Is oxycodone (Immediate Release) stronger than oxycodone/acetaminophen?

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From the Guidelines

Oxycodone immediate release is not stronger than oxycodone/acetaminophen in terms of analgesic efficacy, as equianalgesic doses of opioids are equally efficacious in relieving pain 1.

Key Points

  • The recommended starting dose for oxycodone and oxycodone/APAP is the same, 5-15 mg PO Q4-6h PRN 1.
  • Equianalgesic doses of opioids have similar efficacy in the treatment of acute pain, regardless of their Drug Enforcement Administration classification 1.
  • Studies have compared schedule II and III opioids combined with nonopioid analgesics and found them to be equal in terms of analgesic efficacy 1.
  • The presence of acetaminophen in combination products may provide a longer duration of pain relief due to synergistic effects, but the analgesic efficacy of the opioid component itself is not enhanced 1.
  • The duration of action for oxycodone IR is typically shorter, ranging from 4-6 hours, whereas the combination product may provide a longer duration of pain relief 1.

From the Research

Comparison of Oxycodone (Immediate Release) and Oxycodone/Acetaminophen

  • The potency of oxycodone (immediate release) compared to oxycodone/acetaminophen is not directly addressed in the provided studies, but we can look at the efficacy and characteristics of each formulation.
  • A study comparing morphine sulfate immediate release (MSIR) to oxycodone/acetaminophen found that MSIR provided similar analgesic efficacy to oxycodone/acetaminophen for short-term pain relief in the emergency department 2.
  • Another study found that oxycodone has a higher oral bioavailability and is about twice as potent as morphine 3.
  • The comparison between oxycodone (immediate release) and oxycodone/acetaminophen is complex, as the addition of acetaminophen can provide multimodal analgesia, but the potency of oxycodone itself is not directly compared to the combination in the provided studies.
  • A study on the extended-release formulation of oxycodone/acetaminophen notes that current FDA-approved combination analgesics, such as Percocet (oxycodone/acetaminophen), are available solely in immediate-release (IR) formulations, but does not directly compare the potency of oxycodone (immediate release) to oxycodone/acetaminophen 4.
  • The efficacy of an immediate-release fixed combination of oxycodone/acetaminophen for moderate-to-severe background cancer pain and breakthrough cancer pain was evaluated in a study, which found that the combination provided an adequate level of analgesia, but does not directly compare the potency of oxycodone (immediate release) to the combination 5.
  • A study comparing controlled-release oxycodone to immediate-release oxycodone and immediate-release oxycodone in combination with acetaminophen found that all active treatments were significantly superior to placebo for many hourly measurements, but does not directly address the potency comparison 6.

Key Findings

  • Oxycodone has a higher oral bioavailability and is about twice as potent as morphine 3.
  • The combination of oxycodone and acetaminophen provides multimodal analgesia, but the potency of oxycodone itself is not directly compared to the combination in the provided studies.
  • The efficacy of oxycodone (immediate release) and oxycodone/acetaminophen is supported by various studies, but a direct comparison of their potency is not available in the provided evidence.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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