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Hydrocodone and oxycodone are two types of opioids available for pain relief. Opioids are strong drugs that can minimize the body’s perception of either acute or chronic pain. 

Even though both are prescription opioids and listed as Schedule II substances, there are some minor differences between the two drugs. 

Hydrocodone Uses

Hydrocodone (brand names include Hysingla® and Zohydro ER®) acts as a cough suppressant (antitussive) and narcotic analgesic drug (painkillers) for moderate to severe pain. It is comparable to codeine (used to suppress coughs), if not more effective, and is as powerful as morphine for pain management.

When other pain medications do not perform as desired or cause tolerance problems, healthcare professionals may prescribe hydrocodone as a treatment option.

It is not uncommon to find hydrocodone combined with other painkillers like ibuprofen or acetaminophen. A hydrocodone/ibuprofen combination (brand names include Ibudone®, Reprexain®, and Vicoprofen®) helps treat acute pain that has become too severe. A hydrocodone/acetaminophen combination (brand names include Vicodin®, Norco®, and Lortab®) is the most common opioid/painkiller mix prescribed. 

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

Oxycodone Uses

Oxycodone (brand names include OxyContin®, OxyIR®, and OxyFast®) also acts as a cough suppressant but is not as potent as antitussives. Additionally, it is used to treat moderate to somewhat severe pain and is available in opioid/painkiller combinations (Percodan®, Percocet®, and Percodan®). However, it may not cause constipation as much as hydrocodone. 

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

Is Hydrocodone or Oxycodone More Effective?

Both drugs were used in a double-blind, randomized, controlled trial in an emergency room setting for acute pain associated with fractures. Pain relief was comparable at 30 minutes and 60 minutes for both drugs. Another study demonstrated hydrocodone and oxycodone to have similar effects on pain relief, but that oxycodone was one and a half times stronger than hydrocodone.

Both hydrocodone and oxycodone are potent painkillers with a high potential for abuse. They are typically used when milder painkillers do not deliver effective relief or cannot be tolerated.

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

Which Drug is Right for You?

Hydrocodone and oxycodone are two opioid medications that can effectively interfere with pain signals in the central nervous system (CNS).  

Studies comparing oxycodone and hydrocodone have not observed any significant differences in efficacy. Both drugs can aid in the treatment of acute pain or pain caused by chronic conditions. These conditions include arthritis, fractures, or cancer.

However, both drugs are also habit-forming. This means that a person taking these drugs can develop psychological or physical addiction after long-term use. It is recommended to speak with a healthcare provider about the risks and benefits of taking either prescription drug. It is equally important to define pain treatment goals, length of treatment, and other pain management avenues to help make the right decision. 

People with low blood pressure or other conditions, such as mental illnesses or a family history of alcohol abuse, should discuss these aspects with their doctor.

Elderly individuals who take hydrocodone may have a higher chance of experiencing confusion, severe drowsiness, and age-related liver, kidney, heart, or lung issues. 

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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 has been reported to be 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 the generic alternative of either of the two opioid medications 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 equivalent strength of active ingredients. 

Regardless, it is always best to speak with a healthcare professional to determine drug suitability and treatment plan. Those aspects can affect the final cost, as well as if there is insurance coverage.

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 and could lead to a severe health condition. 

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

  • Anticholinergic agents (to block a neurotransmitter called acetylcholine) with hydrocodone  using both of these medications simultaneously may result in paralytic ileus (when the intestines become obstructed due to intestinal muscle paralysis). 
  • Opioids with serotonergic antidepressants some people may have a higher risk of developing serotonin syndrome (when too much serotonin builds up in the body and 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 combination, like hydrocodone/acetaminophen, may cause acetaminophen acute liver injury (when the liver does not function properly).

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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:

  • Opioids like hydrocodone and oxycodone have a risk of addiction and abuse. This can potentially lead to overdose and death. Patients should be evaluated for risk before taking an opioid, and their use monitored regularly.
  • To ensure that the health benefits of opioids outweigh the risks of addiction and abuse, drug companies must teach and educate healthcare providers. Healthcare providers must finish a REMS (Risk Evaluation and Mitigation Strategy) compliant program. They must also thoroughly advise and teach patients and caregivers about each prescription and emphasize the importance of reading the medicine guide provided with each prescription.
  • 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.
  • Accidental ingestion, especially by children, can lead to a fatal overdose. Patients should ensure that opioids are always out of the reach of children.
  • Neonatal opioid withdrawal syndrome can result in extended opioid use during pregnancy. The condition 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, Valium, or other central nervous system depressants like other opioids or alcohol can lead to sedation, respiratory depression, coma, and death. These drug interactions should be avoided if possible. Patients who take one of these combinations due to other alternatives not working must be closely assessed and monitored.

