What class of medications are oxycodone and hydrocodone?

Classification of Oxycodone and Hydrocodone

Oxycodone and hydrocodone are classified as Schedule II opioid analgesics, with oxycodone consistently classified as Schedule II while hydrocodone was historically Schedule III but has been reclassified to Schedule II due to increasing concerns about abuse. 1

Pharmacological Classification

Both medications are semi-synthetic opioids that act primarily as mu-opioid receptor agonists:

• Oxycodone: Acts as an agonist at mu-, delta-, and kappa-opioid receptors 1, 2
• Hydrocodone: Acts as a mu- and delta-opioid receptor agonist 1

DEA Scheduling and Regulatory Classification

The Drug Enforcement Administration (DEA) classifies these medications based on their potential for abuse:

• Schedule II classification indicates high potential for abuse and includes:
  • Oxycodone (standalone and combination products) 1
  • Hydrocodone (now reclassified from Schedule III to Schedule II) 1

The reclassification of hydrocodone combination products from Schedule III to Schedule II occurred in response to increasing levels of abuse of these substances 1.

Available Formulations

Both medications are available in various formulations:

• Oxycodone:

  • Immediate-release (IR) tablets: 5-15 mg PO Q4-6h PRN 1
  • Extended-release (ER) tablets (not for acute pain) 2
  • Combination products with acetaminophen (e.g., Percocet) 1, 2

• Hydrocodone:

  • Available primarily in combination with acetaminophen (e.g., Vicodin, Lortab) or ibuprofen 1
  • Extended-release preparations also available 1

Clinical Considerations

When prescribing these medications, several factors should be considered:

• Both medications carry significant risks of addiction, abuse, and misuse 3
• Equianalgesic doses of opioids have similar efficacy in relieving pain, regardless of their DEA classification 1
• Studies have shown similar analgesic efficacy between oxycodone and hydrocodone at appropriate doses 4

Important Distinctions

1. Metabolism differences:

   • Hydrocodone is a prodrug that requires metabolism to be fully effective 1
   • Oxycodone has direct analgesic effects 5

2. Side effect profiles:

   • Some studies suggest hydrocodone may cause higher rates of constipation compared to oxycodone 4

Safety Considerations

Both medications:

• Require careful patient selection and monitoring
• Should be prescribed at the lowest effective dose for the shortest duration possible 2, 3
• Are not recommended as first-line treatments for chronic musculoskeletal pain 2

The classification of these medications as Schedule II controlled substances reflects their high potential for abuse and the need for careful prescribing practices to minimize risks while providing effective pain management.