Percocet is stronger than Vicodin on a milligram-for-milligram basis. The opioid in Percocet (oxycodone) is roughly 1.5 times more potent than the opioid in Vicodin (hydrocodone). That said, at the doses these medications are typically prescribed, clinical studies show they provide very similar levels of pain relief.
How the Two Drugs Compare in Potency
Both Vicodin and Percocet are combination painkillers that pair an opioid with acetaminophen (the active ingredient in Tylenol). The difference is the opioid component. Vicodin contains hydrocodone, while Percocet contains oxycodone.
Pain specialists use a system called morphine milligram equivalents to compare how strong different opioids are. In this system, 30 mg of oral hydrocodone equals 30 mg of oral morphine, a simple 1:1 ratio. Oxycodone is more potent: only 20 mg of oral oxycodone equals the same 30 mg of oral morphine. That means oxycodone delivers the same pain-relieving effect at about two-thirds the dose, making it approximately 50% stronger by weight.
In practice, though, both drugs are commonly prescribed at 5 mg of their respective opioid per tablet. At that identical dose, the difference in potency is modest enough that most patients experience comparable relief.
What Clinical Trials Actually Show
A double-blind, randomized trial compared 5 mg oxycodone (Percocet) against 5 mg hydrocodone (Vicodin), both combined with acetaminophen, in emergency department patients with acute bone fractures. At 30 minutes, oxycodone patients reported an average pain reduction of 3.7 points on a 10-point scale, while hydrocodone patients dropped 2.5 points. At 60 minutes, the numbers were 4.4 and 3.0 respectively. Despite the oxycodone group trending slightly higher, the statistical analysis found no meaningful difference between the two drugs at either time point.
Side effects were also similar, with one notable exception: 21% of patients taking hydrocodone reported constipation afterward, compared to 0% in the oxycodone group. Rates of nausea, vomiting, itching, and drowsiness were comparable between the two.
What’s in Each Tablet
Vicodin tablets typically contain 5 mg of hydrocodone paired with 300 mg of acetaminophen, though formulations with higher hydrocodone doses (7.5 mg or 10 mg) also exist. Percocet follows a similar pattern, with 2.5, 5, 7.5, or 10 mg of oxycodone per tablet. Since 2014, the FDA has required that all prescription opioid-acetaminophen combination products contain no more than 325 mg of acetaminophen per tablet, down from a previous maximum of 750 mg. That change was aimed at reducing the risk of liver damage from acetaminophen overdose.
Because both drugs contain acetaminophen, taking extra-strength Tylenol or cold medications with acetaminophen on top of either prescription can push you past safe daily limits for your liver. This is worth tracking regardless of which medication you’re prescribed.
DEA Scheduling and Abuse Potential
Both Vicodin and Percocet are now classified as Schedule II controlled substances, the same category as morphine and fentanyl. This wasn’t always the case. Until 2014, hydrocodone combination products like Vicodin were classified as Schedule III, a less restrictive category that allowed phone-in refills and larger prescriptions. The DEA reclassified them after recognizing that hydrocodone’s mechanism of action is identical to that of oxycodone and morphine, and that the lower scheduling had contributed to hydrocodone combinations becoming the most frequently prescribed opioids in the country.
The practical result of both drugs being Schedule II is that neither can be refilled without a new prescription, and both carry the same legal restrictions around how they’re dispensed.
Why Your Doctor Might Choose One Over the Other
Since the two drugs perform similarly for most types of acute pain, the choice often comes down to a patient’s history and how they tolerate each medication. Someone who has taken hydrocodone before and found it effective will likely stay on it. A patient prone to constipation might do better with oxycodone based on the side effect data. For more severe pain, oxycodone’s higher milligram-for-milligram potency gives prescribers a bit more ceiling to work with before needing to move to a stronger class of medication.
Individual metabolism also plays a role. Both drugs are processed by liver enzymes, and genetic differences in how efficiently those enzymes work can make the same dose more or less effective from person to person. If one opioid isn’t providing adequate relief, switching to the other sometimes solves the problem without increasing the dose.