Is Percocet Stronger Than Norco?
Percocet (oxycodone/acetaminophen) and Norco (hydrocodone/acetaminophen) have essentially equivalent analgesic efficacy when given at equianalgesic doses, though oxycodone may be slightly more potent on a milligram-per-milligram basis. 1
Comparative Potency
The evidence demonstrates that these medications are remarkably similar in their pain-relieving capabilities:
Equianalgesic dosing studies show no clinically meaningful difference between oxycodone and hydrocodone combination products for acute pain management 1
Two prospective randomized controlled trials directly comparing short-acting oxycodone (Schedule II) with hydrocodone combination products (Schedule III) found them to be equal in pain relief, doses taken, global evaluations of efficacy, and pain interference with work 1
A 2015 randomized trial comparing oxycodone/acetaminophen 5mg/325mg versus hydrocodone/acetaminophen 5mg/325mg found no statistically significant difference, with both reducing pain scores by approximately 50% 2
Pharmacologic Considerations
While clinically equivalent, there are subtle pharmacologic differences:
Oxycodone is roughly equipotent to or slightly more potent than hydrocodone on a milligram basis, though this difference is not clinically significant at standard doses 3
Oxycodone has an equivalence ratio to morphine of approximately 1:1.5-2, while hydrocodone may be approximately equipotent with oral morphine, though its equivalence data are less well-substantiated 1, 4
Oxycodone has higher oral bioavailability (60-87%) and more predictable metabolism than some other opioids, making titration potentially easier 4
Clinical Implications
In general, equianalgesic doses of opioids are equally efficacious in relieving pain, regardless of their DEA classification 1
Key practical points:
The choice between these medications should be based on factors other than potency, such as patient tolerance, side effect profile, and formulary considerations 1
Both medications should be prescribed at the lowest practical dose for limited duration (e.g., 1 week) when used for acute pain 1
Common side effects (nausea, constipation, drowsiness) are similar between the two agents 4, 2
Important Caveats
Neither medication is inherently "stronger" in clinical practice when prescribed at appropriate doses 1, 2
The perception that Percocet is stronger may stem from its Schedule II classification versus hydrocodone's former Schedule III status, but this classification reflects abuse potential rather than analgesic efficacy 1
Individual patient response can vary due to genetic polymorphisms affecting opioid metabolism, but this applies to both medications 1