Head-to-head clinical analysis & difference comparison: details on mechanism of action, dosing, half-life, interactions, and maternal-fetal safety.
PERCOCET vs ANEXSIA 7.5/325
Clinician-reviewed, head-to-head comparison of mechanism, dosing, pharmacokinetics, and safety profiles.
Last clinically reviewed: July 2026 · OpiCalc Medical Review Team
Oxycodone is a mu-opioid receptor agonist, inhibiting ascending pain pathways and altering pain perception and emotional response. Acetaminophen inhibits cyclooxygenase (COX) in the CNS, reducing prostaglandin synthesis and exerting analgesic and antipyretic effects.
Hydrocodone is a mu-opioid receptor agonist, producing analgesia and euphoria. Acetaminophen inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis and providing analgesic and antipyretic effects.
Management of moderate to moderately severe pain (FDA-approved),Off-label: severe pain when other analgesics are inadequate (individualized use)
Management of moderate to moderately severe pain where treatment with an opioid is appropriate and for which alternative treatments are inadequate
One tablet (5 mg oxycodone/325 mg acetaminophen) every 6 hours as needed for pain; maximum 12 tablets per day.
1 tablet (hydrocodone 7.5 mg / acetaminophen 325 mg) orally every 4 to 6 hours as needed for pain; maximum 6 tablets per day (hydrocodone 45 mg / acetaminophen 1950 mg).
Oxycodone: 3.5–4.5 hours (terminal) in normal renal function; prolonged in hepatic/renal impairment (up to 6–12 hours). Acetaminophen: 2–3 hours (terminal) in overdose, extended with hepatic injury.
Hydrocodone: 3.8-4.5 hours (immediate-release). Acetaminophen: 2-3 hours. Clinical note: Half-life prolonged in hepatic impairment; requires dose adjustment.
Oxycodone: primarily hepatic via CYP3A4 and CYP2D6 to active metabolites (noroxycodone, oxymorphone). Acetaminophen: hepatic via glucuronidation (UGT1A1/1A6), sulfation, and minor CYP2E1 oxidation.
Hydrocodone: CYP3A4 and CYP2D6; Acetaminophen: primarily via glucuronidation (UGT1A1, UGT1A6, UGT1A9) and sulfation, with minor oxidation by CYP2E1.
Oxycodone: primarily renal (up to 19% as unchanged drug, 50% as noroxycodone and oxymorphone metabolites); about 10% biliary/fecal. Acetaminophen: renal (majority as glucuronide and sulfate conjugates, about 5% unchanged).
Renal: ~90-100% as hydrocodone metabolites (conjugated) and unchanged hydrocodone; ~60% as acetaminophen metabolites (glucuronide, sulfate, cysteine); <5% unchanged acetaminophen. Biliary/fecal: <5%.
Oxycodone: 38–45% bound to albumin and alpha-1-acid glycoprotein. Acetaminophen: 10–25% bound to albumin (minimal).
Hydrocodone: ~20-30% (albumin). Acetaminophen: ~10-25% (albumin).
Oxycodone: Vd approximately 2.6 L/kg (extensive tissue distribution). Acetaminophen: Vd approximately 0.9 L/kg (total body water).
Hydrocodone: 3-4 L/kg (extensive tissue distribution). Acetaminophen: ~1 L/kg (uniformly distributed).
Oxycodone: oral bioavailability 60–87% (immediate-release). Acetaminophen: oral bioavailability 85–98% (first-pass metabolism minimal).
Oral: Hydrocodone ~70% (high first-pass metabolism); Acetaminophen ~85-90% (minimal first-pass).
GFR >60 m L/min: no adjustment; GFR 30-60 m L/min: dose every 8 hours; GFR <30 m L/min: avoid use or use with extreme caution, consider reducing dose to 50% or extending interval to every 12 hours; not recommended in ESRD.
For GFR 30-59 m L/min: administer every 6 hours; maximum 4 tablets per day. For GFR 15-29 m L/min: administer every 8 hours; maximum 3 tablets per day. For GFR <15 m L/min: not recommended due to accumulation of metabolites.
Child-Pugh A: no adjustment; Child-Pugh B: reduce total daily dose by 50%; Child-Pugh C: avoid use.
Child-Pugh Class A: no adjustment necessary. Child-Pugh Class B: reduce dose by 25-50% and extend dosing interval to every 6-8 hours; maximum 4 tablets per day. Child-Pugh Class C: contraindicated due to risk of hepatotoxicity.
Not FDA-approved for children <18 years; off-label: 0.1-0.2 mg/kg oxycodone (max 5 mg) plus 5-10 mg/kg acetaminophen every 4-6 hours; total acetaminophen not to exceed 75 mg/kg/day or 4 g/day.
Not recommended for pediatric patients; safety and efficacy not established for children under 18 years. For adolescents ≥18 years: adult dosing.
Start with low end of dosing, e.g., 2.5 mg oxycodone/325 mg acetaminophen every 6 hours; monitor renal function and avoid >4 g/day acetaminophen; titrate cautiously due to increased sensitivity and fall risk.
Initiate at 1 tablet (hydrocodone 5 mg / acetaminophen 325 mg) every 6 hours as needed; titrate cautiously due to increased sensitivity, decreased renal function, and risk of respiratory depression. Maximum 4 tablets per day.
Risk of addiction, abuse, and misuse; life-threatening respiratory depression; accidental ingestion of any dosage (especially in children) can be fatal; neonatal opioid withdrawal syndrome with prolonged use during pregnancy; CYP3A4 inhibitors or discontinuation of CYP3A4 inducers may cause fatal respiratory depression; concomitant use with benzodiazepines or other CNS depressants may cause profound sedation, respiratory depression, coma, and death.
