Quick answer: Oxycodone is about 1.5 times stronger than hydrocodone milligram for milligram, so 10 mg of hydrocodone is roughly equal to 6.5 to 7 mg of oxycodone. Beyond that, the two are more alike than different: both are Schedule II opioids, both relieve moderate to severe pain for four to six hours, both cause drowsiness and constipation, and both carry the same risk of dependence and overdose. Which one a doctor prescribes usually comes down to formulation and history, not one being “safer.”
If you have been handed a prescription for one of these and someone you know was given the other, it is natural to wonder whether you got the stronger one, the more dangerous one, or the one more likely to cause a problem down the road. The short version is that the differences are real but small, and the risks that matter most are shared. This guide lays out what actually separates oxycodone from hydrocodone, what the research says about strength and side effects, and what to watch for with either one.
Oxycodone and hydrocodone at a glance
| Feature | Oxycodone | Hydrocodone |
|---|---|---|
| Drug class | Semi-synthetic opioid (made from thebaine) | Semi-synthetic opioid (made from codeine) |
| Common brand names | Roxicodone, Oxaydo (oxycodone alone); Percocet, Endocet (with acetaminophen); OxyContin, Xtampza ER (extended-release) | Norco, Lortab, Vicodin, generic hydrocodone/acetaminophen 5-325, 7.5-325, 10-325; Hysingla ER, Zohydro ER (extended-release) |
| Relative strength (CDC MME factor) | 1.5 (1 mg oxycodone = 1.5 mg morphine) | 1.0 (1 mg hydrocodone = 1 mg morphine) |
| Onset, immediate-release | 10 to 30 minutes | 20 to 30 minutes |
| Duration, immediate-release | 3 to 6 hours; dosed every 4 to 6 hours | 4 to 6 hours; dosed every 4 to 6 hours |
| Half-life | 3 to 5 hours | About 4 hours |
| How the liver processes it | CYP3A4 and CYP2D6; active metabolite oxymorphone | CYP2D6; active metabolite hydromorphone |
| DEA schedule | Schedule II | Schedule II (combination products moved from III to II in October 2014) |
| Most common side effects | Drowsiness, constipation, nausea, dizziness, itching, dry mouth, headache | Drowsiness, constipation, nausea, dizziness, itching, dry mouth, headache |
| Dependence and overdose risk | High | High |
How each one works
Both drugs do the same job the same way. They attach to mu-opioid receptors in the brain and spinal cord, which turns down pain signals and, as a side effect, slows breathing, digestion and alertness. Both are semi-synthetic, meaning they are made in a lab from natural opium compounds: oxycodone from thebaine, hydrocodone from codeine. Both come as immediate-release tablets that last a few hours and as extended-release products that last about 12 hours.
The one mechanical difference worth knowing is in the liver. Hydrocodone depends almost entirely on one enzyme, CYP2D6, to convert it into hydromorphone, the metabolite that does most of the pain relief. Roughly 5 to 10 percent of people have a slow version of that enzyme and get noticeably less relief from hydrocodone. Oxycodone works well on its own and is broken down by two enzymes, so it is less sensitive to that genetic variation. This is one reason a person can report that “Vicodin never did anything for me” while Percocet worked fine, and it has nothing to do with willpower or tolerance.
Which is stronger: oxycodone or hydrocodone?
Oxycodone, by about 50 percent. The CDC’s conversion table, which prescribers use to compare opioid doses, assigns hydrocodone a factor of 1.0 and oxycodone a factor of 1.5. In practice that means:
- 5 mg oxycodone (one Percocet 5-325) is roughly equal to 7.5 mg hydrocodone (one Norco 7.5-325)
- 10 mg oxycodone is roughly equal to 15 mg hydrocodone
- 10 mg hydrocodone (one Norco 10-325) is roughly equal to 6.5 to 7 mg oxycodone
Two caveats. First, “stronger per milligram” is not the same as “gives more pain relief,” because doctors adjust the dose to compensate. In the one head-to-head trial most often cited, emergency physicians at an urban trauma center gave fracture patients either 5 mg oxycodone or 5 mg hydrocodone, each with acetaminophen, and found no statistically significant difference in pain relief at 30 or 60 minutes. Second, extended-release oxycodone is closer to twice the strength of morphine, so the gap widens with OxyContin and similar products. The strength difference is real, but it is not the thing that should drive how careful you are with either drug.
