Vicodin and Percocet are both used for pain relief but is one stronger or more addictive than the other?
Vicodin and Percocet are both combination pain-relieving tablets. Both contain acetaminophen and an opioid-type ingredient. The opioid in Vicodin is hydrocodone and the opioid in Percocet is oxycodone.
What are the benefits of acetaminophen in these tablets?
Adding acetaminophen to an opioid improves that opioid's pain-relieving capabilities; however, the amount of acetaminophen contained in both Vicodin and Percocet is too small to provide an effective dose when tablets are taken at the recommended dosages. Both hydrocodone and oxycodone are available as single ingredient tablets (hydrocodone [Hysingla, Zohydro]; oxycodone [Oxaylo, Oxycontin]) and in many cases prescribing a single-ingredient opioid product along with additional acetaminophen tablets may allow improved pain control with less risk of side effects compared with giving a combination tablet such as Vicodin or Percocet.
Is oxycodone more effective than hydrocodone, or more likely to be abused?
Studies have shown no differences in the pain-relieving properties of hydrocodone and oxycodone; however, oxycodone appears to have a higher abuse liability potential than hydrocodone, which means Percocet is more likely to be abused. Neither Vicodin nor Percocet are available as abuse-deterrent forms. There does appear to be some controversy over the potency on a mg for mg basis between hydrocodone and oxycodone; however, one study found 5mg oxycodone to be just as effective as 5mg of hydrocodone. Hydrocodone is also effective as a cough suppressant.
Which one is better long-term?
Both Vicodin and Percocet should only be used short-term, unless given for unremitting, cancer-related pain. Vicodin, Percocet, and other similar opioid-type pain-relieving tablets should NOT be used long-term for chronic non-cancer related pain relief, in fact guidelines actively discourage this practice because of the risk for addiction, dependence and abuse. Opioid-containing medications should only be used for cancer-related pain or as a last resort for moderate-to-severe pain that is unresponsive to less potent pain-relief medicines. Non-narcotic pain relievers (such as acetaminophen, NSAIDs) and non pharmacological therapy (such as acupuncture, cognitive behavioral therapy) are the preferred options for the relief of chronic non-cancer related pain.
Are there any differences in side effects?
Hydrocodone-related side effects are similar to oxycodone-related side effects and include constipation, nausea, vomiting, itching and drowsiness. The incidence of constipation appears higher with hydrocodone. Both oxycodone and hydrocodone can cause physical and psychological dependence, and tolerance can develop on repeated administration (tolerance is when the same dosage no longer provides the same level of pain relief).
AbbVies's Vicodin is available as a tablet containing 5mg hydrocodone and 300mg acetaminophen. Vicodin ES contains 7.5mg hydrocodone and 300mg acetaminophen and Vicodin HP contains 10mg hydrocodone and 300mg acetaminophen. Generic forms are also available.
Percocet is available in four different strengths: 2.5mg oxycodone/325mg acetaminophen, 5mg oxycodone/325mg acetaminophen, 7.5mg oxycodone/325mg acetaminophen, and 10mg oxycodone/325mg acetaminophen. Generic forms are also available. Percocet and Vicodin should not be taken together; however, if changing from one to another (for example from Percocet to Vicodin), the Percocet can be stopped one day and the Vicodin started the next.
What does the CDC have to say about opioid pain relievers?
The CDC offers the following guidance about opioids:
- All opioids pose a risk to all patients
- Always use nonopioid therapies first (such as acetaminophen, NSAIDs if appropriate)
- When using opioids, start with the lowest effective dose and only increase slowly if necessary. Use immediate-release opioids instead of extended-release opioids
- Do not use opioids routinely for chronic pain. If opioids are used, combine them with nonpharmacologic or nonopioid pharmacologic therapy (such as acetaminophen) to provide greater benefits
- Studies have shown nonpharmacologic therapies (such as acupuncture, exercise and cognitive behavioral therapy) and nonopioid pharmacologic therapies (such as anti-inflammatories) are effective for chronic pain.
From a professional point of view, neither Vicodin nor Percocet is a good choice; however, Vicodin contains hydrocodone, which means it is less likely to be abused than Percocet.
- Schmidt-Hansen M, Bennett MI, Arnold S, Bromham N, Hilgart JS. Oxycodone for cancer-related pain. Cochrane Database of Systematic Reviews 2015, Issue 2. Art. No.: CD003870. DOI: 10.1002/14651858.CD003870.pub5.
- Rodriguez RF, Castillo JM, Castillo MP et al. Hydrocodone/acetaminophen and tramadol chlorhydrate combination tablets for the management of chronic cancer pain: a double-blind comparative trial. Clin J Pain. 2008 Jan;24(1):1-4. doi: 10.1097/AJP.0b013e318156ca4d
- Marco, C. A., Plewa, M. C., Buderer, N., Black, C. and Roberts, A. (2005), Comparison of Oxycodone and Hydrocodone for the Treatment of Acute Pain Associated with Fractures: A Double-blind, Randomized, Controlled Trial. Academic Emergency Medicine, 12: 282–288. doi: 10.1197/j.aem.2004.12.005, http://onlinelibrary.wiley.com/doi/10.1197/j.aem.2004.12.005/epdf
- Reinecke H, Weber C, Lange K, Simon M, Stein C, Sorgatz H. Analgesic efficacy of opioids in chronic pain: recent meta-analyses. British Journal of Pharmacology. 2015;172(2):324-333. doi:10.1111/bph.12634
- Wightman R , Perrone J , Portelli I , Nelson L. Likeability and abuse liability of commonly prescribed opioids. Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology [2012, 8(4):335-40. PMID:22992943 PMCID:PMC3550270
- Injury Prevention & Control: Prescription Drug Overdose. Centers For Disease Control and Prevention. 01/2016 - http://www.cdc.gov/drugoverdose/
- Lyford J. Reformulated OxyContin reduces abuse but many addicts have switched to heroin. The Pharmaceutical Journal 16 Mar 2015 http://www.pharmaceutical-journal.com/news-and-analysis/news/reformulated-oxycontin-reduces-abuse-but-many-addicts-have-switched-to-heroin/20068119.article
- Can the U.S. Win the War On Opioids? 02/2016 https://blog.drugs.com/2016/02/can-the-u-s-win-the-war-on-opioids/
- Hydrocodone. National Center for Biotechnology Information. PubChem Compound Database; CID=5284569, https://pubchem.ncbi.nlm.nih.gov/compound/5284569
- Oxycodone. National Center for Biotechnology Information. PubChem Compound Database; CID=5284603, https://pubchem.ncbi.nlm.nih.gov/compound/5284603
- Vicodin [Package Insert] Abbott Laboratories Revised 10/2012 https://www.drugs.com/pro/vicodin.html
- Percocet [Package Insert] Endo Pharmaceuticals Revised 6/2016 https://www.drugs.com/pro/percocet.html
- Options for Chronic Pain: A Health Care Professional's Guide. Revised 03/2016. Drugs.com https://www.drugs.com/slideshow/chronic-pain-management-options-1229#slide-1
- Obama Administration Steps Up Efforts to Beat Painkiller, Heroin Epidemic. 03/2016 Drugs.com https://www.drugs.com/news/obama-administration-steps-up-efforts-beat-painkiller-heroin-epidemic-60676.html
- Vicodin dosing and strengths. AbbVie. https://www.vicodin.com/hcp
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