This article compares hydrocodone and oxycodone with respect to their chemical structure, potency, side effects, risk for addiction, and appropriate uses in medicine. This is general information for educational purposes. It is not medical advice.
Two of the most widely prescribed opioid pain relievers in the United States are hydrocodone and oxycodone. [1] While both are effective at treating moderate to severe pain, there are several ways these two medications differ and may influence which one a doctor prescribes for a specific patient.
Both medications are opioids (a group of drugs that attach to receptors in the central nervous system and body, thereby reducing pain) synthesized in a lab from naturally occurring compounds found in the opium poppy. Both are also classified as Schedule II controlled substances, meaning that they have a high potential for misuse, dependence and addiction.[2] The chief difference between the two is that oxycodone contains one more oxygen atom than hydrocodone. This small difference changes how each medication is processed by the body.
Hydrocodone is typically combined with acetaminophen (an over-the-counter pain reliever and fever reducer with no risk of dependency) in products with the brand names Vicodin and Norco. Oxycodone may be prescribed alone in products like OxyContin (long-acting extended release oxycodone) or with acetominophen as Percocet.
| Feature |
Hydrocodone |
Oxycodone |
| Brand name |
Vicodin; Norco; Lortab |
OxyContin, Percocet, Roxicodone |
| Controlled substances schedule |
Schedule II |
Schedule II |
| Combination with acetaminophen? |
Yes — most products. |
Possible yes — also available as oxycodone alone. |
How Do These Opioids Act in the Body?
Both hydrocodone and oxycodone provide pain relief by attaching to mu-opioid receptors in the central nervous system and throughout the body, blocking pain messages sent to the brain and spinal cord, also producing relaxation or drowsiness. [3]
Once ingested, hydrocodone breaks down into hydromorphone, and oxycodone breaks down into oxymorphone. There are immediate-release formulations for short-term use that may need administration every 4 to 6 hours. Long-acting versions of both medications exist for sustained treatment of pain.
Is Oxycodone Stronger Than Hydrocodone?
Oxycodone is more potent per milligram than hydrocodone. About 20 mg of oxycodone provides similar amounts of pain relief as 30 mg of hydrocodone, indicating that oxycodone is about 1.5 times stronger per mg than hydrocodone. [4]
Although there is considerable variability in how the drug affects people, some studies evaluating the effectiveness of short-acting hydrocodone versus short-acting oxycodone found minimal differences in pain relief for users who had an acute injury. Still, individual responses may vary.
Ultimately, whether a physician will choose to prescribe oxycodone instead of hydrocodone depends on the type of injury or painful condition, physician experience and preference, and the patient’s previous opioid experience.
Relief Timing, Duration, and Available Forms
For immediate-release formulations, oxycodone usually begins relieving pain within about 10 to 15 minutes, while hydrocodone typically starts working within about 20 to 30 minutes. Both medications usually provide pain relief for about 4 to 6 hours when taken in immediate-release form.
Long-acting formulations provide continuous pain relief for 12 hours or longer and are commonly used to manage pain in patients who need consistent treatment throughout the day. Because long-acting formulations contain higher total doses of active ingredients than short-acting versions, they carry a higher risk of toxicity if misused.
Comparing Side Effects
Both hydrocodone and oxycodone exhibit similar side effects including:
- Nausea
- Vomiting
- Dizziness
- Dry mouth,
- Abdominal discomfort and constipation
- Sedation
- Euphoria
However, hydrocodone is more likely to cause fatigue and constipation in some people, while oxycodone is known to create a stronger euphoric feeling, which can increase the risk of misuse. [5]
The most dangerous risk associated with both medications is respiratory depression, which is slow or shallow breathing resulting in inadequate oxygen in the body. When taken in excessive amounts, or either drug is combined with alcohol, other opioids, benzodiazepines, or any other depressant, respiratory depression can become life-threatening. Individuals experiencing difficulty breathing, excessive sleepiness, or confusion should seek emergency medical care immediately.
Addiction Risks and Signs of Abuse
Both hydrocodone and oxycodone act on the brain’s reward pathway, resulting in physical and psychological dependence or addiction when used regularly. According to the Substance Abuse and Mental Health Services Administration (SAMHSA) data, millions of Americans misuse prescription opioids annually, with both hydrocodone and oxycodone among the most commonly misused. [6] Extended-release formulations of oxycodone may pose slightly greater risk of dependence due to increased potency. Regardless of which medication is prescribed, however, use for prolonged periods poses a significant risk for development of dependence and addiction in any patient.
Signs of opioid misuse include:
- Taking more of the drug than prescribed
- Seeking prescriptions from multiple providers
- Strong cravings for the drug
- Social withdrawal
- Continued use despite negative consequences
- Problems with relationships
- Significant time spent obtaining, using, and recovering from use of the drug
- Failure to manage responsibilities
- Financial difficulties
Reaching out to a healthcare professional or recovery center can provide necessary support. The earlier in addiction professional help is obtained, the better the potential outcome and chance for long-term recovery.
When Doctors Prescribe Hydrocodone vs. Oxycodone
Hydrocodone is generally prescribed for moderate-to-severe acute pain, including postoperative or dental surgical pain. Its combination with acetaminophen provides additional pain relief, and many physicians prefer prescribing it post-surgery since it may produce less euphoria than oxycodone.
Oxycodone is often chosen to treat more severe or breakthrough pain due to its higher potency and faster onset. Chronic conditions involving continuous pain management, such as cancers, are also more likely treated with extended-release formulations of oxycodone.
Non-opioid medications and treatments and multi-modal treatments, such as combining medication with physical therapy and cognitive behavioral therapy, should be considered, especially for long-term care, since many individuals can achieve equivalent relief without opioids. [7]
Drug Interactions, Dependence, and Getting Help
Dangerous drug interactions may occur when hydrocodone or oxycodone are combined with benzodiazepines, antihistamines, muscle relaxers, sedatives, or alcohol, resulting in significantly increased risk for respiratory depression or death. [8] In addition, combination products containing acetaminophen like hydrocodone must never be combined with other acetaminophen products, as it may result in liver toxicity.
Abruptly stopping regular use of an opioid leads to withdrawal symptoms such as muscle cramps, restlessness, insomnia, nausea/vomiting, diarrhea, and sweating. Safe tapering off the medication is necessary to alleviate withdrawal symptoms. Medical detoxification, where healthcare professionals help patients manage withdrawal symptoms safely using medication and other interventions, can assist patients during this process.
There are many treatment options for opioid dependence and addiction, including medication-assisted treatment (MAT) programs or therapeutic models like cognitive behavioral therapy and dialectical behavioral therapy.
At Alpas, we understand how difficult the journey through opioid dependence can be. We encourage anyone struggling with prescription drug dependence or addiction to reach out to us, so our multidisciplinary team can support you through evidence-based recovery services designed specifically to meet your needs.
