Hydrocodone vs. oxycodone

Both hydrocodone and oxycodone provide good pain relief…but oxycodone withdrawal is more severe. Review similarities and differences to choose between hydrocodone and oxycodone here.

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Reviewed by: Dr. Dili Gonzalez, M.D. Dr. Juan Goecke, M.D.

ARTICLE OVERVIEW: Oxycodone and hydrocodone are prescription pain medications. Both can treat short-term pain or pain that is chronic, or long-term but also interfere with your central nervous system’s pain signals. They prevent the nerves in your body from sending pain signals to your brain. The differences between the two are primarily in the side effects they cause.



According to the database, PubChem, hydrocodone is a narcotic analgesic used for the treatment of moderate to moderately severe pain. It is also used as a cough suppressant. In fact, studies indicate that hydrocodone is as effective or more effective than codeine for the suppression of cough and almost equivalent to morphine for pain relief. There are several hundred products brand and generic hydrocodone marketed, most of which are combined products. The most frequently prescribed combination is hydrocodone and acetaminophen (Vicodin, Lortab). [1]

Also listed in the PubChem database, oxycodone is a narcotic analgesic, widely prescribed in the United States. The controlled-release tablets are prescribed for the treatment of moderate to severe pain when a continuous analgesic is needed for 24 hours for a prolonged period. It is marketed only as controlled release (OxyContin) and immediate release formulations (OxyIR, OxyFast), or in combination with other non-narcotic analgesics such as aspirin (Percodan) or acetaminophen (Percocet). [2]
Both hydrocodone and oxycodone are highly effective for moderate to severe pain relief. During clinical trials, oxycodone and hydrocodone have shown similar potent pain relieving effects in the first hour of treatment. However, some people claim that oxycodone pain relief is more intensive than hydrocodone.

Use Patterns

In the United States, 58.8 million oxycodone prescriptions were dispensed in 2013. According to the DEA, The Drug Enforcement Agency, hydrocodone is the most commonly prescribed opioid in the United States with more than 136 million prescriptions for hydrocodone-containing products dispensed in 2013 and nearly 65.5 million dispensed in the first six months of 2014. [3] More on U.S. prescribing rates for painkillers from the Centers for Disease Control here. [4]

Mechanisms Of Action

Both hydrocodone and oxycodone are formulated in laboratories. Although the formulas are based on natural opiates (codeine and thebaine), they are technically called “semi-synthetic opioids,” meaning they have been derived from natural opiate products.

The precise mechanism of the analgesic action of oxycodone is unknown. However, specific opioid receptors of the central nervous system have been identified for endogenous compounds with activity similar to opioids throughout the brain and spinal cord and play a role in the analgesic effects of this drug.

Hydrocodone works by flooding opioid receptors in the brain, which is why you experience blocked pain, and increased serotonin that gives you a relaxed and pleasant feeling throughout the body. It works by changing the way the brain and nervous system respond to pain.

However, both drugs also affect the pleasure center of the brain. They both cause euphoria and can be habit forming. Check out this illustration of the reward center of the brain from this article published in 2002 in Addiction Science & Clinical Practice. [5]


Hydrocodone dosing:

  • 5 to 10 mg every 4 to 6 hours as needed for pain (maximum 60 mg/day).
  • Dose for extended release tablets is 10mg capsule every 12 hours.

Oxycodone dosing:

  • 2.5 to 5 every 6 hours as needed for pain.
  • Dose for the extended release tablets is 10 to 40 mg every 12 hours.

Side Effects

Hydrocodone and oxycodone have common side effects like dizziness, nausea, vomiting, constipation, dry mouth and sweating. Both opioids can impair thinking and the physical abilities to drive or operate machinery. They can also slow breathing in the elderly, disabled, and people with serious lung disease. However, these two narcotics differ mainly in their serious adverse effects.

The hydrocodone side effects are the following:

  • Back pain.
  • Chills.
  • Hot flashes.
  • Muscle spasms.
  • Peripheral edema (swelling).
  • Tachycardia (rapid heartbeat).
  • Tremor.
  • Upper respiratory tract infections.
  • Urinary tract infections.

The oxycodone side effects are the following

  • Anxiety.
  • Asthenia (loss of energy or strength).
  • Confusion.
  • Depression.
  • Dermatitis.
  • Dry skin.
  • Flatulence.
  • Gastritis (inflammation especially of the mucous membrane of the stomach).
  • Hiccups.
  • Impotence.
  • Insomnia.
  • Tinnitus (ringing or buzzing in the ears).
  • Twitching.

Oxycodone is more likely to cause side effects of dizziness and drowsiness, as well as fatigue, headaches, and feelings of euphoria. Hydrocodone is more likely to cause constipation and stomach pain.

Safety Considerations

The considerations to be taken when taking hydrocodone or oxycodone are similar, among which are:

1. The combination of these narcotics with other drugs that suppress the central nervous system can increase the risk of respiratory depression. So, if you mix either hydrocodone or oxycodone with other drugs, your system can become so sedated that your lungs cannot absorb enough oxygen to breathe, which can lead to coma and death. Drugs to avoid include tranquilizers (Valium), hypnotics (Ambien, Intermezzo), benzodiazepines (Ativan, Xanax, Restoril), other narcotics (morphine, fentanyl or other products of the opium), and alcohol.

