Oxycontin, Percocet, and Vicodin Prescription Information
The focus of this article will be on practical information. If you are a pharmacy or medical student hoping that this article will help you cram for your pharmacology exam, you may be disappointed. You will need to turn to your textbooks for information about the kinetics and mechanisms of these drugs.
I want to focus on real life, not the half-life. (Excuse the bad joke that probably only the students will get).
I will discuss each of these three drugs in depth and provide some of my advice and commentary. Below, you will find information on:
But first, I want to talk about my reasons for writing about these specific drugs.
Why Write About These Drugs?
Maybe the title of this article seems a bit strange to you. For those who are only infrequently acquainted with pain, or who have never had to consider treatment with narcotics, these drugs may seem unimportant. Worse than that, they may conjure up thoughts about drug addiction and abuse, pharmacy robberies, and stolen prescription pads.
But for those of us who work in pharmacies myself included, we are aware that questions about these three medications are almost a daily occurrence. Therefore, I give the following reasons for specifically writing about Oxycontin, Percocet, and Vicodin:
- They are very commonly prescribed narcotics for pain. If you have ever had major surgery or even dental work, suffered from bad back pain or headaches, had a serious and painful injury, or have a painful disease or condition like cancer or severe arthritis...you have heard of these drugs. You probably have a bottle of 1 or more of them in your cabinet right now.
- They are frequently interchanged over time, and, thus, patients often wonder, "What is the difference between Oxycontin and Percocet?" Maybe you were wondering that yourself: "Why did they tell me NOT to take Tylenol with Vicodin?" "How come my Oxycontin says 20 mg but my Percocet says just 5 mg?" Questions like this come up all the time. I would like to help you get some answers.
- Due to the stigma and image created by the media, I believe many patients are reluctant to ask important questions about these medications. Some people are embarrassed by the fact that they need these pills. They have been made to feel, albeit, unintentionally, that they are committing some sort of crime simply by taking Oxycontin, Percocet, or Vicodin. You don't want anyone to find out. You are afraid what they might think. By writing this article, I hope to be able to answer some of the questions which you may have been unable to ask.
- Information on these drugs is not as easy to come by as one might think. Many other prescription drugs have a whole website devoted to information about them. But for a variety of reasons, you will not find the manufacturers to provide any such website for information about these products. I won't go into all the reasons right here, but suffice it to say that doing your own research on these products is far from easy.
- Finally, I have decided to write about Oxycontin, Percocet and Vicodin because they are powerful drugs which are dangerous if mis-used, and often have a variety of side effects even when used appropriately. I am grateful for the education and experience I have received as a pharmacist, and consider it a privilege and duty to pass along what I know to help patients use their medication safely and effectively.
Note: These medications can only be prescribed by a physician.
Chronic pain managment
One tablet every 12 hours
oxycodone and acetaminophen
Acute pain relief
One tablet every 6 hours
Roxicet, Endocet, Oxycodone/APAP
hydrocodone and acetaminophen
Acute pain relief
One tablet every 4-6 hours
Hydrocodone/APAP or Hydroco/APAP
Oxycontin is a narcotic pain reliever manufactured by Purdue Pharmaceuticals and is indicated for moderate to severe persistent pain. It is not used for pain on an as-needed basis but only for pain that needs constant management (i.e. chronic pain). In other words, your Oxycontin prescription should never say something like, "Take as needed for pain." It is only used for pain management that requires regular dosing (in this case, every 12 hours).
- Active Ingredient: Oxycodone.
- What is oxycodone? Well, think of it as a sleeker and stronger version of codeine. It is a synthetic drug. Oxycodone is the only active ingredient in Oxycontin. This is significant. There are other prescription narcotics for pain that contain oxycodone, but Oxycontin is the only long-acting product with just oxycodone. There are, by the way, short-acting products that contain just oxycodone like Roxicodone or Oxy IR, for example.
- Strengths: 10mg, 15mg, 20mg, 30mg, 40mg, 60mg, 80mg.
- Schedule: Oxycontin is a Schedule II controlled substance. The practical significance of this is that prescriptions for Oxycontin are subjected to more regulations and restrictions than other prescriptions. Schedule II substances have the highest potential for addiction or abuse, so they have to be managed carefully. For example, doctors cannot write refills for an Oxycontin prescription. You must obtain a new prescription every time. They may only be written for a 1 month supply, in most cases. Additionally, prescriptions for Schedule II drugs need to be hand-written and cannot be phoned in, except under special circumstances.
