Updated on February 6, 2024
7 min read

Hydrocodone vs. Oxycodone: What's the Difference?

Key Takeaways

Hydrocodone and oxycodone are two types of opioids available for pain relief. Opioids are powerful drugs that reduce acute and chronic pain. They are highly addictive.

Even though both are opioids and controlled substances, there are some minor differences between them.

Is Hydrocodone or Oxycodone More Effective?

Both drugs were used in a double-blind, randomized, controlled trial in an emergency room setting. Acute pain relief was comparable for both drugs.

Another study found them to have similar effects, but oxycodone was one and a half times stronger.

Both hydrocodone and oxycodone are potent painkillers with a high potential for abuse. They're typically only used after trying more mild painkillers first.

Your doctor will determine the most effective medication for your situation. They will consider your medical condition, history, and other medications you are taking.


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Which Drug is Right for You?

Hydrocodone and oxycodone are two opioid medications that suppress pain.  

Studies comparing them have not found any significant differences in efficacy. Both can aid in the treatment of acute pain or chronic pain.

Cases for which they may be prescribed include:

  • Arthritis
  • Broken bones
  • Cancer
  • Neck or lower back pain
  • Immediately after surgery
  • Workplace or battlefield injuries

However, both drugs are also habit-forming. This means that a person taking them can develop psychological or physical addiction after long-term use.

It's essential to speak with a healthcare provider about the risks and benefits of taking either drug.

It's equally important to define treatment goals, length, and other options to help make the right decision.

People with low blood pressure, mental illnesses, or substance abuse problems should speak with their doctor first.

Hydrocodone Uses

Hydrocodone is a painkiller that is as powerful as morphine. It also acts as a cough suppressant similar to codeine.

Healthcare professionals prescribe it when other painkillers don't perform as desired.

It is not uncommon to find it combined with other painkillers like ibuprofen or acetaminophen for severe pain.

Brand names for Hydrocodone-ibuprofen combinations include Ibudone®, Reprexain®, and Vicoprofen®.

Hydrocodone-acetaminophen combinations are more common. Brand names here include Vicodin®, Norco®, and Lortab®.

Because of the high potential for abuse, prescriptions for hydrocodone products have decreased in the past decade. In 2013, there were more than 136.7 million prescriptions in the United States. In 2018, there were only 70.9 million prescriptions. 

Oxycodone Uses

Oxycodone (OxyContin®) also acts as a cough suppressant but is not as potent as Hydrocodone.

It can also treat moderate to severe pain and is available in opioid-painkiller combinations. Some brand names here include Percodan®, Percocet®, and Percodan®.

There has been a dramatic increase in oxycodone prescriptions over the last 25 years, specifically for long-term use in patients with chronic pain.

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Side Effects of These Drugs

Using hydrocodone or oxycodone may produce some side effects. Here is a list of common side effects:

  • Severe drowsiness
  • Lightheadedness
  • Nausea
  • Constipation (this is reportedly more frequent with hydrocodone use)
  • Slowed breathing 
  • Trouble sleeping 
  • Dry mouth
  • Headache 
  • Vomiting 
  • Back pain

Cost of Hydrocodone and Oxycodone

Hydrocodone and oxycodone are available as brand-name drugs or generic substitutes. This means that choosing their generic versions will save you money. 

It is important to remember that the differences between generic alternatives and brand-name drugs are minor. The Food and Drug Administration (FDA) makes sure that generic drugs include the same levels of active ingredients. 

Regardless, it's best to speak with a healthcare professional first. Aspects such as treatment plan, insurance coverage, and drug suitability can affect the final cost.

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Dangerous Drug Interactions

People should not take hydrocodone and oxycodone with other medications without a doctor’s approval. Doing so could result in undesired side effects or severe health conditions. 

Other drug medications that could result in serious health conditions include:

  • Anticholinergic agents with hydrocodone  using both of these medications together may result in paralytic ileus. This is when the intestines become obstructed due to intestinal muscle paralysis. It's a potentially fatal condition.
  • Opioids with SSRIs some people may have a higher risk of developing serotonin syndrome. This is when too much serotonin builds up in the body. It causes symptoms like anxiety or muscle spasms. 

People should also not mix either opioid medications with alcohol, especially if it is an opioid-painkiller combination. Both substances depress the central nervous system (CNS).

Drinking alcohol places an additional burden on the liver and may worsen the pain reliever’s side effects. Similarly, opioid-painkiller combinations may cause acute liver injury.

Warnings of Hydrocodone and Oxycodone

There is a boxed warning on both hydrocodone and oxycodone, which is the strongest warning by the FDA.

