Percocet vs Vicodin

What is Percocet? What is Percocet used for?

Percocet is a Brand name for a medicine that contains a combination of two active ingredients: oxycodone which is an opioid pain reliever that works in the brain changing feel perception and acetaminophen which is a less potent pain reliever and fever reducer that enhances oxycodone effects.

Percocet is used to treat moderate to severe acute or chronic pain. It is available in tablet form in next dosage combinations: 2.5/325 mg, 5/325 mg, 7.5/325 mg and 10/325 mg. The FDA approved the combination of oxycodone and acetaminophen in 1980.

It is manufactured by Endo International plc, formerly Endo Pharmaceuticals. Other Brand names on the market with same combinations are Endocet and Ratio – Oxycocet.

What is Vicodin? What is Vicodin used for?

Vicodin is a Brand name for a medicine that contains a combination of two active ingredients: hydrocodone which is an opioid pain reliever that works in the brain changing feel perception and acetaminophen which is a less potent pain reliever and fever reducer that enhances hydrocodone effects.

Vicodin is used to treat moderate to severe acute or chronic pain. It is available in tablet form in next dosage combinations: 5/300 mg, and 5/500 mg, 7.5/325 mg and 10/325 mg.  The FDA approved the combination of hydrocodone and acetaminophen in 1985. This combination is also available under different Brand names such as:  Hycet, Lorcet, Lorcet Plus, Norco,  Lortab and Maxidone.

How Percocet and Vicodin work in the body?

Oxycodone is a weak agonist of mu, kappa, and delta opioid receptors in the brain. This drug primarily binds to opioid mu-type receptors coupled with G-protein receptors. It works as positive or negative modulator of synaptic transmission through G-proteins that in last step activate effector proteins.

Binding of oxycodone to its receptors stimulates the exchange of GTP for GDP on the G-protein complex. By inhibiting adenylate cyclase oxycodone lowers cAMP intracellular levels. Furthermore, oxycodone inhibits the effects of pain transmission neurotransmitters such as substance P, dopamine, GABA, acetylcholine, and noradrenaline.

Oxycodone may also inhibit hormone release of vasopressin, insulin, somatostatin and glucagon. Oxycodone closes N-type voltage-operated calcium channels by activating kappa-receptor and open calcium-dependent inwardly rectifying potassium channels by activating mu and delta receptors. This result is hyperpolarization of neural membrane and reduced neuronal excitability.

Hydrocodone from Vicodin is a semisynthetic opioid analgesic and antitussive agent with different actions similar to those of codeine. It produces effects on CNS and smooth muscle. Hydrocodone also produces drowsiness, changes in mood and mental clouding.  Hydrocodone works as an opioid receptors agonist in the brain by blocking pain perception in the cerebral cortex.

This drug reduces synaptic chemical signaling in the brain, inhibiting pain sensation in the higher centers of the brain. On the μ and k opioid receptors hydrocodone causes analgesia, miosis and decreased body temperature. By agonizing μ receptors hydrocodone may also cause opiate withdrawal suppression, while antagonist activity can result in precipitation of withdrawal.

Hydrocodone has its actions at several different regions within the brain by connecting several neurotransmitter systems to produce pain relieving, but the actual mechanism has not been fully yet understood. Hydrocodone can also produce inhibition at the chemoreceptors through μ-opioid receptors and in the medulla through μ and δ receptors leading to dose-related respiratory depression.

Acetaminophen from Percocet and Vicodin is a selective COX-2 inhibitor that inhibits synthesis of prostaglandins. The analgesic action of acetaminophen involves mostly peripheral influences, but it can also inhibit COX-2 in Central Nervous System.  Acetaminophen also inhibits enzyme prostaglandin synthetase.

Antipyretic activity is mediated through hypothalamic heat regulating centers. Acetaminophen’s reactive metabolite chemically known as N-acetyl-p-benzoquinone imine (NAPQI) can cause a very dangerous and potentially fatal, hepatic necrosis through processes of lipid peroxidation if it is overdosed (taken of more than 4g daily).

Similarities between Percocet and Vicodin

Percocet and Vicodin are very similar medicines. Both are combination of opioid analgesic and acetaminophen. Opioid analgesic is hydrocodone and oxycodone and they are structurally very similar. Only difference is that oxycodone contains one hydroxyl group more than hydrocodone.

