What is the difference between hydrocodone and codeine?

From our video partners

Chemotherapy
Learn what to expect, and what can be done to improve the experience.

Answer

Hydrocodone and codeine are NOT the same chemical compound; they're two different drugs [as noted below, the inaccurate answers have been deleted in the interest of safety].

Codeine is the 3-methylether of morphine. It's almost inactive on it's own, and needs to be converted into morphine via the enzyme CYP2D6 in the liver to cause opioid effects, hence it's a prodrug. It's still a pretty weak opioid painkiller and severe pain will typically require something stronger.

Hydrocodone's chemical structure is similar to codeine's but NOT the same, hence it is a different compound altogether. It differs in a few places. First, the 6-hydroxy group of codeine is changed to a ketone group. Also, the double bond between carbons 7 and 8 is hydrogenated to a single bond by the addition of two hydrogen molecules. Hydrocodone is not a prodrug. It's a great deal stronger than codeine and is hence more effective in reducing severe pain. Hydrocodone also has less severe side effects, such as itching and nausea, than codeine. They may still be present but to a lesser degree. Hydrocodone, because it is not a prodrug, has no ceiling dosage above which the effects will not increase - in other words the dosage of hydrocodone could theoretically be increased indefinitely to gain greater effect, unlike codeine. All of these reasons make hydrocodone a preferred opiate painkiller over codeine. This is why vicodin prescriptions are FAR more common for post op and another pain than tylenol w/ codeine prescriptions.

One note unrelated to the question but VERY important: When taking narcotic pain pills that ALSO contain an NSAID like tylenol/APAP (acetaminophen), it's VERY important to limit your dose of APAP, since APAP is severely liver toxic in high doses and mildly liver toxic even in high end therapeutic doses. Don't exceed 4000 mg of APAP in a single 24 hour period!!! If you have painkillers such as vicodin, which contains APAP in addition to hydrocodone, and your desired dose of narcotic would result in exceeding a safe dose of APAP, you MUST do a cold water extraction to protect your liver health!!! This is important! <This is mentioned because hydrocodone in pure form is almost never prescribed. Instead, Vicodin or one of its relatives is, which typically contain another painkiller of the NSAID family. VIcodin, for instance, contains, APAP).

Hope this helped!

Answer

The only reason I know is because I have to be re-certified every year, for my job, which deals with dispensing medication. What I'll do to make it easier to read and absorb, is I'll list all the strong pain medication that I know of, then list the most common ones and some brief information like other names it's known by; approximate strength; and anything else important.

NARCOTIC AND OPIOID ANALGESICS:

1. alfentanil hydrochloride
2. buprenorphine hydrochloride
3. butorphanol tartrate
4. codeine phosphate
5. codeine sulfate
6. fentanyl citrate
7. hydromorphone hydrochloride
8. morphine hydrochloride
9. morphine sulfate
10. oxycodone hydrhchloride
11. hydrocodone bitartrate
12. tramadol hydrochloride
13. hydrocodone bitartrate and Tylenol; class II (or schedule II) controlled (not that hydrocodone is Schedule II only in pure form; Vicodon is Schedule III)
14. CODEINE a.k.a. --usually mixed with Tylenol; class II controlled; (Or Class IV with Tylenol).
15. NOT THE SAME AS HYDROCODONE>>> OXYCODONE a.k.a. --oxycodone hydrochloride, mixed with Tylenol, class II controlled (or Schedule III with Tylenol)
16. HYDROMORPHONE HYDROCHLORIDE a.k.a. --hydromorphone hydrochloride, class II controlled
17. MORPHINE a.k.a. --morphine sulfate, class II controlled

Each and evey one of these painkillers is a different chemical composition and acts slightly differently. I hope this helps!!

Hydrocodone and codeine are not the same although they, in some ways, ACT the same. ALWAYS ask to speak to a registered pharmacict (Rph) and ask for a computer printout that will tell you EVERTHING about the medication you ever wanted to know and then some!! GOOD LUCK!

Answer

Hydrocodone (aka Vicodin) is awesome. Note that Hydrocodone is one of two active ingredients in Vicodin. The other is acetaminophen or APAP

Codeine (aka Tylenol 3) is not as awesome cause you have to take like 8 to really feel anything.

