Vicodin vs. Percocet: Differences and Similarities

Medically reviewed by Mary Choy, PharmD

Vicodin (hydrocodone and acetaminophen) and Percocet (oxycodone and acetaminophen) are potent prescription pain medications used to manage moderate to moderately severe pain.

Vicodin is no longer marketed under its brand name, but it is still available in a generic version. However, it is still commonly referred to by its former brand name. Hydrocodone-acetaminophen is approved for use in children 2 years and older, whereas Percocet should only be used by adults.

Both medications combine acetaminophen (the active ingredient in Tylenol) with either hydrocodone or oxycodone.

Opioid-containing medication can cause severe side effects, so it's important to talk to your healthcare provider about these risks before starting treatment.

This article discusses the similarities and differences between Vicodin and Percocet.

Boxed Warnings

Hydrocodone-acetaminophen and Percocet come with boxed warnings regarding the serious risks associated with each drug.

Misuse of Vicodin or Percocet can cause addiction, overdose, or death. These medications can also put you at risk for breathing problems, especially when starting or increasing your dose.

Fatal side effects can occur if you use opioid-containing medications with alcohol or other drugs that cause drowsiness, respiratory depression, coma, and death. Additionally, using either of these medications while taking CYP450 3A4 inhibitors or stopping any CYP450 3A4 inducers may increase or prolong adverse effects.

Taking either of these during pregnancy may cause life-threatening withdrawal symptoms in the newborn. This is called neonatal opioid withdrawal syndrome.

Acetaminophen can cause acute liver failure, sometimes leading to liver transplantation or death. Most liver injuries are linked to the consumption of acetaminophen in doses exceeding 4,000 milligrams (mg) per day and often involve the use of multiple acetaminophen-containing products.

For this reason, it's especially important to take only the prescribed amount and be aware of the ingredients in other medications you take at the same time.

Vicodin vs. Percocet: Uses

Hydrocodone-acetaminophen is a potent pain reliever that combines two medications. Hydrocodone binds to various opioid receptors, providing relief from pain, but it also causes sedation, euphoria (intense excitement), and slowed breathing. Acetaminophen, on the other hand, reduces pain and fever by blocking the production of certain pain-causing chemicals in the body.

Hydrocodone-acetaminophen is prescribed for managing moderate to moderately severe pain when other pain treatments, such as non-opioid pain medications, do not provide adequate relief or are not well-tolerated. The generic version of Vicodin comes in formulations containing 5 mg, 7.5 mg, or 10 mg of hydrocodone and 300 mg of acetaminophen. Other formulations are available under the brand name Norco.

Percocet is another strong prescription pain medication that contains oxycodone and acetaminophen. Oxycodone interacts with opioid receptors to deliver pain relief. The exact mechanism of acetaminophen is unclear, but it is believed to work in the central nervous system (made up of the brain and spinal cord).

Like hydrocodone-acetaminophen, Percocet is used for managing moderate to moderately severe pain when other pain treatments, such as non-opioid pain medications, are not effective or are not well-tolerated.

Dosage: How to Take Vicodin vs. Percocet

The following table summarizes the differences and similarities in how Percocet and hydrocodone-acetaminophen should be taken.

Safety Precautions

Because both medications contain opioids, they have similar safety risks to be mindful of.

Neither hydrocodone-acetaminophen or Percocet should be used in people who have the following characteristics:

• Are allergic to it

• Have used a monoamine oxidase inhibitor (MAOI) use within 14 days

• Have severe breathing problems, including severe asthma

• Have known or suspected bowel blockage or issues like paralytic ileus

• Are experiencing shock, coma, or unconsciousness

If you have kidney or liver problems, your healthcare provider may prescribe a lower dose of this medication to prevent any possible harmful effects.

If you are planning to conceive or are already pregnant, you must talk to your healthcare provider before starting treatment. Opioid-containing medications can lead to adverse effects in your newborn if taken during pregnancy. They can also pass into breast milk, which can be harmful to the baby.

Percocet is not approved for use in children. However, hydrocodone-acetaminophen can be used in children using weight-based dosing.

Overdose Risk

Taking opioid-containing medications raises the risk of an overdose, which can happen if you take it in large amounts. Do not take more than recommended or use it for longer than prescribed.

Symptoms of an overdose can include:

• Nausea or vomiting

• Excessive sweating

• Severe drowsiness

• Pinpoint pupils

• Dizziness or light-headedness

• Slowed breathing

Your healthcare provider may suggest keeping (Narcan) naloxone with you. Naloxone is a medicine that can reverse an opioid overdose. Someone who is taking care of you or lives with you should know how to use naloxone and where you keep it.

Naloxone is available without a prescription, so you may be able to purchase it in drugstores, convenience stores, or online. If you're unsure how to get naloxone, talk to your healthcare provider or pharmacist.

What Are the Side Effects of Vicodin vs. Percocet?

Both medications have some common side effects that include:

• Constipation

• Dizziness

• Light-headedness

• Nausea and vomiting

• Pruritus (itchiness)

• Rash

• Sedation

In one clinical study, nausea and dizziness were 10% more common in those taking Percocet than those taking hydrocodone-acetaminophen.

