Percocet: 7 things you should know
Medically reviewed by Carmen Fookes, BPharm. Last updated on Oct 6, 2020.
1. How it works
- Percocet is a combination narcotic pain-relieving medication (analgesic) that contains acetaminophen and oxycodone.
- Acetaminophen and oxycodone both relieve pain, but each works differently.
- Experts believe acetaminophen works by blocking the effects of a specific enzyme, known as cyclooxygenase (COX), mainly in the brain. Oxycodone binds to specific receptors called mu opioid receptors and blocks pain signals on their way to the brain.
- Percocet belongs to the group of medicines known as combination narcotic analgesics.
- Effective for the management of severe pain unresponsive to other non-narcotic treatment options. Percocet should be reserved for more severe types of pain, such as that caused by cancer.
- The combination is more effective than using either acetaminophen or oxycodone alone.
- The duration of the effect of oxycodone and acetaminophen is similar.
- Percocet is available as a generic under the name oxycodone and acetaminophen.
If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:
- May cause nausea and vomiting, dizziness, and headache (oxycodone component). Most of the side effects of Percocet are due to the oxycodone component.
- May cause drowsiness or impair reaction skills and affect a person's ability to drive or operate machinery (oxycodone component). Avoid alcohol as the combination may increase the risk of sedation and other potentially fatal side effects.
- Other common side effects include constipation, dizziness, nausea, vomiting, and confusion. Can lead to low blood pressure, which may increase the risk of falls. May cause flushing, red eyes, sweating, and an itchy rash (although the oxycodone component of Percocet is less likely to cause an itchy rash than some other opioids).
- May cause life-threatening respiratory depression (slow and shallow breathing) (oxycodone component). The risk is higher in children, the elderly, debilitated, those with pre-existing breathing problems, on Percocet initiation, or with a dosage increase.
- Rarely, the acetaminophen component may cause liver failure especially when higher dosages are used (this may occur if other acetaminophen-containing products are inadvertently taken at the same time). The risk is also increased with chronic alcohol use, some medications, and in patients with significant liver disease.
- There is a high risk of addiction or dependence associated with the use of Percocet (attributable to the oxycodone component) and a high likelihood of withdrawal reactions if it is stopped abruptly in people who have become dependent on it. Symptoms include restlessness, pupil dilation, watery eyes, and a runny nose, sweating, muscle aches, insomnia, irritability, and gastrointestinal complaints. Percocet may be sought out by drug seekers. Babies born to mothers who are physically dependent on Percocet will be born physically dependent on Percocet themselves.
- The dosage of Percocet may need reducing in people with kidney or liver disease.
- The oxycodone component of Percocet interacts with several different drugs, including those that inhibit or induce hepatic enzymes, particularly CYP3A4 or CYP2D6 (such as erythromycin, ketoconazole, ritonavir); depress the CNS (such as benzodiazepines, muscle relaxants, antipsychotics); have partial agonist or mixed effects on opioid receptors (such as buprenorphine, pentazocine); diuretics; with anticholinergic effects; and monoamine oxidase inhibitors.
- Interaction or overdosage with the oxycodone component of Percocet may cause serotonin syndrome. Symptoms include mental status changes such as agitation, hallucinations, coma, delirium, fast heart rate, dizziness, flushing, muscle tremor or rigidity, and stomach symptoms (including nausea, vomiting, and diarrhea).
- Percocet is not suitable for use in people with severe asthma or other breathing problems, or a blockage in the stomach or intestines.
- Long-term use of oxycodone (contained in Percocet) also affects the endocrine system, which may cause symptoms such as sexual dysfunction, an absence of periods, or infertility.
Notes: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. For a complete list of all side effects, click here.
- May be taken with or without food.
- Take Percocet exactly as directed by your doctor. Do not take more than prescribed unless advised to do so by your doctor. The effective dosage for pain relief varies significantly from person to person. Over time, your dosage may need adjusting, especially if you find that your pain is no longer being controlled. Talk with your doctor if this happens.
- Seek urgent medical advice if you experience any breathing difficulties, wheezing, itching, or facial swelling.
- Tell your doctor if you think you have become addicted to Percocet.
- Avoid taking extra acetaminophen while taking Percocet. Be especially cautious when taking cough and cold remedies in addition to Percocet. Some of these may also contain acetaminophen. Always check with your doctor or pharmacist that products you buy over-the-counter are compatible with Percocet.
- Avoid alcohol while taking this medicine; excessive sedation or fatal breathing problems may occur.
- Percocet may cause sedation which may impair your reaction skills and affect your ability to drive or operate machinery. Do not drive or operate machinery if Percocet impairs you in this way.
- Withdrawal symptoms (muscle and bone pain, diarrhea, insomnia, vomiting) may occur if long-term Percocet is stopped abruptly. Your doctor will advise you how to discontinue Percocet slowly if you need to stop taking it.
- Do not use during pregnancy and breastfeeding unless specifically recommended by your doctor.
- Percocet may cause constipation which can be relieved with laxatives. Nausea or vomiting caused by Percocet may be treated with antiemetics. Talk to your doctor if you experience any troublesome side effects.
- May lower blood pressure on standing. Take your time when going from a lying down to a standing up position.
- Avoid grapefruit juice, grapefruit products, Seville oranges (used to make orange marmalade), and tangelos (a tangerine-grapefruit cross) due to possible food-drug interactions.
- Keep this medicine in a safe place and out of the reach of children and pets. Accidental ingestion of even one dose of Percocet can result in a fatal overdose.
6. Response and Effectiveness
- The maximum effect of the oxycodone component of Percocet is reached in 1.8 hours and its duration of activity lasts for 3-4 hours. The peak acetaminophen effect is reached within 30-60 minutes of administration and its analgesic effect lasts around 3 to 4 hours.
Medicines that interact with Percocet may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with Percocet. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.
Common medications that may interact with Percocet include:
- antibiotics, such as clarithromycin and erythromycin
- antidepressants, such as tricyclic antidepressants (eg, amitriptyline), monoamine oxidase inhibitors (eg, isocarboxazid, phenelzine, and tranylcypromine), or SSRIs (eg, fluoxetine, sertraline)
- antifungal agents, such as itraconazole and ketoconazole
- anticonvulsants, such as carbamazepine, lamotrigine, phenytoin, phenobarbital, or primidone
- antipsychotics (such as butyrophenones, phenothiazines, or thioxanthenes) and atypical antipsychotics (eg, olanzapine, quetiapine, ziprasidone)
- any medication that may cause drowsiness, such as benzodiazepines (eg, diazepam, lorazepam), first-generation antihistamines (such as doxylamine or promethazine), metoclopramide, or opioids (such as codeine, morphine)
- migraine medications, such as almotriptan, eletriptan, or sumatriptan
- muscle relaxants, such as cyclobenzaprine
- any other medication that inhibits hepatic enzymes CYP3A4 or CYP2D6 or induces CYP3A4
- other medications that affect serotonin, such as amphetamines, fentanyl, lithium, tramadol, triptans (eg, almotriptan, eletriptan, or sumatriptan), or St. John's Wort.
Avoid grapefruit products and drinking alcohol or taking illegal or recreational drugs while taking Percocet.
Note that this list is not all-inclusive and includes only common medications that may interact with Percocet. You should refer to the prescribing information for Percocet for a complete list of interactions.
Percocet (oxycodone hydrochloride and acetaminophen) [Package Insert]. Revised 05/2020. Endo Pharmaceuticals, Inc. https://www.drugs.com/pro/percocet.html
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Percocet only for the indication prescribed.
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