ADDED INFO

IF YOU take 8 Tylenol #3, you are ingesting 2,600 mg of tylenol, which is more than half of a safe dose in 24 hours. NOT GOOD for the liver! <<>>

Hydrocodone and codeine are two seperate medications. However, they have many similarities and are often confused as being the same:

Similarities: each are opiate agonists (occupy opiate receptors in the human body), both possess analgesic (painkilling) and antitussive (cough suppressant) properties, both are controlled substances ranging from Schedule II-V, each is often combined with another medication such as another painkiller or antihistmine, each has a high addictive potential, both have the side effects of euphoria, drowsiness, wakefullnes (see 2008 PDR) and respiratory depression (in high doses) among others

Differences: chemical structure is different, mechanism of action in the body is not exactly the same, codeine is actually a prodrug (inactive drug which is converted to an active drug in the body) of morphine - people with a deficiency of the enzyme in the liver which does this will not feel any therapeutic effects of codeine because it will not be converted to morphine in the body, hydrocodone is a slightly superior cough suppressant than codeine and a much more potent painkiller than codeine, hydrocodone is more sedating than codeine, codeine can be given by mouth or IV while hydrocodone is most often given via the oral route

May be more information than you were looking for, but I hope this last bit helps!

Mostly good information here (maybe more technical than required), but a simple answer is: Hydrocodone and Codiene are different versions of the same drug. Basically, Codiene occurs in nature while Hydrocodone is man-made (in a lab) and has an extra Hydrogen molecule added. The important point is that they both work the same (at the same dosage) and your body doesn't know the difference.

Also related are Morphine and Hydromorphone. Whatever the name or composition of the medication is doesn't matter, since the body converts mosts opiates into Morphine (including heroin), to be used by the brain.

Cautions

Codeine is NEVER given by IV as it can cause pulmonary edema and result in death. One should never inject codeine under any circumstances whatsoever, and a hospital or doctor would never, ever, administer IV codeine.

Hydro may be given by IV, but typically is not.

With respect to hydrocodone and codeine, the argument is a frequent one, but one which is largely irrelevant. Hydrodone is stronger per milligram, but a typical hydrocodone dose is 5mg. A typical codeine does is 30mg.

The fact that hydrocodone is 6x stronger is largely irrelevant to the end user, because DOSE is the most important aspect of pain relief, and codeine tablets typically contain 6 times as much drug as hydrocodone tablets contain.

One ounce of Vodka is twelve times stronger than one ounce of beer ... but either one will get you equally as drunk of you ingest them in their usual quantities.

Narcotics are the same. They all eventually bind to Mu, Kappa, and other opiod receptors. Some hit you faster because of their initial potentcy and delivery method, and some are converted in the liver slowly after oral ingestion, but the end result is more or less the same.

They all are pretty much broken down to morphine when all is said and done, and that is where the effect comes from.

Hydrocodone may be stronger than codeine, but 120mg of codeine will still be more far more effective for pain than 5mg of hydrocodone (assuming your liver can properly convert codeine to morphine and hydromorphone ... 10% of people cannot do so).

Just to illustrate a point, in a double-blind placebo conducted in a hospital setting, most heroin addicts were not able to identify an injection of heroin from an injection of morphine. Even though heroin is twice as potent, they identified morphine as herion at least half of the time.

While some people swear by certain optiates as being "better" than another, much of it is psychological or just personal preference since much like alcohol, all of the different opiates act in exactly the same manner.

They all bind to opiod receptors.

Codeine exerts it's effects by being converted to morphine (and hydromorphone to a small extent) in the liver, and morphine is a perfectly "strong" pain reliever.

Really minor correction:

While pure hydrocodone is indeed DEA Schedule II, pure hydrocodone is almost never prescribed. Instead, we see Vicodin, which contains hydrodone and APAP, and is a Schedule III med.

minor corrections to some of the above:

QUOTE --

The fact that hydrocodone is 6x stronger is largely irrelevant to the end user, because DOSE is the most important aspect of pain relief, and codeine tablets typically contain 6 times as much drug as hydrocodone tablets contain.

One ounce of Vodka is twelve times stronger than one ounce of beer ... but either one will get you equally as drunk of you ingest them in their usual quantities.

