Hydrocodone and codeine are both opioids commonly prescribed for pain with similar side effects. However, hydrocodone is stronger than codeine to treat severe pain.
A serious crisis is occurring in the U.S. when it comes to opioid abuse. Opioids are responsible for thousands of deaths each year, and it’s important for individuals to understand what these drugs are and what their effects can be before they are prescribed to them. The following provides an overview of two opioids in particular: codeine and hydrocodone.
Article at a Glance:
- Codeine and hydrocodone are both opioids that can be prescribed for pain.
- Hydrocodone is considered a more potent opioid than codeine.
- Both drugs are controlled substances that carry a risk of abuse and addiction.
Codeine vs. Hydrocodone
|Drug Class||Natural opioid||Semi-synthetic opioid|
|Drug Schedule||Schedule II to Schedule V, depending on the product||Schedule II|
|Dosage||Can vary; a sample dose is 15 to 30 mg every 4 hours as needed||Can vary; a sample dose is 10 mg every 12 hours|
|Side Effects||Constipation, nausea, and sedation||Constipation, nausea, and sedation|
|Warnings||Carries an FDA Black Box Warning for addiction, overdose, and drug interactions with central nervous system depressants||Carries an FDA Black Box Warning for addiction, overdose, drug interactions with central nervous system depressants, and a warning against drinking alcohol with the long-acting form of the drug|
|Drug Interactions||Avoid with other central nervous system depressants, including benzodiazepines||Avoid with other central nervous system depressants, including benzodiazepine|
Codeine is a prescription opioid that’s used to treat pain and as a cough suppressant. It is a natural opioid derived from morphine. Among opioids, it’s considered relatively mild, but it still carries a risk of abuse, addiction and overdose.
Codeine is often combined with other medications such as Tylenol to create combination formulations that more effectively relieve pain or cough.
Codeine is a narcotic that converts to morphine in the user’s body. It binds to opioid receptors in the brain, which changes how the person experiences pain. It increases the person’s tolerance to pain, but it doesn’t necessarily alleviate pain.
Common codeine side effects can include dizziness, lightheadedness, nausea, vomiting and sedation.
Hydrocodone is also classified as an opioid pain reliever that binds to certain central nervous system receptors. If high doses are taken, it can cause weak or shallow breathing as well as other side effects.
Hydrocodone is considered a semi-synthetic opioid, which means it’s partially man-made. The drug is intended for pain ranging from moderate to severe. Hydrocodone is also sometimes used as an antitussive, meaning it can treat a cough.
Hydrocodone is often used in combination drugs such as Vicodin and Lortab, which include both hydrocodone and acetaminophen. It’s also available in controlled-release versions for more around-the-clock pain relief.
Neither hydrocodone nor codeine is objectively “better” than the other. That said, each drug has a role for which it may be a better choice. As a more potent opioid, hydrocodone may work better for severe pain. As a less potent opioid, codeine may work effectively and more safely for moderate pain and cough.
Codeine is not in hydrocodone. Each drug is a chemically distinct opioid.
The primary differences between codeine vs. hydrocodone include the potency of hydrocodone being stronger than that of codeine and the fact that hydrocodone is available as an extended-release medication.
Both have many of the same risks and side effects, so if you’re prescribed either, you should follow your doctor’s instructions.
No, hydrocodone does not contain codeine. Hydrocodone is a distinct and separate opioid from codeine.
No, codeine is much weaker than hydrocodone. It would take only 30 mg of hydrocodone to equal the potency of 30 mg of the opioid morphine, while it would take 200 mg of codeine to achieve the same effect.
Similarities Between Codeine & Hydrocodone
Codeine and hydrocodone have many similarities:
- Both are classified as narcotic or opioid pain relievers that change the perception of pain in the user, and both are available only by prescription.
- Both codeine and hydrocodone affect the same areas of the brain and can create a high in the user, although this happens at lower doses with hydrocodone in most people.
- Both codeine and hydrocodone are central nervous system depressants with similar side effects.
- Most side effects from codeine and hydrocodone usually subside over time, although how side effects impact people can vary between individuals.
- Both may be habit-forming and can lead to physical dependence.
- Both can have dangerous interactions with many of the same substances. This includes central nervous system depressants like benzodiazepines, for which both drugs carry an FDA Black Box Warning. Because opioids are central nervous system depressants, combining them with other depressants may increase the risk of overdose and death.
A risk of abuse and addiction exists with both codeine and hydrocodone. However, these risks may be more significant with hydrocodone since it’s considered more potent than codeine.
Physical Dependence & Withdrawal Symptoms
Both codeine and hydrocodone can cause physical dependence. This occurs when someone’s brain and body become used to the presence of these drugs. When you are physically dependent on a drug, you will go through uncomfortable withdrawal symptoms if you suddenly stop taking them.
If a doctor has prescribed codeine or hydrocodone and the patient wishes to stop, they will usually put patients on a tapering-down schedule where they use less and less until they stop completely to lessen or prevent withdrawal symptoms from occurring. If a person struggles with codeine or hydrocodone addiction, a medical detox program followed by inpatient rehab may be the best option to come off the medication.
Opioid withdrawal symptoms are similar in codeine and hydrocodone and include:
- Nausea and vomiting
- Trouble sleeping
- Hot or cold flashes
- Muscle cramps
- Watery discharge from eyes or nose
Differences Between Codeine & Hydrocodone
Despite their similarities, codeine and hydrocodone have many differences:
- Codeine is a naturally occurring opiate, while hydrocodone is synthetic.
- Hydrocodone is considered more powerful than codeine, so it can be used for more severe pain, while codeine is usually prescribed for moderate pain requiring an opioid.
- Codeine is available as an immediate-release medication, while hydrocodone is available in both immediate-release options and extended-release tablets.
American Academy of Family Physicians. “Opioid Conversion Table.” Accessed July 2, 2021.
Stephenson, Joan. “Drug Overdose Deaths Head Toward Record […]r in 2020, CDC Warns.” Journal of the American Medical Association Health Forum, October 20, 2020. Accessed July 2, 2021.
Drug Enforcement Administration. “Controlled Substances.” June 26, 2021. Accessed July 2, 2021.
Centers for Disease Control and Prevention. “Commonly Used Terms.” January 26, 2021. Accessed July 2, 2021.
Drugs.com. “Codeine.” October 30, 2020. Accessed July 2, 2021.
Drugs.com. “Hydrocodone.” August 1, 2020. Accessed July 2, 2021.
World Health Organization. “Clinical Guidelines for Withdrawal Manag[…]e in Closed Settings.” 2009. Accessed July 2, 2021.
The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.