Comparing the Strength of Norco (Hydrocodone) and OxyContin (Oxycodone)
OxyContin (oxycodone) is approximately 1.5-2 times stronger than Norco (hydrocodone) on a milligram-per-milligram basis. 1
Relative Potency Comparison
- Oxycodone has a relative potency of 1.5-2 compared to oral morphine, making it about twice as potent as hydrocodone 1, 2
- Hydrocodone (found in Norco) is classified as a Schedule III opioid (now Schedule II), while oxycodone (found in OxyContin) has always been classified as a Schedule II opioid, reflecting its higher potency and abuse potential 3
- OxyContin is a controlled-release formulation of oxycodone specifically designed for moderate to severe pain requiring around-the-clock analgesia 3
- Norco contains hydrocodone combined with acetaminophen and is typically used for moderate pain in short-acting formulations 4
Pharmacological Differences
Oxycodone (OxyContin)
- Higher oral bioavailability (60-87%) compared to other opioids 1
- Metabolized primarily through the CYP2D6 enzyme pathway 5
- Available in immediate-release and controlled-release formulations (OxyContin) 6
- Half-life of 3-5 hours for immediate release, 12 hours for controlled-release 1
- Binds to mu, kappa, and delta opioid receptors 1
Hydrocodone (Norco)
- Available primarily in combination with acetaminophen (325mg) 4
- Typical dosing ranges from 5-15mg every 4-6 hours as needed 3
- Classified as a Schedule III opioid until recent reclassification to Schedule II 3
- Lower potency compared to oxycodone on a milligram basis 3
Clinical Implications
- OxyContin (controlled-release oxycodone) should not be used for acute pain management but is indicated for chronic pain requiring around-the-clock analgesia 3
- Equianalgesic dosing suggests that 10mg of oxycodone is approximately equivalent to 15-20mg of hydrocodone 3, 1
- Clinical trials have shown that oxycodone provides stronger analgesia at equivalent doses compared to hydrocodone combinations 7
- Both medications carry risks of dependence, tolerance, respiratory depression, and other opioid-related side effects 6
Important Considerations and Cautions
- OxyContin is a long-acting formulation that should never be crushed, chewed, or broken as this can lead to rapid release and potential overdose 6
- Patients with liver dysfunction may experience increased effects from both medications, but particularly with oxycodone which is metabolized through the CYP2D6 pathway 3, 5
- Both medications should be prescribed at the lowest effective dose for the shortest duration possible 3
- Neither medication should be combined with alcohol, benzodiazepines, or other CNS depressants due to increased risk of respiratory depression 6
Special Populations
- In patients with hepatic impairment, dose adjustments may be necessary for both medications, but particularly for oxycodone 3
- For cancer pain management, oxycodone is often preferred as an alternative to morphine when rotation is needed 3
- Elderly patients may be more sensitive to the effects of both medications and may require lower starting doses 1