Narcotics are the same. They all eventually bind to Mu, Kappa, and other opiod receptors. Some hit you faster because of their initial potentcy and delivery method, and some are converted in the liver slowly after oral ingestion, but the end result is more or less the same.

They all are pretty much broken down to morphine when all is said and done, and that is where the effect comes from. -- EndQuote

For most opioids, it is true that an equivalent dose will result in equivalent effects. For example, lets take hydrocodone and oxycodone and examine them. If a person took a dose of 40 mg oxycodone one time, and then another time took a dose of 40 mg hydrocodone, whether they were seeking pain relief or euphoric recreational effects, the oxycodone would have felt much stronger. However, say this person took 40 mg oxycodone once, then took 80 mg hydrocodone another time; in THIS case, the effects, either pain relief or recreational euphoria, would have felt about the same. You can compensate for an opioid being weaker by using a higher dose, absolutely.

HOWEVER, there is a catch; this only applies to opioids that are full mu agonists and aren't prodrugs. Any opioid that is either a prodrug (especially if the metabolic process that converts the prodrug into its active metabolite is inefficient because the reaction is complex and/or enzymes to carry out the reaction are relatively scarce) [example: codeine] or is a partial agonist [example: pentazocine, buprenorphine] is subject to a "ceiling effect". "Ceiling effect" means that above a certain dose in drugs that are subject to this effect, a greater pain relieving and / or euphoric effect cannot be had.

For codeine, this dose is around 350 mg. Above 350 mg of codeine, the enzyme that converts it to morphine (CYP2D6) in the liver is "saturated" with codeine molecules and cannot convert any more into morphine. So 350 mg of codeine is effectively the maximum amount of codeine that can be taken to increase opioid effects. Any dose higher than that will only increase side effects like itching. With buprenorphine, a ceiling effect happens too, just for a different reason: buprenorphine only partially activates the mu opioid receptors it binds to, so you'll fill all of your mu receptors at some dose eventually and have less opioid activity than you would with a full agonist that fills much less of the receptors overall. With buprenorphine, this is not much of an issue in opioid naive people; bupe is sufficiently strong that its ceiling effect only starts to matter in people with very high opioid tolerance, like long term CP patients or opioid addicts. With codeine however, it becomes inadequate early on in the treatment of a new pain patient. A new patient will reach the ceiling of 350 mg over the course of a few months and need to switch to a drug that doesn't require hepatic demethlyation to work.

So my correction to the above quoted portion is about codeine -- what was said in the quote about codeine isn't entirely true, with codeine, you cannot increase the dose indefinitely to gain more analgesia and/or euphoria.

However, with opioids that are 1) full mu opioid receptor agonists and 2) are not prodrugs that requre inefficient enzyme catalyzed reactions where the enzyme is easily saturated by the drug -- the dose can be increased higher and higher to gain more opioid effect and overcome tolerance. Drugs that are full mu agonists and are not problematic prodrugs include the following -- hydrocodone, oxycodone, hydromorphone, oxymorphone, morphine, fentanyl, diamorphine (heroin), levorphanol, sufentanil, nicomorphine, hydromorphinol, desomorphine, and many, many more. these drugs can give increasing effects with increasing dose indefinitely; the sky is the limit with these. It logically follows that if one of these drugs is weaker than another, the weaker can be made to have equivalent analgesic and euphoric effects as the stronger by simply taking a higher dose of the weaker drug.

One final thing... NOT all opioids have morphine as an active metabolite. In fact, the vast majority of them don't. Only a few have morphine as an active metabolite. Some opioids have chemical structures that are so extremely different from morphine that hell would freeze over before the body could find a pathway to convert them to morphine. The mu opioid receptor is a bit promiscuous; as long as a few rules are met (tertiary amine, quaternary carbon in a specific spot, correct arrangement of aromatic and alkane ring systems in 3D space), many different chemical classes can have activity as mu opioid receptor agonists. It is mu opioid receptor agonism that gives the effects of opioid painkillers / euphoriants.

A brief addendum:

While the painkilling effects of Morphine, for instance, amy not top out, after a point respiratory depression commences -- so the dosage is limited by other factors.

First answer by Ncbutts. Last edit by Cjonb. Contributor trust: 469 [recommend contributor]. Question popularity: 127 [recommend question]