Both medicines work by interfering signal trasmission in central nervous system that delivers pain sensation to your brain.  They are most commonly used for short-term pain relief, after a surgery or injury. Some doctors also prescribe these medicines to treat chronic conditions, such as arthritis.

Both medicines have a quick onset of action, as sustained release form of Oxycodone and Hydrocodone takes about 30 min to 1 hour to show their effect, whereas, the immediate release version of Oxycodone takes about 10min to 15min to show its effect. Percocet and Vicodin have been shown to be very effective at treating pain.

It is difficult to tell which one is more effective when temporary pain from an injury is in case.  One study found that, in the event of pain, caused by fractured bone, both of these medicines works equally well.  Both medicines are classified as Schedule II drugs, and have a high risk of abuse. Prescription is needed for both medicines.   These medicines are not so expensive compared to other pain killers available on the market.

Difference between Percocet and Vicodin

The biggest differences between Percocet and Vicodin are in their chemical production, side effects profile, and causing addiction.

percocet vicodin comparison

Oxycodone from Percocet is a semisynthetic opioid analgesic drug, synthesized from thebaine, an opioid alkaloid drug that can be found in the Persian poppy. Thebaine can be also found in opium poppy alkaloid mixture. In other hand, hydrocodone from Vicodin, which is structurally very similar to oxycodone, is derived from codeine which is also one of the opioid alkaloids found in the opium poppy.

When effectiveness is in question, these drugs are almost the same. Many studies found equal degrees of their pain reduction. However, one study found that Percocet was 1.5 times more potent than Vicodin when prescribed and taken at equal doses.  It can be said that 7.5 mg of Hydrocodone is equal to 5mg of Oxycodone.

Because of Oxycodone’s high potency, doctors not readily prescribe it. You can buy Percocet only if you have an original hard copy of the prescription. Vicodin can be obtained either with an original hard copy or a faxed copy of the order.

One study found that patients who used Vicodin experienced constipation more frequently than patients who used Percocet.  21% of hydrocodone patients reported constipation compared with no oxycodone patients.  It has been also found that Percocet has a safer side effects profile than Vicodin, and that cause opioid side effects with less incidence.

Hydrocodone’s half-life time is 1.5-3 hours compared to oxycodone’s which is 4.5 hours. So, hydrocodone doesn’t remain in the body for a long time, therefore it is easier to deal with withdrawal symptoms. Oxycodone remains in the system for a longer time, and may cause severe withdrawal symptoms compared to hydrocodone.

Which one is better pain reliever, Percocet or Vicodin?

  • For pain related with cancer, many different studies have concluded that both Percocet and Vicodin have similar effectiveness for pain relieving.
  • For acute and severe pain, for example, during a fracture, no difference in effectiveness at relieving pain was noted between Percpcet and Vicodin.
  • When these medicines are used for chronic non-cancer-related pain, trials suggest no support of opioids use over other forms of pain relief. A meta-analysis of 46 studies showed no important difference in pain relieving comparing opioids with other pharmacological for example NSAIDs use or non-pharmacological treatments such as psychotherapy or physiotherapy. This analysis highlights the widespread misconceptions that the most effective treatment for any sort of pain is opioids.
  • When Percocet or Vicodin is used for chronic, non-cancer-related pain, risks such as withdrawal symptoms and addiction associated with their use outweigh any benefits.

Which one is more abusive medicine, Percocet or Vicodin?

Hydrocodone is one of the most addictive and abused opiate substance in the U.S. It should therefore only be taken as prescribed by a doctor.  Opioid abuse is one of the major challenges in countries such as the U.S., Mexico and Canada.

Reported abuse rates of these drugs in North America are almost five times than the global average (3.7% North America vs 0.7% rest of the world). More than 16,000 deaths that are caused by overdoses of opioid drugs occur every year involving oxycodone, hydrocodone, or methadone, out numbering those involving heroin and cocaine combined.

Which one is expensive, Percocet or Vicodin?