Other warnings include:

  • Hydrocodone and oxycodone have a risk of addiction and abuse. This includes potential overdose and death. Patients should be evaluated before taking them, and their use should be monitored.
  • To ensure that the benefits outweigh the risks, drug companies must provide education to healthcare providers. Healthcare providers must also comply with special FDA regulations. And they must advise patients and caregivers about each drug and the importance of reading the medicine guide.
  • Opioids may cause severe, life-threatening, or fatal respiratory depression. Patients should be assessed and monitored. This is especially important at the beginning of treatment and following a dosage adjustment.
  • Patients should ensure that opioids are out of the reach of children. Accidental ingestion can lead to a fatal overdose.
  • Neonatal opioid withdrawal syndrome can result in extended opioid use during pregnancy. This can be life-threatening if not recognized and treated.
  • Using opioids with particular medications metabolized by the enzyme cytochrome P 450 3A4 may boost opioid levels. This may lead to increased side effects and potentially fatal respiratory depression.
  • Using benzodiazepine drugs like Xanax or Valium is extremely dangerous. Side effects can include sedation, breathing issues, coma, and death. These drug interactions should be avoided if possible.

Hydrocodone & Oxycodone: Abuse, Addiction & Overdose

Due to being illegal in most countries, over 99% of hydrocodone use occurs in the United States. Worldwide, Oxycodone has been found to be more abused compared to hydrocodone.

Abuse of either drug can lead to addiction. People who develop tolerance to these drugs will need higher doses to achieve the same high. As a person becomes more dependent, the risk for overdose increases. 

Overdose symptoms on either drug include:

  • Slowed heart rate
  • Breathing difficulties
  • Low body heat
  • Dizziness
  • Seizures
  • Weakness

When these symptoms show up, call 911 or your local emergency services immediately.

Hydrocodone Vs Oxycodone: Questions and Answers

How much stronger is hydrocodone vs oxycodone?

Different studies show both are effective pain medications. However, hydrocodone may cause constipation more often than oxycodone.

Can hydrocodone and oxycodone be mixed?

No. Combining them is a type of opioid abuse. It can lead to severe side effects, like slowed breathing, coma, or death.

Will hydrocodone and oxycodone test the same?

They won't test the same, even though the turn-around time for results may be the same. Different concentrations of each drug is needed for detection. Other factors include the type of analysis and individual metabolisms.

Is hydrocodone or oxycodone better?

Studies show both deliver effective pain relief. However, both drugs are potent with a high potential for abuse. Speak with your doctor for advice before taking either.

Can you use hydrocodone or oxycodone while pregnant?

You should not take either unless your doctor decides that the benefits to you outweigh the risks to the fetus. Using opioids for extended periods during pregnancy can cause dependence in the fetus. This can lead to neonatal opioid withdrawal syndrome.

Can you use hydrocodone or oxycodone with alcohol?

Neither should be taken with alcohol. The combination could result in sedation, respiratory depression, coma, or death.

Can you take hydrocodone and oxycodone together?

No. Combining them can be dangerous, potentially leading to respiratory depression or death. This is why it's essential to dispose of old prescription opioids when you no longer need them.

If you need to dispose of old medications, ask your pharmacist how to do so locally.

Why do some people use hydrocodone for recreational effects?

Besides reducing pain, opioids like hydrocodone and oxycodone can also cause euphoria.

Only take opiods as prescribed. Do not take additional doses. Do not mix with alcohol.

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Updated on February 6, 2024
8 sources cited
Updated on February 6, 2024
  1. Center for Drug Evaluation and Research. “Generic Drugs.” U.S. Food and Drug Administration, FDA, 21 Nov. 2019.

  2. Hydrocodone (Oral Route) Description and Brand Names.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 1 Sept. 2020.

  3. Hydrocodone.” Drug Enforcement Administration. Diversion Control Division. Drug & Chemical Evaluation Section, Drug Enforcement Administration, Oct. 2019.

  4. Hydrocodone.” National Center for Biotechnology Information. PubChem Compound Database, U.S. National Library of Medicine.

  5. Hydrocodone: MedlinePlus Drug Information.” MedlinePlus, U.S. National Library of Medicine, 15 Oct. 2019.

  6. Marco, Catherine A, et al. “Comparison of Oxycodone and Hydrocodone for the Treatment of Acute Pain Associated with Fractures: a Double-Blind, Randomized, Controlled Trial.” Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, U.S. National Library of Medicine, Apr. 2005.

  7. Slawson, David C. “No Difference Between Oxycodone/Acetaminophen and Hydrocodone/Acetaminophen for Acute Extremity Pain.” American Family Physician, 1 Mar. 2016.

  8. Want to Know More? Some FAQs about Opioids.” National Institute on Drug Abuse, National Institute on Drug Abuse, 3 June 2020.

    Zacny, James P, and Sandra Gutierrez. “Within-subject comparison of the psychopharmacological profiles of oral hydrocodone and oxycodone combination products in non-drug-abusing volunteers.” Drug and alcohol dependence vol. 101,1-2 : 107-14. doi:10.1016/j.drugalcdep.2008.11.013.

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