- Dosing: Oxycontin is designed to be dosed every 12 hours. It is a slow-release, or timed-release, drug. It is very important to NEVER break or crush an Oxycotin tablet, as this could cause a dangerous amount of oxycodone to enter your bloodstream too quickly.
- Generic alternatives: Oxycontin is not available over-the-counter at the moment. There have been some patent issues that have been contested, and there was a generic on the market for a short time. But, presently, only brand name Oxycontin is available. This product is quite expensive. Maybe your insurance covers it, and the cost is somewhat hidden to you. But, if you have to pay for it yourself, you may want to research other options, like immediate-release oxycodone, which is available generically and is far more affordable.
General Commentary & Advice: Okay, so here are my thoughts on Oxycontin. Oxycontin is not evil. Yes, it has created opportunities for some pretty scary stuff. Yes, it is sold on the streets—and people use it inappropriately and unsafely—but these facts only remind us that good things can be turned to bad uses. Don't throw out the baby with the bathwater.
I advise you to use the lowest effective dose, as this will make stopping the drug easier. Yes, if you do eventually stop taking Oxycontin, you will need to slowly taper down to avoid withdrawal symptoms. Remember, even caffeine can cause withdrawal symptoms.
Other over-the-counter products for pain, like Tylenol or Advil, can generally be used with Oxycontin, if necessary. Check with your doctor or pharmacist to be sure these will not interfere with anything else you are taking.
Do's and Don'ts:
Do organize your medication in a pillbox. It is very easy to forget if you actually took your pill, especially if it is part oof your daily routine. You must find some method to remember you took it, and a pill organizer is an easy and effective way to do so.
Do keep a pain diary. Write down some reflections on your pain levels every day. Bring this with you to the doctor. Your physician will be better able to help you manage your pain if they can get a sense of what you're going through. Keep it brief and as objective as possible.
Do stick with one local pharmacy. Hopping around to different pharmacies and filling prescriptions for Oxycontin looks suspicious. Not only that, but your prescription insurance plan might raise a fuss about this as well.
Don't crush or chew Oxycontin.
Don't give Oxycontin to someone other than for whom it was prescribed. I don't mean to scare you, but someone who is not used to taking it could die from the same dose that you take safely. This is very serious. Don't do it. Not to mention, doing so is illegal.
Don't allow yourself to run out of Oxycontin before trying to obtain a new prescription. Always discuss with your doctor, or his/her office, exactly how you should obtain your next prescription. If possible, pick it up in person. If they mail it, just be sure you have it in time. Trying to persuade a covering physician to call you in an emergency Oxycontin prescription at 8:30 at night will not be fun—and probably not successful.
Don't wait until the last minute to fill your Oxycontin prescription. My advice: Have the prescription in your hand and get it filled exactly five days before you run out. Not 6 days. Five days. If you will run out on the 30th of the month, then fill it on the 25th. Most insurance plans will allow you to fill it within 5 days of running out. Also, getting it filled five days early allows some wiggle room for issues like:
- the pharmacy running out of your strength
- your insurance company rejecting due to the need for prior approval
- your doctor forgot to write some critical piece of information on the prescription
- just about anything else!
Percocet is a prescription narcotic pain reliever manufactured by Endo Pharmaceuticals and is used to treat moderate to moderately severe pain. It is a combination drug typically prescribed to treat acute (short-term) pain, although, it is sometimes also prescribed for chronic pain. Percocet was originally approved for marketing in the U.S. by the FDA in 1976.
- Active Ingredients: Oxycodone and acetaminophen—the same ingredients found in Oxycontin and Tylenol, respectively. So is taking Percocet just like taking Oxycontin with Tylenol? Not exactly. The difference is that the oxycodone in Oxycontin has a slow-release formulation and is dosed every 12 hours. The oxycodone in Percocet is an immediate-release formulation and is dosed more frequently.
Because Percocet has acetaminophen, which becomes very dangerous to your liver at high dosages, it is important not to exceed the recommended amount of Percocet in any given day. This is very important!
Also, be very careful to not take any other pain reliever that may also contain acetaminophen like Tylenol, Excedrin, and some cold and flu products. As a rule, you do not want to exceed 4,000 mg of acetaminophen per day. This works out to about 6-8 tablets of Percocet maximum per day, depending on the strength you take (see below).
Overdosing with Acetaminophen is the second most common cause of liver failure requiring liver transplants in the US, according to a medical review study in 2009.
