Hydrocodone vs Oxycodone: The Difference Explained

Hydrocodone and oxycodone are prescription opioid painkillers that are effective medications to treat moderate to severe pain. Oxycodone is more likely to cause side effects like drowsiness and dizziness, while hydrocodone is more likely to cause stomach upset and constipation.

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Pain from a fracture, surgery, or chronic condition may require a more powerful painkiller than acetaminophen or ibuprofen. When you’re in moderate to severe pain, prescription opioid painkillers like hydrocodone and oxycodone can provide an effective pain management option.

However, these medications can only be used with a prescription due to their high risk of abuse and addiction.

If you’re curious about the benefits and risks of hydrocodone vs oxycodone, here is the difference explained.

Overview

Hydrocodone and oxycodone are generic prescription medications that belong to a class of drugs called opioid analgesics, commonly referred to as opioids.

Medications in this class of drugs affect the way that the brain and central nervous system process pain signals received from the nerves in the body.

Both hydrocodone and oxycodone are classified by the U.S. Drug Enforcement Administration (DEA) as Schedule II controlled substances, which means that they have valid medical uses but a high potential for abuse and addiction.

Hydrocodone is available under the brand names Hysingla ER and Zohydro ER, while oxycodone is sold under a number of different brand names, the most common of which is OxyContin.

Both medications are also commonly combined with over-the-counter painkillers, such as acetaminophen, to relieve pain.

Conditions Treated

Both hydrocodone and oxycodone are used to treat moderate to severe pain that occurs on a short-term, long-term, or chronic basis.

The medications are appropriate for the treatment of pain caused by surgery or injury or pain caused by chronic conditions, such as arthritis and cancer.

Due to the high risk of abuse and dependence associated with the use of hydrocodone and oxycodone, the medications are most commonly recommended for the treatment of short-term pain.

Additionally, the body can adapt to the use of opioids over time, which makes them less effective and causes people to take more to achieve the same effect, increasing their risk of addiction.

Use and Dosing

Oxycodone and hydrocodone are used slightly differently for the treatment of pain.

Oxycodone is typically taken every four to six hours for the management of pain. Immediate-release tablets of oxycodone are available in strengths of 5 mg, 10 mg, 15 mg, 20 mg, and 30 mg.

The dosage prescribed to a patient will vary depending on their age, severity of pain, how long the drug will be used, other medications that may interact with the drug, the patient’s potential for abuse and addiction, and other medical conditions that the patient may have.

The drug is also available in an extended-release tablet that can last up to 12 hours and only needs to be taken once or twice per day for pain management. Oxycodone is also the opioid pain reliever in Percocet.

Hydrocodone comes in different forms that can be taken every 12 hours or every 24 hours for the management of pain.

Available strengths range from 10 mg to 120 mg, and doctors typically prescribe patients the lowest dose possible for treatment.

The dosage prescribed to a patient will vary depending on their age, cause and severity of pain, how long the drug will be used, other medications that may interact with the drug, the patient’s potential for abuse and addiction, and other medical conditions that the patient may have. 

Side Effects

Oxycodone and hydrocodone both have the potential to cause side effects in addition to treating pain. Side effects of the medications may be mild or severe with some serious side effects requiring . 

Oxycodone

Common side effects of oxycodone include:

  • Constipation
  • Nausea
  • Lack or loss of strength
  • Drowsiness
  • Dizziness
  • Vomiting
  • Itching
  • Headache 
  • Dry mouth
  • Sweating

Less common side effects of oxycodone include:

  • Indigestion
  • Abdominal pain
  • Diarrhea
  • Fever
  • Anxiety
  • Shortness of breath
  • Gas
  • Fluid retention
  • Thirst
  • Chest pain

Other side effects associated with oxycodone are potentially serious and require immediate medical attention. Less common side effects associated with oxycodone that require immediate medical attention may include:

  • Trouble breathing
  • Fast heartbeat
  • Chest pain
  • Extreme drowsiness
  • Agitation
  • Fever
  • Confusion
  • Stiff muscles

Oxycodone may also cause other side effects in addition to those that are listed above. Patients should speak to their doctors for a full list of potential side effects.