Do they feel different?
Most people cannot tell them apart at equivalent doses. Both produce the same warm, heavy, relaxed feeling and the same drowsiness. Oxycodone tends to come on a little faster, and some people describe it as producing more of a mood lift or euphoria, especially the immediate-release form taken without much pain to blunt it. Hydrocodone is sometimes described as more sedating. Those are tendencies, not rules, and individual response varies more than the drug does.
That mood lift is also the part that matters most for risk. Opioids that come on quickly and feel good are the ones the brain learns to want, which is part of why oxycodone, and OxyContin in particular, became so central to the first wave of the opioid crisis. But hydrocodone was the most prescribed opioid in the country for years and drove an enormous amount of dependence of its own. Neither is the “safe” one.
Side effects: mostly the same, with one real difference
The side effect lists are nearly identical: drowsiness, constipation, nausea, dizziness, itching, dry mouth, headache and, at higher doses or with other sedatives, dangerously slowed breathing. If you are trying to understand the drowsiness specifically, we cover it in detail in Does Hydrocodone Make You Sleepy?, and the same answer applies to oxycodone.
The one difference with decent evidence behind it is constipation. In that same fracture trial, 21 percent of the hydrocodone patients reported constipation compared with none of the oxycodone patients, with no difference in nausea, vomiting, itching or drowsiness. That is a single small study, so treat it as a tendency, but it matches what clinicians see: hydrocodone is often the more constipating of the two. If you are prescribed either one for more than a couple of days, ask about a stool softener at the same time rather than waiting for the problem.
Both drugs are usually combined with acetaminophen (Percocet, Norco, Vicodin, Lortab). That adds a separate risk that has nothing to do with the opioid: too much acetaminophen damages the liver. Do not take Tylenol or cold medicine containing acetaminophen on top of a combination opioid, and keep the daily total under the limit your prescriber gives you. For a full walkthrough of what to watch for, see our guide to hydrocodone side effects.
Which is more addictive?
Neither, in any way that should change your behavior. Both are Schedule II controlled substances, the most restrictive category for a drug that can still be prescribed. Hydrocodone combination products used to sit one tier lower, in Schedule III, which is where the idea that hydrocodone is “less serious” came from. The DEA closed that gap in October 2014 after concluding that hydrocodone’s potential for misuse was comparable to oxycodone’s. Any article still telling you hydrocodone is less controlled is more than a decade out of date.
What actually predicts dependence is not which of the two you were given. It is dose, how long you take it, whether you have a personal or family history of substance use or untreated anxiety, depression or trauma, and whether you start using it for how it makes you feel rather than for pain. Physical dependence, where your body objects when you stop, can begin within a couple of weeks of daily use with either drug. That is a normal biological response and not the same thing as addiction, but it is the point where stopping gets hard without help.
Massachusetts law reflects this. Since 2016, a first-time opioid prescription for an adult in Massachusetts has been limited to a seven-day supply. That rule applies to oxycodone and hydrocodone equally.
Can you take oxycodone and hydrocodone together?
Not unless a prescriber has deliberately set it up that way, which is uncommon. They act on the same receptors, so combining them is the same as taking a larger dose of one, with the same increase in overdose risk and no added benefit. If you have leftover pills of one and a new prescription for the other, do not mix them, and do not use one to “top off” the other when it wears off. Bring the leftovers to a pharmacy take-back kiosk.
The same logic applies to alcohol, benzodiazepines (Xanax, Klonopin, Ativan, Valium), sleep medications and muscle relaxers. The FDA requires a boxed warning on every opioid about combining them with benzodiazepines because the combination causes extreme sedation, slowed breathing, coma and death. This is where most prescription opioid deaths actually happen: not from one drug, but from two depressants stacked.
Signs of overdose, and what to do
An oxycodone or hydrocodone overdose looks the same. The person cannot be woken, or wakes briefly and slips back under. Breathing is slow, shallow, or has long gaps, sometimes with a gurgling or snoring sound. Pupils are pinpoint. Lips or fingertips turn blue or gray. Skin is cold and clammy.