Both hydrocodone-acetaminophen and Percocet can also cause potentially severe side effects, including:

• Adrenal insufficiency (a condition in which the adrenal glands don't produce enough cortisol)

• Agranulocytosis (low neutrophil count)

• Androgen deficiency (low levels of certain sex hormones)

• Sleep apnea

• Hemolytic anemia (low red blood cell count caused by the destruction of red blood cells)

• Kidney damage

• Liver toxicity

• Seizures

• Severe allergic reaction

• Severe skin reaction

• Severely low blood pressure

• Slowed or labored breathing

• Thrombocytopenia (low platelet count)

• Withdrawal, if stopped suddenly

Serotonin syndrome is a potential complication that can occur when opioids are taken with other drugs that increase serotonin levels in the body. Symptoms of serotonin syndrome can include:

• Agitation

• Dilated pupils

• Tremor

• Hyperreflexia (overactive muscle reflexes)

• Involuntary muscle contractions

• Akathisia (restlessness)

• Muscle rigidity

• Flushed skin

Interactions

It is important to know that hydrocodone-acetaminophen and Percocet can have dangerous interactions with many other drugs.

The following medications can interact with both hydrocodone-acetaminophen and Percocet. Be sure to inform your healthcare provider if you are taking any of the following:

• Diuretics (water pills), such as Lasix (furosemide)

• Anticholinergic drugs, which include certain drugs that treat overactive bladder and chronic obstructive pulmonary disease (COPD)

• Other opioids

• Other sedating drugs, like Valium (diazepam), Xanax (alprazolam), Klonopin (clonazepam), Versed (midazolam), and others

• Muscle relaxers, such as Flexeril (cyclobenzaprine) and Soma (carisoprodol)

• Medications that affect serotonin levels in your body, such as stimulants or medications for depression, Parkinson's disease, and migraine headaches

• Antibiotics or antifungal medication or medicine to treat human immunodeficiency virus (HIV) or hepatitis C

• Heart or blood pressure medication, including beta-blockers such as propranolol

• Lamotrigine (a seizure medication)

• Probenecid (used to treat gout)

Hydrocodone-acetaminophen oral solution contains 6.7% ethanol (ehyl alcohol). Therefore, it is important to avoid or minimize alcohol use.

This is not an exhaustive list, and there may be other potential drug interactions. For this reason, tell your healthcare provider about all the prescription or over-the-counter (OTC) medications, supplements, and herbal medicines you take.

Which Is More Effective?

Both drugs are used for pain management and are a combination of opioid (hydrocodone or oxycodone) and non-opioid (acetaminophen) analgesics.

However, a 2015 clinical trial found no significant clinical or statistical difference between the effectiveness of hydrocodone-acetaminophen and oxycodone-acetaminophen.

The study included 220 people whose pain was measured 24 hours following discharge from the emergency department. Both medications reduced pain scores by approximately 50%.

Summary

Vicodin and Percocet are potent prescription medications for managing moderate to moderately severe pain. Both drugs contain acetaminophen, but Vicodin contains hydrocodone, while Percocet contains oxycodone. Still, they are equally effective in managing pain.

Although commonly known by its brand name Vicodin, hydrocodone-acetaminophen is now only available as a generic.

The recommended dosage for both medications varies. Moreover, people with kidney or liver impairment may be prescribed a lower dose to avoid toxicity.

As with all opioids, both medications have safety considerations, including the risk of an overdose, and potentially severe side effects. Your healthcare provider may recommend you have naloxone, a medicine to reverse an opioid overdose, on hand.

Before starting treatment, talk to your healthcare provider about the risks and benefits of using these medications and follow their instructions carefully to minimize risks.

Frequently Asked Questions

Who shouldn’t take Vicodin or Percocet?

Vicodin and Percocet are prescription pain medications containing opioids, which are drugs that can be habit-forming and lead to dependence and addiction. Consult your healthcare provider before using either drug, especially if you have a history of substance abuse, kidney or liver disease, or are pregnant and breastfeeding. You should also avoid these medications if you have used an MAOI within 14 days, have severe breathing problems, or have a bowel blockage.

How does acetaminophen combined with an opioid work?

Vicodin and Percocet are strong prescription pain medications that combine opioids and acetaminophen. The opioid interacts with various opioid receptors, producing pain relief. The mechanism of action of acetaminophen is not well defined but it's thought to block the production of certain pain-causing chemicals in the body.

When combined with an opioid, the effectiveness of pain relief from acetaminophen is increased and the dose of the opioid required to achieve the same level of relief can be lowered.

Can Vicodin or Percocet be used for chronic pain?

Chronic pain is characterized as pain that lasts more than three months. Non-opioid therapies are preferred for chronic pain. Opioids are typically only used if the benefits outweigh the risks and other non-opioid alternatives don't work well enough.

When used, opioids should be combined with nondrug therapies. Consult a healthcare provider to determine appropriate treatment, including non-opioid medications, physical therapy, or alternative therapies.

Read the original article on Verywell Health.