- Strengths: Percocet is available in the following six strengths. These are typically expressed in a way to show the amount of oxycodone on the left and the amount of acetaminophen on the right. Therefore, 2.5/325 means 2.5 mg of oxycodone per tablet and 325mg of acetaminophen per tablet.
- 7.5/500 (discontinued)
- 10/650 (discontinued)
The most frequently prescribed strength of Percocet is 5/325. It is so common, that doctors often forget to write the strength on the prescription, assuming that 5/325 is to be understood. However, the strength must be written on the prescription for it to be valid.
- Schedule: Percocet, like Oxycontin, is a Schedule II controlled substance. All the same rules and regulations for prescribing Schedule II drugs apply. See the comments above, in the Oxycontin section, to review those details.
- Dosing: The usual dosing for Percocet is one tablet every 6 hours. This can be adjusted up to two tablets every 4-6 hours, as long as the total daily dose of acetaminophen does not exceed 4 grams (4000 mg). See the chart below for the dosing recommendations of the manufacturer.
Maximal Daily Dose
- Generic alternatives: Unlike Oxycontin, Percocet is available generically. This makes Percocet far less expensive and a more affordable choice, especially if you do not have a prescription insurance plan. Because you will probably receive the generic Percocet from the pharmacy, your bottle will probably not say the word "Percocet" on it. Rather you will have the generic name. Here are some samples of what your generic prescription for Percocet might say for the "name" of your prescription: Roxicet—manufactured by Roxane Labs in Columbus, OH); Endocet—made by Endo Pharmaceuticals—yes, the same Endo Pharmaceuticals who make Percocet! Imagine that!; Oxycodone/APAP—APAP is an abbreviation for acetaminophen. The abbreviation is actually derived from the chemical name, N-acetyl-para-aminophenol).
- Side Effects: Percocet, like all narcotic pain relievers, may have certain side effects. Common side effects include lightheadedness, dizziness, drowsiness, nausea, constipation, and vomiting. Taking your Percocet with food may help reduce stomach irritation. Be sure to drink lots of water to help reduce constipation. An effective over-the-counter remedy for constipation caused by narcotics is Senokot tablets. If you develop hives or a rash, stop your medication immediately and contact your doctor.
General Advice & Commentary:
Percocet is a powerful painkiller. It is also likely to cause significant drowsiness.
Be aware that your prescription does not have refills on it. Additional prescriptions must be obtained directly from your doctor. They cannot, ordinarily, call in this prescription to your pharmacy. You must pick it up. Since Percocet is used for short-term pain, you may not need additional refills.
Do's and Don'ts:
Do take with food or milk to avoid an upset stomach.
Do discuss your need for another prescription with your doctor before you run out.
Don't drive or operate heavy machinery while taking Percocet.
Don't drink alcohol with Percocet as the added effects of drowsiness and sedation can be dangerous. Also, beware taking other medications which also cause drowsiness, like some antihistamines.
Don't take more than the recommended dose.
Don't share your Percocet with someone else. This medication is strong enough to seriously harm someone for whom this medication is not appropriate.
Vicodin is the last of our three pain relievers that I will discuss in this article. Like Percocet, Vicodin is used for moderate to moderately severe pain. It is a product of Abbott Pharmaceuticals, located in Abbott Park, IL.
Since it's approval by the FDA in 1984, Vicodin has risen to near-celebrity status amongst painkillers in the U.S. However, the addictive potential of Vicodin has been highlighted by the real-life addiction problem of conservative talk show host, Rush Limbaugh, and the fictional TV character Dr. Gregory House.
- Active Ingredients: Hydrocodone and acetaminophen. Hydrocodone is a powerful narcotic pain reliever, approximately equal in potency to oxycodone. Additionally, hydrocodone has been shown to be effective as a cough suppressant and is included in several prescription cough syrups like Hycodan. The acetaminophen is the same one found in Percocet and Tyelonol.
- Strengths: Vicodin, as such, refers to one specific strength, which is 5mg of hydrocodone with 300mg of acetaminophen. On the prescription label, this would look like 5/300 mg. However, the makers of Vicodin have also provided two additional varieties known as Vicodin ES and Vicodin HP. Here are the strengths of all three products: Vicodin, 5/300; Vicodin ES, 7.5/300; Vicodin HP, 10/300.
- Schedule: As of October 2014, Vicodin—and all hydrocodone-containing products—are now considered Schedule II, just like Percocet and Oxycontin.
