Vicodin vs. Percocet: Treatment for Severe Pain

Both Percocet and Vico­din bind to opioid receptors and depress your central nervous system and pain signals. They are similar, but not exactly the same. Both contain acetaminophen (Tylenol). In addition, Percocet contains oxycodone, a strong opioid pain medication. Vicodin contains a combination of hydrocodone and acetaminophen, which is also a strong opioid pain reliever. Both drugs can cause serious consequences if taken in higher quantities than prescribed. Overdose of either substance can result in dangerous outcomes. 

Other than their similar side effects and the efficacy of Percocet and Vicodin in the management of severe discomfort, there are some differences between these two medications. When researching analgesic efficacy, one study shows that Percocet is more likely to cause nausea, dizziness, drowsiness, fatigue, and headache. Additionally, studies show that people using Vicodin experience constipation more frequently than those who take Percocet.

Percocet (Oxycodone & Acetaminophen)

Percocet is a brand-name prescription medicine that is commonly used to help relieve moderate to severe discomfort. It is made up of a combination of acetaminophen and oxycodone. This substance binds with specific opioid receptors and provides feelings of relief, relaxation, and euphoria. Common side effects include:

  • Dizziness
  • Lightheadedness
  • Drowsiness
  • Sedation
  • Nausea
  • Vomiting
  • Headache
  • Dry Mouth

Vicodin (Hydrocodone & Acetaminophen)

Vicodin is also an opioid that is prescribed for pain relief. It is a combination drug made up of the following: hydrocodone and acetaminophen. Unlike Percocet, it does not contain oxycodone. It is used for severe, acute pain, and should not be used for extended periods unless instructed otherwise by your healthcare provider. The active ingredient, hydrocodone , can be known as habit-forming. Physical dependence is unlikely, as is psychological dependence when used for short-term relief as intended.

The side effects of Vicodin are similar to the ones listed above for Percocet. 

Drug Interactions With Oxycodone, Hydrocodone, and Acetaminophen

Combining alcohol or any other type of sedative with hydrocodone depresses the central nervous system and can lead to life-threatening respiratory issues. Combining carbamazepine (Tegretol, Tegretol XR , Equetro, Carbatrol) with acetaminophen increases the risk of liver toxicity and liver damage.

Hydrocodone shouldn’t be taken in combination with any version of the monoamine oxidase inhibitor (MAOI) class of antidepressants. For example, isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), selegiline (Eldepryl), and procarbazine (Matulane) or anything else that inhibits monoamine oxidase, like linezolid (Zyvox). These combinations can lead to confusion, high blood pressure, tremor, hyperactivity, coma, and death. Hydrocodone should not be administered within 14 days of stopping an MAO. 

Taking Percocet or Vicodin with any type of medication that is metabolized by enzymes called CYP3A4 or CYP2D6 may result in a drug interaction. They are both enzyme inhibitors and include certain antibiotics, antifungals, and protease inhibitors. Using one of these medications in combination with Percocet or Vicodin can result in a buildup of opioids in your body and this can be very dangerous.

Other substances are enzyme inducers, and will have the opposite effect—they lower the opioid level so that it is no longer as effective or can even cause opioid withdrawal symptioms such as headache, chills, sleep disruptions, nausea, and more. Benzodiazepines or other CNS depressants (which include other opioids) in combination with Percocet or Vicodin can cause low blood pressure, slowed breathing, profound sedation, coma, or even death.

Taking Percocet or Vicodin with other medications that increase serotonin levels can increase the risk of serotonin syndrome, a very serious or even life-threatening condition. Other medications that increase serotonin levels include certain antidepressants, muscle relaxants, MAO inhibitors (MAO inhibitors should not be used within 14 days of Percocet or Vicodin), and triptans. 

If you are taking either of these substances, remember that Tylenol is an active ingredient in both, and many over-the-counter cough and cold medications and pain relievers contain APAP as well. Check with your pharmacist, who can help you select an over-the-counter (OTC) medication that does not contain APAP.

Additional drug interactions can occur, reach out to your prescribing healthcare provider with any questions or for further information and medical advice.

Cost Comparison

State laws typically limit the first fill of any narcotic prescription to a small number of tablets. The generic version of Percocet is covered by most insurance companies and Medicare Part D plans. A typical prescription of generic Percocet could cost over $50.

Vicodin is usually covered in its generic form by most insurance and some Medicare Part D plans. (Some plans prefer Norco, which contains 5, 7.5, or 10 mg tablets of hydrocodone, and 325 mg of APAP.) Typically, a prescription of generic Vicodin costs about $200.

Are The Risks of Abuse Worth The Relief?

Both Percocet and Vicodin come with a black box containing a warning, which is the strongest warning required by the FDA. Other warnings include:

  • Potential for abuse and misuse, this can result in overdose and even death. Taking your medication as prescribed, and only for the purpose it was prescribed will help you to avoid these consequences. 
  • Life-threatening respiratory depression can be a symptom of abusing either of these substances. Patients should be monitored closely, especially when initially prescribed and whenever the dose is changed. Elderly patients are at higher risk for respiratory depression, as well as anyone with pre-existing lung issues.
  • Fatal overdose can result from accidental ingestion by anyone, but especially in children. 
  • Neonatal opioid withdrawal syndrome can result from using opioids for prolonged durations during pregnancy. This can be life-threatening for newborns.
  • Liver problems are also often associated with Tylenol (acetaminophen).  This could possibly result in a liver transplant or death. A patient should always be educated on the maximum daily dose of acetaminophen and should be advised not to combine any other products that contain acetaminophen.

Respiratory depression, sedation, coma, and even death can result from using opioids in combination with any benzodiazepines or other central nervous system depressants. 

If it is not possible to avoid the combination of an opioid and a benzodiazepine, the lowest dose should be prescribed, and the medication should be used for the shortest period of time possible. During this period, the patient should be closely monitored.

Potential for Addiction and Dependence

Percocet and Vicodin are opioids that alter the way you respond to acute pain, and therefore the way you feel. They both have a lot of potential for abuse that can easily lead to opioid addiction. Percocet is stronger than Vicodin, and there is a higher risk associated with the use of Percocet.

Percocet and Vicodin are indicated for short-term use and should only be taken as prescribed by a medical professional.

In Conclusion…

Although these two substances differ in their opioid composition, studies have shown that they both treat discomfort equally. Percocet and Vicodin have similar half-lives of approximately 4 hours, and both are used to treat the acute onset of severe pain and can be expected to provide relief for anywhere between 4 to 6 hours.

Both prescription drugs are available in either generic form or brand name. They are both intended to be used for short-term pain management; however, those with chronic pain might continue taking Percocet or Vicodin for longer durations, depending on the instruction of your healthcare provider. Any patient that takes either of these substances should be monitored closely.

Read more about Vicodin withdrawal.

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