From the Guidelines
Oxycodone (OxyContin) and hydrocodone (Vicodin) have been found to be equal in terms of pain relief when used in equianalgesic doses, with no significant difference in efficacy between the two medications. The difference between the two lies in their classification, with oxycodone being a Schedule II opioid and hydrocodone being a Schedule III opioid when combined with acetaminophen or ibuprofen [ 1 ].
- Key points to consider:
- Both medications are opioid analgesics that work by binding to opioid receptors in the brain and spinal cord to reduce pain perception.
- Equianalgesic doses of opioids are equally efficacious in relieving pain, regardless of their Drug Enforcement Administration classification [ 1 ].
- Two prospective randomized controlled trials have compared the efficacy of short-acting oxycodone with hydrocodone combination products and found them to be equal [ 1 ].
- The recommended starting doses for oxycodone and hydrocodone are 5-15 mg PO Q4-6h PRN and 5-15 mg PO Q4-6h PRN, respectively, when combined with acetaminophen [ 1 ].
- It's essential to note that long-acting or extended-release schedule II products, such as oxycodone ER (OxyContin), are indicated for chronic pain and should not be used for acute pain [ 1 ].
- In terms of potency, while oxycodone may be considered more potent than hydrocodone in some contexts, the provided evidence does not support the claim that oxycodone is approximately 1.5 times more potent than hydrocodone milligram for milligram [ 1 ]. The choice between oxycodone and hydrocodone should be based on individual patient needs and medical history, rather than a perceived difference in potency or efficacy.
From the Research
Comparison of Oxycodone and Hydrocodone
- Oxycodone (OxyContin) and hydrocodone (Vicodin) are both opioids used for pain management, but they have different properties and effects 2, 3, 4, 5, 6.
- In terms of potency, studies suggest that oxycodone is roughly equipotent to or slightly more potent than hydrocodone 6.
- A study found that oxycodone was associated with a higher risk of overdose compared to hydrocodone, especially when used in monotherapy or combined with acetaminophen 5.
- Another study found that hydrocodone users were generally risk-averse women, elderly people, noninjectors, and those who prefer safer modes of acquisition, while oxycodone was more attractive to risk-tolerant young, male users who prefer to inject or snort their drugs to get high 4.
- The risk of developing chronic use was slightly higher with hydrocodone, whereas the risk of overdose was higher after oxycodone 5.
Differences in Effects and Abuse Liability
- Both oxycodone and hydrocodone produce typical mu opioid agonist effects, including increased ratings of liking, good effects, and high, as well as observer-rated and physiological effects 6.
- The abuse liability profile and relative potency of oxycodone and hydrocodone do not differ substantially from one another 6.
- Oxycodone was found to be associated with a greater locomotor supersensitivity to quinpirole, a D2/D3 dopamine receptor agonist, compared to hydrocodone and morphine 2.
- The decision to use one drug over another is a complex one, largely attributable to individual differences, such as personality, gender, age, and other factors 4.
Clinical Implications
- The choice between oxycodone and hydrocodone should be based on individual patient characteristics and medical history, taking into account the potential risks and benefits of each medication 3, 5.
- Healthcare providers should be aware of the potential for overdose and chronic use associated with both oxycodone and hydrocodone, and monitor patients closely for signs of abuse or addiction 5.