What is the difference between Hydrocodone and Oxycodone?

From the Guidelines

Hydrocodone and oxycodone are both effective opioid pain medications, but they have similar efficacy in relieving pain, with no significant difference in analgesic effectiveness between the two, as demonstrated by equianalgesic doses being equally efficacious in relieving pain 1.

Key Differences

• Hydrocodone is commonly combined with acetaminophen in medications like Vicodin or Norco, while oxycodone is available both alone (OxyContin, Roxicodone) and in combination products (Percocet) 1.
• Oxycodone is classified as a Schedule II opioid, whereas hydrocodone is classified as a Schedule III opioid when combined with acetaminophen or ibuprofen 1.

Efficacy and Potency

• The potency of oxycodone and hydrocodone is not significantly different in terms of analgesic efficacy, with equianalgesic doses providing similar pain relief 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.

Side Effects and Risks

• Both medications carry risks of dependence, addiction, and respiratory depression, and the choice between them should be made under medical supervision 1.
• Some patients may experience different side effect profiles between the two medications, such as nausea with oxycodone or constipation with hydrocodone, but these differences are not well-established in the literature 1.

Clinical Decision-Making

• The choice between hydrocodone and oxycodone should be based on individual patient needs, tolerance, and response to each medication, rather than on perceived differences in efficacy or potency 1.
• Clinicians should consider the patient's medical history, current medications, and potential risks of addiction or dependence when selecting an opioid pain medication 1.

From the Research

Difference between Hydrocodone and Oxycodone

• Hydrocodone and oxycodone are both opioid analgesics used for pain management, but they have different pharmacological profiles and potencies 2, 3.
• Oxycodone is a strong opioid that acts at mu- and kappa-opioid receptors, with a greater analgesic potency than morphine 2.
• Hydrocodone is also an opioid analgesic, but its pharmacokinetics and pharmacodynamics are different from those of oxycodone, and it is often used in combination with other medications such as acetaminophen or ibuprofen 3, 4, 5.
• Studies have compared the efficacy and tolerability of hydrocodone and oxycodone in various pain models, including postoperative pain and chronic pain, with mixed results 4, 5.
• One study found that oxycodone 5 mg/ibuprofen 400 mg provided significantly greater analgesia than hydrocodone 7.5 mg/acetaminophen 500 mg in patients with moderate to severe postoperative pain 4.
• Another study found that combination hydrocodone and ibuprofen was as effective as combination oxycodone and acetaminophen in the treatment of moderate to severe postoperative obstetric or gynecologic pain 5.
• The choice between hydrocodone and oxycodone may depend on individual patient factors, such as the type and severity of pain, medical history, and tolerance to opioids 2, 3.

Pharmacokinetics and Pharmacodynamics

• Oxycodone has a higher bioavailability and a slightly longer half-life than morphine, and is hepatically metabolized by cytochrome P450 6.
• Hydrocodone is metabolized to hydromorphone, which is also an active opioid analgesic, and its pharmacokinetics can vary depending on the individual patient and the dosage form 3.
• The pharmacokinetics and pharmacodynamics of hydrocodone and oxycodone can be affected by various factors, including age, liver and kidney function, and concomitant medications 6, 3.

Clinical Use

• Both hydrocodone and oxycodone are commonly used for the management of moderate to severe pain, including acute and chronic pain 2, 3.
• Oxycodone is available in a range of formulations, including oral, intraspinal, and parenteral administration, and is often used for the management of cancer pain and other chronic pain conditions 2.
• Hydrocodone is often used in combination with other medications, such as acetaminophen or ibuprofen, and is commonly prescribed for the management of acute pain, such as postoperative pain 3, 4, 5.