Call 911, then give naloxone (Narcan) if you have it, and stay with the person. Naloxone works on both drugs and is available at any Massachusetts pharmacy without a prescription. Massachusetts also has a Good Samaritan law that protects the person who calls for help. If someone in your home takes either of these medications regularly, keeping naloxone in the house is a reasonable precaution, not an accusation.
If one of these has become a problem
Most people take oxycodone or hydrocodone for a short stretch after surgery or an injury and stop without difficulty. For some, the prescription ends and the body does not agree. The pills start doing more for mood than for pain. A refill turns into a search. If that is where you or someone you love is, you already know that the oxycodone-versus-hydrocodone question stopped being the important one a while ago.
At Rockland Recovery in Braintree, our clinical team treats opioid dependence every day, whether it started with a Percocet script or a Norco script. That includes medically supervised detox so withdrawal does not have to be endured alone, and medication-assisted treatment with buprenorphine (Suboxone) or naltrexone (Vivitrol), which stops cravings and withdrawal without the high. If you want to understand how those medications work first, start with How Does Suboxone Work?. Most commercial insurance and MassHealth cover treatment. Call 855-732-4842 to talk it through. The call is confidential and you do not have to decide anything on it.
Frequently asked questions
Is oxycodone stronger than hydrocodone?
Yes, by about 50 percent milligram for milligram. The CDC rates oxycodone at 1.5 morphine milligram equivalents per mg and hydrocodone at 1.0. Doctors account for this when choosing a dose, so a prescription for either is intended to deliver similar relief.
How much stronger is oxycodone than hydrocodone?
Roughly 1.5 times. Ten milligrams of hydrocodone is about equal to 6.5 to 7 mg of oxycodone. Extended-release oxycodone (OxyContin) is closer to twice as strong as morphine, so the gap is larger for those products.
Is hydrocodone the same as oxycodone?
No, but they are close relatives. Both are semi-synthetic opioids that work on the same receptors, last about the same length of time, and cause the same side effects. They are made from different starting compounds and are processed differently by the liver.
Which is more addictive, oxycodone or hydrocodone?
Both carry a high risk, and both are Schedule II. Oxycodone has a faster onset and a reputation for more euphoria, which is part of why it featured so heavily in the early opioid crisis, but hydrocodone has caused an enormous amount of dependence as well. Dose, duration and personal history matter far more than which drug it is.
Is Percocet stronger than Norco?
Per tablet at the same number, yes. Percocet 5-325 contains 5 mg oxycodone; Norco 5-325 contains 5 mg hydrocodone, which is about a third weaker. A Norco 7.5-325 is close to a Percocet 5-325 in strength.
Is oxycodone 5 mg stronger than hydrocodone 10 mg?
No. Hydrocodone 10 mg is equivalent to about 6.5 to 7 mg of oxycodone, so it is the stronger of those two doses. Compare the milligrams, not just the drug name.
Can you take oxycodone and hydrocodone together?
Not unless a prescriber has specifically directed it. They work on the same receptors, so combining them is simply a higher opioid dose with higher overdose risk and no added benefit.
This article is for general education and is not medical advice. Opioids should only be taken exactly as prescribed, and questions about dose, switching medications or stopping should go to a licensed provider who knows your history. If you think someone is overdosing, call 911.
Sources
- Centers for Disease Control and Prevention. Calculating Total Daily Dose of Opioids for Safer Dosage (morphine milligram equivalent conversion factors).
- StatPearls (NCBI Bookshelf). Oxycodone and Hydrocodone. Pharmacokinetics, metabolism, adverse effects.
- MedlinePlus (National Library of Medicine). Oxycodone and Hydrocodone Combination Products. Brand names, dosing intervals, side effects.
- Drug Enforcement Administration. Rescheduling of Hydrocodone Combination Products From Schedule III to Schedule II. Federal Register, effective October 6, 2014.
- Marco CA, et al. Comparison of Oxycodone and Hydrocodone for the Treatment of Acute Pain Associated with Fractures: A Double-blind, Randomized, Controlled Trial. Academic Emergency Medicine, 2005.
- U.S. Food and Drug Administration. New Safety Measures Announced for Opioid Analgesics, Prescription Opioid Cough Products, and Benzodiazepines.
- Commonwealth of Massachusetts. Update for Prescribers: New Law Regarding Opioids (seven-day limit on first-time adult opioid prescriptions, Chapter 52 of the Acts of 2016).