increases the effects of drugs that slow brain function, such as:
  • Combined use of the above drugs and oxycodone may lead to increased respiratory depression.
  • Oxycodone should not be taken with any of the monoamine oxidase inhibitor (MAOI) class of antidepressants, for example, isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), selegiline (Eldepryl), and procarbazine (Matulane) or other drugs that inhibit monoamine oxidase, for example, linezolid (Zyvox). Such combinations may lead to confusion, high blood pressure, tremor, hyperactivity, coma, and death. Oxycodone should not be administered within 14 days of stopping an MAOI.
  • Since oxycodone causes constipation, the use of antidiarrheals, for example, diphenoxylate and atropine (Lomotil) and loperamide (Imodium), in persons taking oxycodone, can lead to severe constipation.
  • Drugs which stimulate and also block opioid receptors for example, pentazocine, nalbuphine (Nubain), butorphanol (Stadol), and buprenorphine (Subutex) may reduce the effect of oxycodone and may precipitate withdrawal symptoms.
  • Combining oxycodone with drugs that affect activity of certain liver enzymes or discontinuing such drugs may result in fatal oxycodone overdose.
  • A fatty meal may increase the absorption of oxycodone by 27%.

Vicodin drug interactions

  • Combining alcohol and other sedatives with hydrocodone can lead to increased sedation and even cause confusion.
  • Combining carbamazepine (Tegretol, Tegretol XR , Equetro, Carbatrol) with acetaminophen may increase the risk of liver toxicity.
  • Hydrocodone should not be taken with any of the monoamine oxidase inhibitor (MAOI) class of antidepressants, for example, isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), selegiline (Eldepryl), and procarbazine (Matulane) or other drugs that inhibit monoamine oxidase, for example, linezolid (Zyvox). Such combinations may lead to confusion, high blood pressure, tremor, hyperactivity, coma, and death. Hydrocodone should not be administered within 14 days of stopping an MAOI.

Are oxycodone and Vicodin (hydrocodone/acetaminophen) safe to take during pregnancy or while breastfeeding?

Oxycodone, pregnancy, and breastfeeding safety

  • 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 and may cause side effects in the newborn.

Safety of Vicodin during pregnancy or while breastfeeding

  • There are no adequate studies of hydrocodone and acetaminophen in pregnant women.
  • Hydrocodone/acetaminophen is excreted in breast milk, and, therefore should be used cautiously by nursing mothers.

REFERENCES:

Drug Enforcement Agency. "Drug Fact Sheet Oxycodone."
<https://www.dea.gov/druginfo/drug_data_sheets/Oxycodone.pdf>

FDA Prescribing Information.

U.S. Department of Justice; Drug Enforcement Administration; Diversion Control Division. "Answers to Frequently Asked Questions Regarding OxyContin®."
<https://www.deadiversion.usdoj.gov/drug_chem_info/oxycodone/oxycontin_faq.htm>

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

Summary

Oxycodone and Vicodin (hydrocodone/acetaminophen) are narcotic medications prescribed to treat moderate to severe pain. Vicodin also may be prescribed to treat fever, inflammation, and cough. Common side effects of oxycodone and Vicodin include:

The dosage for oxycodone and Vicodin are not the same. Oxycodone and Vicodin both interact with MAOIs, a type of antidepressant, and drugs like alcohol and other sedatives. Both oxycodone and Vicodin are habit forming and the patient may become addicted to the drug or experience withdrawal symptoms when the drug is discontinued. Brand names available for oxycodone include:

Brand names available for Vicodin (hydrocodone and acetaminophen) include:

All drug information including pregnancy and breastfeeding safety should be reviewed prior to taking any medication.

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Reviewed on 1/4/2017
References
REFERENCES:

Drug Enforcement Agency. "Drug Fact Sheet Oxycodone."
<https://www.dea.gov/druginfo/drug_data_sheets/Oxycodone.pdf>

FDA Prescribing Information.

U.S. Department of Justice; Drug Enforcement Administration; Diversion Control Division. "Answers to Frequently Asked Questions Regarding OxyContin®."
<https://www.deadiversion.usdoj.gov/drug_chem_info/oxycodone/oxycontin_faq.htm>

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

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