Is oxycodone more potent per milligram than hydrocodone (hydrocodone bitartrate)?

From the Guidelines

Yes, oxycodone is more potent per milligram than hydrocodone, with a conversion factor of 1.5 compared to hydrocodone's conversion factor of 1.0, as indicated in the CDC clinical practice guideline for prescribing opioids for pain - United States, 2022 1. This difference in potency is crucial for healthcare providers when converting between these medications or determining appropriate dosing.

• Oxycodone is approximately 1.5 times more potent than hydrocodone, meaning that 10 mg of hydrocodone is roughly equivalent to about 6.67 mg of oxycodone in terms of pain relief.
• Both medications are opioid analgesics that work by binding to mu-opioid receptors in the brain and spinal cord to reduce pain perception, but oxycodone has greater binding affinity and bioavailability.
• This higher potency means that patients typically require lower doses of oxycodone compared to hydrocodone to achieve similar pain relief.
• However, the increased potency also means oxycodone may carry a higher risk of side effects and dependence at equivalent pain-relieving doses.
• Both medications should be used at the lowest effective dose for the shortest duration necessary to minimize risks, as emphasized in the CDC guideline 1 and further supported by the discussion on dosage thresholds and risks in the same guideline 1.

From the Research

Potency Comparison of Oxycodone and Hydrocodone

• The potency of oxycodone and hydrocodone can be compared based on their pharmacological effects and relative potencies.
• A study published in 2010 2 found that the potency relationship between oxycodone, hydrocodone, and morphine was as follows: oxycodone > morphine > hydrocodone.
• This suggests that oxycodone is more potent than hydrocodone, with a higher magnitude of effects observed at equivalent doses.
• The study used a double-blind, randomized, within-subject, placebo-controlled design to examine the relative abuse potential of IV doses of oxycodone, hydrocodone, and morphine in recreational opioid users.

Pharmacological Effects

• Oxycodone and hydrocodone are both mu-opioid receptor agonists, which means they produce similar pharmacological effects, including analgesia, euphoria, and respiratory depression.
• However, the potency and duration of action of these effects can vary between the two drugs.
• Oxycodone has been shown to have a faster onset of action and a shorter half-life compared to morphine 3, which may contribute to its higher potency.
• Hydrocodone, on the other hand, has a slower onset of action and a longer half-life, which may result in a lower potency compared to oxycodone.

Clinical Implications

• The difference in potency between oxycodone and hydrocodone has important clinical implications for pain management.
• Oxycodone may be more effective for managing severe pain, while hydrocodone may be more suitable for mild to moderate pain.
• However, the choice of opioid should be based on individual patient needs and medical history, rather than solely on potency.
• Further research is needed to fully understand the relative potencies and clinical effects of oxycodone and hydrocodone in different patient populations.