Announcement About Hydromorphone vs Oxycodone

Wondering what the key differences are between Oxycodone vs Hydromorphone?

Oxycodone and Hydromorphone provide relief from serious pain by binding mu-opioid receptors in the brain.

oxycodone vs hydromorphone relative analgesic potency The World Health Organization developed a three step ladder for the management of pain. The first rung of the treatment ladder is non-opioids like aspirin or ibuprofen. The next step is relatively weak opioids like codeine. The third and final step - reserved for patients with serious pain - are potent opioids like Oxycodone and Hydromorphone.

Here's everything you need know about Oxycodone compared to Hydromorphone:

  • Both Oxycodone and Hydromorphone are opioids that provide relief from pain.
  • The analgesic (pain killing) effects of Hydromorphone are 5x stronger than morphine, whereas Oxycodone is 1.5x stronger than morphine.
  • The most common side effects of Hydromorphone and Oxycodone are the same (e.g., nausea and constipation). However, Hydromorphone's side effects have been reported to be more frequent and severe compared with Oxycodone.
  • The bioavailability of Hydromorphone is low (~30%) verses 60–87% for Oxycodone. Hydromorphone's low oral bioavailability is the reason it's most frequently administered intravenously during surgery.
  • Each tablet of Oxycodone for oral administration contains 5 mg, 10 mg, 15 mg, 20 mg or 30 mg of Oxycodone hydrochloride, USP. The initial dose of hydromorphone is 2 - 4 mg orally every 4 to 6 hours.
  • Both Hydromorphone and Oxycodone have a high addictive potential - they're habit forming and can cause severe withdrawal syndromes. Hydromorphone has more abuse potential than Oxycodone because it's analgesic effects are 3.3x stronger and it has a much stronger affinity for mu-opioid receptors.

Further reading: Four Strategies For Managing Opioid-Induced Side Effects

Hydromorphone Oxycodone
Description

Hydromorphone is an semi-synthetic opioid pain medication (also called a narcotic). It's used to treat moderate to severe pain. The extended-release form of this medicine is for around-the-clock treatment of moderate to severe pain. Oxycodone is a narcotic pain-reliever and cough suppressant similar to morphine, codeine, and hydrocodone. Like Hydromorphone, it's mechanism revolves around stimulating mu opioid receptors in the brain.
Type

Semi-synthetic opiates were developed in the early 20th century and are derived from naturally-occuring organic compounds in opium plants. Semi-synthetic opiates were designed to be safer and more effective than natural opiates for medical purposes (e.g., for the management of chronic pain).

Semi-synthetic opioid Semi-synthetic opioid
Relative analgesic potency

An equianalgesic (or opioid) chart is a conversion chart that lists equivalent doses of analgesics (drugs used to relieve pain). Equianalgesic charts are used for calculation of an equivalent dose (a dose which would offer an equal amount of analgesia) between different analgesics.

5 1.5
Appearance

Side Effects

Most common adverse effects:
  • constipation (20.9%)
  • nausea (19.8%)
  • vomiting (9.7%)
  • headache (14.0%)
  • somnolence (14.0%)
Most common adverse effects:
  • constipation (15%)
  • nausea (12%)
  • somnolence (8%)
  • vomiting (7%)
  • depression (2%)
Route of Administration

The path by which a drug enters the body. Routes of administration (ROAs) are categorized by the location where the substance is applied. The most common routes of administration are oral and intravenous. Other ROAs include topical, sublingual, and intramuscular.

Intravenously due to low oral bioavailability Single-ingredient medication and combined with non-narcotic analgesic ingredients such as paracetamol (acetaminophen)
Chemical structure

Half life

The half life is the period of time needed for the concentration of drug in the body to be reduced by 50%.The plasma half life of a drug depends on how swiftly the drug is eliminated from the plasma (the colorless fluid part of blood).

2.3 h 3.2 h
Duration of effects

The duration of effects is simply how long the therapeutic and adverse effects of the drug last. In the case of hydromorphone and oxyocodone, we'd be talking about analgesia (pain relief) and side effects like constipation and nausea.

2-4 hours 3–6 hours (instant release)
Legal status

Schedule II substances like oxycodone and hydromorphone meet these criteria: 1) high potential for abuse, 2) currently accepted medical use in treatment in the United States,and 3) abuse of the drug or other substances may lead to severe psychological or physical dependence.

Schedule II Schedule II
Bioavailability

Bioavailability is the fraction of a drug that enters circulation when introduced into the body and is therefore able to have an active effect.

Oral: 30–35%, Intranasal: 52–58%, Intravenous: 100% Oral: 60–87%
Metabolism

The organ systems or enzymatic pathways that degrade a drug and allow it to be excreted. Some drugs are excreted unchanged.

Hepatic Hepatic: CYP3A, CYP2D6
Mechanism

In pharmacology, the mechanism of action of a drug refers to the cellular pathways a drug targets to produce the desired effect. For example, opioids generally target the mu opioid receptor; they are full agonists at this receptor.

μ-opioid receptor agonist (Ki = 0.6 nM) μ-opioid receptor agonist (Ki = 18 nM)
Chemical name

A chemical nomenclature is a rule set to generate systematic names for organic compounds. The nomenclature used most frequently worldwide is the one created and developed by IUPAC.

4,5α-epoxy-3-hydroxy-17-methylmorphinan-6-one hydrochloride 4, 5α-epoxy-14-hydroxy-3-methoxy-17-methylmorphinan-6-one hydrochloride
Pharmacokinetics

Pharmacokinetics encompasses the time course of drug absorption, distribution, metabolism, and excretion. Clinical pharmacokinetics applies these principles to the safe and effective management of drugs in individual patients.

For an 8 mg tablet. Cmax = 5.5 ng, Tmax = 0.74 h, AUC = 23.7 ng hr/ml, T1/2 = 2.6 h For 30 mg: AUC = 377 ng hr/ml, Cmax = 34.6 ng/ml, tmax = 4.61
Abuse liability

Abuse liability is simply the potential a drug has for addiction.

Very high High