- Dosing: Like Percocet, Vicodin dosing is primarily limited by the amount of acetaminophen that can safely be taken in any given day. The typical dose for Vicodin is 1-2 tablets every 4-6 hours, as needed, not to exceed 8 tablets in any given day. For the higher strengths (Vicodin ES and Vicodin HP) you want to keep it at just 4-5 tablets per day.
- Generic alternatives: Vicodin is available generically. When you bring in your prescription for Vicodin, what you will see on the bottle is something like Hydrocodone/APAP, Hydroco/APAP, or something along those lines.
This is the way the generic product is identified. If "Vicodin" is on the label, then you got the brand name product. Is the brand name more effective? No. There is no significant difference between the effectiveness of the generic and the brand name. You don't need to pay more to have the word Vicodin stamped on the pill. It really won't make it work any better.
- Side Effects: These include drowsiness, dizziness, nausea, constipation, vomiting and mental clouding. Taking Vicodin with food or milk should help reduce the irritation to your stomach. More serious side effects like hives or a rash should be immediately addressed with your physician. Stop the medication if you develop a rash.
General Advice & Commentary:
Okay, just a few things about Vicodin. I will focus on the practical stuff.
Addiction. Yes, it is possible to become addicted to or dependent on Vicodin. If you have been on it regularly, for any length of time, you will need to be slowly tapered off to avoid withdrawal symptoms. But, just because you take it regularly does not mean that you will become a narcotic abuser or criminal. It is strong medicine, but it is also very effective to reduce pain and improve the quality of life for those suffering acutely or chronically.
As for refills, since Vicodin is now a Schedule II controlled substance, it cannot be refilled. A new prescription must be obtained for every filling of hydrocodone products.
Never take more than the recommended dose, and never take Vicodin with anything else that already has acetaminophen in it. Seriously. Liver failure is not funny, and acetaminophen overdose is far too common.
Also, taking too many and then trying to get your refill early from the pharmacy is a sure way to get yourself pegged as an abuser and a problem. If the Vicodin dose you were prescribed is not working to control your pain, talk to your doctor, don't just eat more pills.
If the pain is still a problem after taking Vicodin, you can safely use ibuprofen with Vicodin until you are able to talk about it with your doctor, unless you have some other condition or medication that would forbid this.
Final Thoughts and Advice
Alcohol Use and Narcotics:
Is it safe to have a beer, a glass of wine, or some form of alcohol while taking these medications? Let me lay out the concerns and the issues for you:
- Alcohol, like narcotics, suppresses the central nervous system (CNS). Think of your CNS as sort of like the electrical panel in your home that controls all the electricity going through your house. Knock that out, and you are powerless. Your CNS controls basic actions that you have really gotten used to over the years, like breathing, thinking, and the pumping of your heart. Now, you don't want these to stop, so how much additional CNS depression is safe? There is simply no practical way to answer that question. Will one sip kill you? Probably not. In the case of a chronic medication like Oxycontin, your body may develop enough tolerance to allow for an occasional drink. But you should be aware of the risks.
- Acetaminophen and alcohol may not be a good combination for your liver. Notice I said, "may not be." I am fully aware that the medical evidence seems to suggest that one or two drinks will not likely pose a threat to the liver of an otherwise healthy, non-alcoholic individual who takes acetaminophen. Fine. If it were me, and if I could, I would skip the Vicodin or Percocet if I intended to have a drink. I'm not laying down a law—just giving my advice.
- Driving. Don't do it. If you chose to have a drink, and you also are taking Oxycontin, Vicodin or Percocet, don't drive. Please. There is no way to know for sure you can safely operate a vehicle. Your life and the lives of others are at risk.
Some strengths of Oxycontin are available over-the-counter, but not all. Generics of Percocet and Vicodin are available, but they may not be strong enough to manage your pain. One alternative, if cost is a problem, is to ask your doctor about OxyIR, which is an "immediate-release" formulation of oxycodone. You will need to take more pills and take them more often, but the cost is substantially less. You might also ask your doctor about switching to something different altogether, like a long-acting morphine product (e.g. MS Contin).
Addiction to painkillers is not uncommon. In an ABC news report several years ago, Fred Berger, medical director of a drug rehab center in California, was quoted saying. "What makes opioids—the class of common pain drugs like Oxycontin and Vicodin—effective pain relievers is also what makes them so highly addictive..."
Want to Learn More?
For a comparison of three similar pain relievers, see my other article: Vicodin vs. Lortab vs. Norco.
Disclaimer: The information provided in this article, and any subsequent questions and answers, are not intended to replace or substitute for the advice of your personal physician.