Accorting to on average, price for 120 tablets of generic Vicodin (5mg hydrocodone + 325mg acetaminophen) is between $12 and $25. The average cash price for 120 tablets of generic Percocet is between $23 and $73.

Percocet and Vicodin side effects

Percocet may cause following side effects:

  • Lightheadedness
  • Drowsiness or sedation
  • Dizziness
  • Nausea and vomiting
  • Dysphoria
  • Constipation
  • Euphoria
  • Pruritus
  • Skin and urticarial eruptions
  • Fatal hepatic necrosis (rare and associated with high and chronic acetaminophen use)
  • Renal tubular necrosis

Vicodin may cause following side effects:

  • Biliary tract spasm
  • Hallucinations
  • Circulatory collapse
  • Histamine release
  • Physical and psychological dependence with prolonged use
  • Urinary tract spasm
  • Bradycardia
  • Cardiac arrest
  • Confusion
  • Decreased urination
  • Dizziness
  • Drowsiness
  • Dyspnea
  • Fatigue
  • Hypotension
  • Coma
  • Dysphoria
  • Euphoria
  • Lethargy
  • Lightheadedness
  • Mood changes
  • Stupor
  • Mental clouding
  • Nausea
  • Sedation
  • Vomiting
  • Weakness
  • Peptic ulcer
  • Agranulocytosis
  • Hemolytic anemia
  • Hepatic necrosis
  • Respiratory depression

Percocet and Vicodin use during pregnancy and breastfeeding

Percocet is listed in category C by the FDA pregnancy category list of drugs.  This means that there have been many studies done to test the safety of medicine, however, only few of them have used human test subjects; alternately, it could also mean that studies done on animals may have not produced negative results or that there have not been enough studies done on animals to determine risk factors.

The use of Percocet during pregnancy, even it is not considered and promoted by the FDA, might be considered as safe but only in situations when there is a strong pain issue that cannot be managed through other methods. The two active ingredients, oxycodone and acetaminophen have been individually studied by the FDA and they do not have a risk to the mother or to the in-utero fetus. P

ercocet also has no mutagenic or teratogenic properties. There are no data of birth defects or long-term health consequences that can be predicted from the use of Percocet during pregnancy.

Hydrocodone is addictive drug, so it is important to consult the doctor before using the drug. Use of this drug in later stages may transfer dependency from mother to baby. Thus Percocet should not be used in last trimester. The risk increases when the drug is abused.

Percocet is not recommended for use during breastfeeding; however there is no evidence of side effects and thus many physicians prescribe Percocet when it is the best option for severe pain. Acetaminophen may pass into breast milk; but there are no known data of adverse effects in baby for this.

The oxycodone portion may has however narcotic effects on the baby, so parents should be aware to monitor signs of lethargy or exhaustion in breastfeeding babies. Side effects for infants may include: excessive sleeping, difficulty feeding and breathing issues. If mother plan to stop taking Percocet before breastfeeding, she should her doctor first.

Vicodin has not been relevantly studied in for its use during pregnancy and breastfeeding. It is categorized in Category C of FDA pregnancy list of drugs, thus indicating that it may cause negative effects for pregnant and breastfeeding women. Vicodin may increase the risk of birth defects.

If mother uses Vicodin during pregnancy, her baby may experience withdrawal symptoms such as: irritability, vomiting, fever, tremors and increased stools.  One study in 2009 showed that small doses of Vicodin administrated for short periods of time (24-48 hours) did not negatively affect the fetus or breasfeeding infant.

Vicodin pass through the breast milk and may cause serious side effects to the infant. If you notice side effects such as difficulty breathing and drowsiness in your infant, you should seek medical attention right away.

Percocet and Vicodin withdrawal

If Percocet is taken during a long period of time withdrawal symptoms may happen if medication discontinued abruptly. Patient may experience next withdrawal symptoms:

  • Agitation and irritation
  • Sweating
  • Anxiety
  • Muscle aches and pains
  • Nausea
  • Insomnia
  • Flu-like symptoms, including runny nose, nausea and fever

Vicodin may also cause withdrawal symptoms if it is discontinued abruptly after long-term use. Symptoms of withdrawal may include:

  • Agitation
  • Running nose
  • Sweating
  • Vomiting
  • Nausea
  • Diarrhea

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