Hydrocodone

Common side effects of hydrocodone include:

  • Constipation
  • Nausea
  • Drowsiness
  • Fatigue
  • Headache
  • Dry mouth
  • Dizziness
  • Vomiting
  • Itching
  • Abdominal pain
  • Muscle spasms
  • Back pain
  • Tremors

Some side effects associated with hydrocodone can be potentially dangerous. If you experience any of the following side effects while taking hydrocodone, seek medical treatment immediately:

  • Trouble breathing
  • Fast heartbeat
  • Chest pain
  • Extreme drowsiness
  • Agitation
  • Fever
  • Confusion
  • Stiff muscles

Consult a healthcare provider for other possible side effects of hydrocodone as this may not be a complete list of side effects. 

Effectiveness

Hydrocodone and oxycodone are both powerful opiate pain medications that are effective at managing pain. Some patients may find that one drug works better than the other for the management of their pain depending on the cause of their pain, their specific body chemistry, and other factors.

Studies and controlled trials have examined the effectiveness of hydrocodone compared to oxycodone in emergency situations and concluded that the medications are equally effective at intervals of 30 minutes and 60 minutes after ingestion.

Tolerance of the drugs was shown to be similar, although hydrocodone was found to be more likely to cause constipation.

Another study by healthcare professionals compared the effectiveness of combination drugs that contain hydrocodone or oxycodone as an active ingredient.

This study concluded that products that combine oxycodone with acetaminophen, commonly known as Tylenol, were approximately 1.5 times more powerful than a combination of hydrocodone/acetaminophen combination. As a result, the combination of oxycodone and acetaminophen was more likely to be abused. 

Cost

Hydrocodone and oxycodone are prescription drugs for the treatment of acute pain and chronic pain both sold in generic and brand name forms from a wide variety of manufacturers.

The generic versions of each medication are considerably less expensive than the brand name forms of the drug, and commercial health insurance, Medicare, and Medicaid commonly cover the cost of the medications.

Because the medications are highly controlled, they are usually only dispensed in low doses, for a treatment period of 10 to 14 days.

Generic hydrocodone can be purchased for less than 10 dollars for one prescription. By contrast, one prescription of brand name Zohydro ER costs approximately 90 dollars.

A prescription of generic oxycodone can also be purchased for less than 10 dollars. Brand-name OxyContin costs approximately 50 dollars for one prescription.

Warnings

Opioid pain medications like hydrocodone and oxycodone carry many warnings and risks associated with their use. Schedule II controlled substances are associated with a high risk of abuse or withdrawal and are associated with a higher risk of addiction, overdose, and death.

These pain relievers are known to be addictive even when taken at low doses for a short period of time.

Patients with a history of substance abuse should exercise extreme caution when using the medications. Addiction treatment programs are available for those suffering from drug abuse.

Hydrocodone and oxycodone should not be taken by patients who have kidney or liver disease. People with kidney or liver disease may have difficulty processing these medications safely. 

Hydrocodone and oxycodone naturally slow the respiratory system, so people with asthma or breathing difficulties should also exercise extreme caution when using the drugs and may not be able to use them safely.

Additionally, opioid medications can cause constipation as a side effect, so they should not be used by patients who struggle with constipation or intestinal blockages.

Women who are pregnant or breastfeeding should not use opioid drugs like hydrocodone or oxycodone.

Studies have shown that the use of opioids during pregnancy can cause birth defects, and opioids can pass through breast milk and cause withdrawal symptoms in infants.

When used during pregnancy, opioids can cause side effects like lightheadedness, difficulty breathing, constipation, or behavioral changes.

Summary

Opioid pain medications like hydrocodone and oxycodone have a high risk of abuse and dependence but offer an effective treatment option for moderate to severe pain.

Other opioid examples include codeine and hydrocodone/acetaminophen (Vicodin and Norco).

Patients using hydrocodone or oxycodone should use caution when taking the medications and take them only as prescribed.

References, Studies and Sources:
https://www.mayoclinic.org/drugs-supplements/oxycodone-oral-route/side-effects/drg-20074193 
https://pubmed.ncbi.nlm.nih.gov/15805317/ 
https://medlineplus.gov/druginfo/meds/a614045.html#side-effects

medically reviewed and fact checked
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