No, Percocet and Hydrocodone Are NOT the Same Medication
Percocet (oxycodone/acetaminophen) and hydrocodone products (Vicodin, Norco) are distinct opioid medications with different active ingredients, though they have similar analgesic effects and are often used interchangeably for acute pain management. 1
Key Differences Between the Medications
Active Opioid Components
- Percocet contains oxycodone as the opioid component 1
- Vicodin/Norco contains hydrocodone as the opioid component 1
- Both are combined with acetaminophen (APAP), but the opioid itself is chemically different 1
DEA Scheduling Classification
- Oxycodone products (Percocet) are classified as Schedule II controlled substances 1
- Hydrocodone combination products were historically Schedule III but have been reclassified to Schedule II due to abuse concerns 1
Potency Differences
- Oxycodone is approximately 1.5 times more potent than hydrocodone 2
- Hydrocodone 10 mg is roughly equivalent to oxycodone 6.7-7.5 mg in analgesic effect 2
- Hydrocodone may be approximately equipotent with oral morphine, though equivalence data are not fully substantiated 1
Clinical Equivalence for Pain Relief
Analgesic Efficacy
- At equianalgesic doses, both medications provide similar pain relief 1
- Two prospective randomized controlled trials found oxycodone and hydrocodone combination products to be equal in efficacy for acute pain 1
- A 2017 JAMA trial found no clinically important differences between oxycodone/acetaminophen and hydrocodone/acetaminophen for acute extremity pain in the emergency department 3
Dosing Conversion
- When converting from Norco 10-325 mg to Percocet, the equivalent dose would be approximately Percocet 7.5-325 mg 2
- Both medications are typically dosed every 4-6 hours as needed for acute pain 1
Safety Profile Differences
Overdose Risk
- Oxycodone carries a higher risk of opioid overdose compared to hydrocodone 4
- Oxycodone monotherapy shows particularly elevated overdose risk (adjusted hazard ratio 2.18) compared to hydrocodone with acetaminophen 4
- Oxycodone combined with acetaminophen also shows increased overdose risk (adjusted hazard ratio 1.26) 4
Chronic Use Development
- Hydrocodone has slightly higher odds of developing chronic opioid use compared to oxycodone 4
- Among opioid-naïve patients, 2.8% developed chronic use after initial prescription 4
Adverse Events
- Both medications carry similar risks of respiratory depression, particularly in opioid-naïve patients 2
- Oxycodone/acetaminophen was associated with 34% adverse event rate versus 9% for acetaminophen alone in one trial 5
Important Clinical Considerations
Acetaminophen Limits
- Monitor total daily acetaminophen dose, which should not exceed 3000-4000 mg/day to avoid hepatotoxicity 2
- Current formulations limit acetaminophen to 325 mg or less per tablet 1
Appropriate Use
- Both medications are indicated for short-acting, as-needed treatment of acute pain 1
- Neither should be used as first-line therapy; reserve for pain not controlled by acetaminophen or NSAIDs 1
- Extended-release formulations are for chronic pain in opioid-tolerant patients only 1
Common Pitfall to Avoid
- Do not assume these medications are interchangeable at the same milligram dose - oxycodone is more potent and requires dose adjustment when converting 2
- Given the higher overdose risk with oxycodone, hydrocodone may be the more favorable initial agent for opioid-naïve patients when opioid therapy is necessary 4