Hydrocodone Vs Oxycodone: Questions and Answers

How much stronger is hydrocodone vs oxycodone?

Both hydrocodone and oxycodone are effective prescription pain medications. Different studies in emergency rooms have shown that the two semi-synthetic opiates provide pain relief. However, hydrocodone may cause constipation more often than oxycodone.

Can hydrocodone and oxycodone be mixed?

No. Combining hydrocodone and oxycodone is a type of opioid abuse that can lead to severe side effects, like slowed breathing, coma, or death.

Will hydrocodone and oxycodone test the same?

Hydrocodone and oxycodone will not test the same, even though the turn-around time for lab results may be the same. Different concentrations of the drugs are needed for detection. Also, the type of analysis used may affect whether the opioid is detected or not. Finally, an individual’s metabolism of the drug may influence the actual detection time.

Is hydrocodone or oxycodone better?

In studies, both hydrocodone and oxycodone have been proven to deliver effective pain relief. However, both drugs are potent with a high potential for abuse. Speak with your doctor for advice before taking either drug.

Can you use hydrocodone or oxycodone while pregnant?

You should not take hydrocodone or oxycodone while pregnant unless your doctor decides that the benefit to you outweighs the risk 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?

No. Hydrocodone and oxycodone should never be taken with alcohol. The combination could result in sedation, respiratory depression, coma, or death.

Can you take hydrocodone and oxycodone together?

No. You should not take hydrocodone and oxycodone together. The combination can be dangerous, potentially leading to respiratory depression or death. This is one reason why it is 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?

In addition to reducing pain, opioids like hydrocodone and oxycodone can also produce a euphoric high. When taking an opioid medicine, only take as prescribed.

Do not take additional doses. Do not mix with alcohol.

Hydrocodone & Oxycodone: Abuse, Addiction & Overdose

Oxycodone has been found to be more abused compared to hydrocodone, with 84% global availability. And because hydrocodone is not widely available anywhere else in the world, more than 99% of hydrocodone use occurs in the United States. 

Abuse of either hydrocodone or oxycodone can potentially 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 greatly. 

Overdose symptoms on either drug include:

  • Bradycardia (slow heart rate)
  • Breathing difficulties
  • Cold, Clammy Skin
  • Dizziness
  • Seizures
  • Weakness

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

Treatment Options for Opioid Abuse & Addiction

There are several options for people suffering from opioid addiction. These include:

  • Medication-Assisted Therapy (MAT) There are three medications approved to treat opioid use disorder: buprenorphine, methadone, and naltrexone. Buprenorphine and methadone can help you manage withdrawal symptoms throughout the detoxification process. Naltrexone is less commonly used, but it blocks your opioid receptors, making it impossible to get high. Medication-assisted therapy is most effective when combined with other forms of treatment.
  • Inpatient Programs — Inpatient programs are the most intensive and effective treatment options for opioid addiction. These programs guide you through medically supervised detoxification, then behavioral therapy and other services (possibly including MAT), will be added to your treatment. They typically last 30, 60, or 90 days, however they may be longer if necessary.
  • Partial Hospitalization Programs (PHPs) PHPs are also known as intensive outpatient programs (IOPs). They are the next most intensive type of treatment for opioid addiction. They provide similar services to inpatient programs such as detoxification, behavioral therapy medical services, and custom treatments such as MAT. The difference is that in a PHP, the patient returns home to sleep. Some programs will include transportation and meals, but this varies by program. Partial hospitalization programs are helpful for both new patients and patients who have completed inpatient treatment and still need intensive recovery therapy.
  • Outpatient Programs Outpatient programs work best for people who have a high level of motivation to recover. They create treatment programs that work around your schedule. These programs can either be an effective treatment option for new patients or a part of an aftercare program for people who complete inpatient or partial hospitalization program.

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Center for Drug Evaluation and Research. “Generic Drugs.” U.S. Food and Drug Administration, FDA, 21 Nov. 2019.

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

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

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

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

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.

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

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 (2009): 107-14. doi:10.1016/j.drugalcdep.2008.11.013.

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