Which is stronger, Norco (hydrocodone) or Percocet (oxycodone)?

Percocet (Oxycodone) is Stronger Than Norco (Hydrocodone)

Oxycodone (Percocet) is stronger than hydrocodone (Norco), with oxycodone being approximately 1.5 times more potent than hydrocodone when comparing equivalent doses. 1

Comparative Potency

• Oxycodone is a Schedule II opioid that is roughly equipotent to or slightly more potent than hydrocodone in controlled studies measuring abuse liability and analgesic effects 1
• Hydrocodone is traditionally classified as a Schedule III opioid (when combined with acetaminophen as in Norco), reflecting its somewhat lower abuse potential compared to Schedule II opioids like oxycodone 2
• When comparing standard formulations, Percocet (oxycodone/acetaminophen) contains 5-15 mg of oxycodone while Norco (hydrocodone/acetaminophen) contains 5-15 mg of hydrocodone, but the oxycodone component provides stronger analgesia at equivalent milligram doses 2

Clinical Efficacy

• In analgesic potency, oxycodone is comparable to morphine, while hydrocodone is generally considered less potent than morphine 3
• Both medications effectively reduce pain scores by approximately 50% in clinical trials, though oxycodone tends to provide slightly better pain relief at equivalent doses 4
• A randomized controlled trial comparing oxycodone/acetaminophen to hydrocodone/acetaminophen found a small but not statistically significant advantage for oxycodone/acetaminophen in reducing pain scores (4.4 vs 4.0 NRS units) 4

Pharmacological Properties

• Oxycodone is a strong mu- and delta-opioid receptor agonist available in immediate-release and extended-release formulations 2
• Hydrocodone is a mu- and delta-opioid receptor agonist that may be approximately equipotent with oral morphine, though clinical experience suggests it functions as a milder initial-use opioid 2
• Oxycodone has higher bioavailability (60%) compared to hydrocodone, contributing to its increased potency 3

Clinical Considerations

• Both medications are effective for acute moderate to severe pain when prescribed at appropriate doses 2
• Oxycodone-containing products may be marginally superior to codeine-containing products for acute pain management in emergency department settings 2
• Hydromorphone is more potent than either oxycodone or hydrocodone, but the difference is less than two-fold, which is inconsistent with prior estimates from analgesic studies 1

Important Cautions

• Both medications carry risks of dependence, addiction, and respiratory depression, with oxycodone potentially carrying slightly higher risks due to its greater potency 5
• Neither medication should be used for long-term pain management without careful consideration of risks and benefits 2
• The combination of either opioid with acetaminophen limits the maximum daily dose due to potential hepatotoxicity from the acetaminophen component 2
• When prescribing either medication, clinicians should use the lowest effective dose for the shortest duration possible 2

Prescribing Considerations

• For acute moderate to severe pain, initial dosing for oxycodone/acetaminophen is typically 5-15 mg every 4-6 hours as needed 2
• Initial dosing for hydrocodone/acetaminophen is also typically 5-15 mg every 4-6 hours as needed 2
• Long-acting or extended-release opioid formulations should not be used for acute pain management 2