2. You should not take these opioids with a type of antidepressant called monoamine oxidase inhibitors or MAOIs [for example, isocarboxazide (Marplan), phenelzine (Nardil) and tranylcypromine (Parnate)] or other drugs that inhibit monoamine oxidase [for example, linezolid (Zyvox)], because the combination of these drugs with these narcotics can cause confusion, tremor, hyperactivity, high blood pressure, coma and even death. If you are taking an MAOI, talk to your doctor before you start taking opium products because you should stop taking MAOIs 14 days before you start opioid treatment.

3. Two very important interactions only oxycodone possesses and that should be taken into account when taking this medication, as they could be fatal: If oxycodone is combined with drugs that affect the activity of certain liver enzymes or the suspension of these drugs can cause a fatal overdose.

4. Fatty foods can increase the absorption of oxycodone by 27%, generating in some cases overdose.

The safety of taking hydrocodone or oxycodone during pregnancy or breastfeeding has not yet been proven. What is known is that small amounts of oxycodone are secreted into breast milk and can have serious effects on a newborn who is breastfeeding. Babies born to women who took narcotics for a prolonged period may have signs of respiratory depression or life-threatening withdrawal symptoms.

Euphoric Effect

The opioids used to control pain in general medicine are not only well known for their analgesic properties, but also for their ability to produce an intense effect of pleasure or well-being, called “euphoria”. Although most classes of opiates have seen an increase in their abuse, hydrocodone and oxycodone, which are the most commonly prescribed opioids in the United States, are by far the preferred drugs among prescription opioid users.

So, which drug is more popular?

Both drugs have a long history of use for non-therapeutic purposes. Scientists investigating why people favor one drug over another have discovered that oxycodone and hydrocodone are the drugs of choice for 75% of people dependent on opiates. Their results show that oxycodone was the most popular drug in general due to the quality of the high for those seeking such effects. However, hydrocodone remains one of the most popular primary drugs, although it has lower euphoric qualities, due to its low costs. [6]

To summarize, oxycodone was the choice of significantly more users (44.7%) than hydrocodone (29.4%) because users of oxycodone (54%) considered that the quality of hyperopia was much better than that of hydrocodone users (20%). Therefore, oxycodone is preferred for the quality of the high it gives, and hydrocodone is less popular because it has a lesser euphoric effect.

Addiction Liability

Are these drugs addictive?

Yes, both hydrocodone and oxycodone are extremely addictive. In fact, long-term use of opioids such as hydrocodone and oxycodone can lead to a psychological and physical dependence, and even an addiction, though they are rarely addictive in people who genuinely need them to control pain and take prescription medications as prescribed.

Today, both hydrocodone and oxycodone are schedule II drugs. A drug schedule is a number that is assigned to a medicine, chemical, or substance, by the Drug Enforcement Administration (DEA). The schedule number indicates the likelihood the substance could be misused, as well as the drug’s accepted medical use. Schedule II drugs, for example, have a relatively high potential for abuse compared to other medications. But before the fall of 2014, hydrocodone and oxycodone were thought to be less addictive. [4] [7] [8]

Signs of a Problem

The exact risk of pain pill addiction is not known, but some factors, which may increase chances of addiction, include:

  • Past drug or alcohol problems.
  • Problem with anxiety.
  • Depression or other mental health disorders.

If you or someone you love have two or more of these symptoms, you may have a drug problem with hydrocodone or oxycodone:

  • Using in larger amounts or for longer than intended.
  • Wanting to cut down or stop using, but not managing to.
  • Spending a lot of time to get, use, or recover from use.
  • Craving.
  • Inability to manage commitments due to use.
  • Continuing to use, even when it causes problems in relationships.
  • Giving up important activities because of use.
  • Continuing to use, even when it puts you in danger.
  • Continuing to use, even when physical or psychological problems may be made worse by use.
  • Increasing tolerance to the drug.
  • Withdrawal symptoms like nausea, muscle cramping, depression, agitation or anxiety.

Where to Go for Help?

If you think you have a problem with hydrocodone or oxycodone, it is important that you seek professional help. There are programs that help treat the withdrawal syndrome of opioids, doing it under medical supervision. In fact, you can detox with the help of medications or supportive therapies. The treatment of withdrawal symptoms ensures that you follow through and complete the process. In fact, can treat adverse withdrawal symptoms immediately.

At the same time, talk therapy and support groups are recommended, as well.

Remember, you are not alone…

Your Questions

Still have questions about the differences between hydrocodone and oxycodone? Would you like to know more? Please ask any questions you may have here in the comments section and we will get back to you personally and promptly.

Reference Sources: [1] NCBI: Hydrocodone
[2] NCBI: Oxycodone
[3] DEA: Hydrocodone
[4] CDC: U.S. Opioid Prescribing Rate Maps
[5] NCBI: The Neurobiology Of Opioid Dependence: Implications For Treatment
[6] ELSEVIER: Prescription Opioid Abusers Prefer To Get High On Oxycodone And Hydrocodone
[7] DEA: Oxycodone
[8] DEA: Rules 2014
FDA: Opioid Medications
MEDLINE PLUS: Hydrocodone
About the author
Lee Weber is a published author, medical writer, and woman in long-term recovery from addiction. Her latest book, The Definitive Guide to Addiction Interventions is set to reach university bookstores in early 2019.
Medical Reviewers
Dr. Dili Gonzalez, M.D. is a general surgeon practicing women's focused medici...
Dr. Goecke is a medical doctor and general surgeon with personal experience of...

All of the information on this page has been reviewed and verified by a licensed medical professional.

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