Addiction, abuse, and misuse; life-threatening respiratory depression; accidental ingestion; neonatal opioid withdrawal syndrome; risks from concomitant use with benzodiazepines or other CNS depressants; hepatotoxicity due to acetaminophen.
Addiction, abuse, and misuse; life-threatening respiratory depression; accidental ingestion; neonatal opioid withdrawal syndrome; risks from concomitant use with benzodiazepines or other CNS depressants; severe hypotension; seizures; serotonin syndrome; adrenal insufficiency; hepatotoxicity (acetaminophen); increased risk of pancreatitis (if combined with alcohol); risk of overuse for acetaminophen.
Risk of opioid addiction, abuse, and misuse; life-threatening respiratory depression; accidental ingestion; neonatal opioid withdrawal syndrome; risks from concomitant use of alcohol, benzodiazepines, or other CNS depressants; hepatotoxicity; severe hypotension; adrenal insufficiency; seizures; GI obstruction; impaired mental/physical abilities; use in elderly, cachectic, or debilitated patients; renal impairment; hepatic impairment; pregnancy; labor and delivery; nursing mothers; pediatric use; driving and operating machinery.
Hypersensitivity to oxycodone, acetaminophen, or any component; significant respiratory depression; acute or severe bronchial asthma in an unmonitored setting or without resuscitative equipment; known or suspected gastrointestinal obstruction, including paralytic ileus; severe hepatic impairment (acetaminophen hepatotoxicity risk).
Significant respiratory depression; acute or severe bronchial asthma; known or suspected GI obstruction; hypersensitivity to hydrocodone or acetaminophen; concomitant use of MAOIs or within 14 days of such therapy.
Avoid alcohol and grapefruit juice. Alcohol can potentiate hepatotoxicity from acetaminophen and CNS depression from oxycodone. Grapefruit juice may increase oxycodone levels, enhancing sedative and respiratory depressant effects. No other significant food interactions.
Avoid alcohol consumption due to increased risk of acetaminophen hepatotoxicity and CNS depression. No specific food restrictions, but grapefruit juice may theoretically affect hydrocodone metabolism via CYP3A4 inhibition; however, clinical significance is uncertain.
Percocet (oxycodone/acetaminophen) is pregnancy category C prior to 30 weeks gestation and category D after 30 weeks. First trimester: No clear evidence of major malformations, but opioid use may be associated with neural tube defects and gastroschisis. Second trimester: Risk of miscarriage, intrauterine growth restriction. Third trimester: Prolonged use can cause neonatal opioid withdrawal syndrome (NOWS) and respiratory depression at delivery. Acetaminophen is considered safe in therapeutic doses but overdose is hepatotoxic to fetus.
FDA Category C (hydrocodone) and Category D (acetaminophen) in third trimester. First trimester: Acetaminophen associated with rare gastroschisis; hydrocodone risk of neural tube defects. Second trimester: No major malformations except with prolonged opioid use. Third trimester: Acetaminophen safe; hydrocodone risk of neonatal opioid withdrawal syndrome (NOWS). Avoid near term.
Oxycodone is excreted into breast milk; relative infant dose is approximately 1-2% of maternal weight-adjusted dose. M/P ratio (milk/plasma) is about 3.2:1 for oxycodone. Acetaminophen M/P ratio ~1.0. Low levels expected, but monitor infant for sedation and poor feeding. Caution with maternal high doses or prolonged use; avoid if mother is ultra-rapid CYP2D6 metabolizer due to risk of toxicity.
Hydrocodone/acetaminophen excreted in breast milk. M/P ratio unknown. Hydrocodone relative infant dose <3% of weight-adjusted maternal dose. Acetaminophen relative infant dose <2%. Use with caution; monitor infant for sedation, apnea, poor feeding. Highest risk in CYP2D6 ultrarapid metabolizers.
During pregnancy, increased plasma volume and hepatic metabolism may require higher doses of oxycodone to achieve analgesic effect. However, due to fetal risks, use lowest effective dose for shortest duration. No specific dose adjustments are validated; clinical response should guide dosing. Acetaminophen dosing remains unchanged but avoid exceeding 3 g/day in pregnancy.
Increased clearance of hydrocodone in pregnancy may require dose adjustment; monitor for inadequate analgesia. Acetaminophen pharmacokinetics unchanged. Avoid high doses (hepatotoxicity risk). Consider baseline hepatic function. No specific dose adjustment recommended; titrate to effect.
Percocet contains oxycodone and acetaminophen; the acetaminophen component limits total daily dosing to avoid hepatotoxicity (max 4 g/day in adults, lower in liver disease or alcohol use). Due to oxycodone, it is a Schedule II controlled substance with high abuse potential. Constipation is a common adverse effect; consider prophylactic bowel regimen (e.g., docusate, senna). Respiratory depression risk is dose-related and increased with concurrent CNS depressants. Use with caution in elderly, renal impairment, or sleep apnea. Tolerance and dependence develop with prolonged use. Taper to discontinue after chronic use. Avoid in patients with known hypersensitivity to opioids or acetaminophen.
ANEXSIA 7.5/325 (hydrocodone/acetaminophen) carries a boxed warning for acetaminophen hepatotoxicity; maximum acetaminophen dose from all sources should not exceed 4 g/day. Hydrocodone is metabolized by CYP2D6 to hydromorphone; ultrarapid metabolizers may experience toxicity. Avoid concurrent use with other CNS depressants including alcohol. Prescribe with caution in patients with renal impairment (hydrocodone accumulation) or hepatic impairment (acetaminophen toxicity). Monitor for signs of respiratory depression, especially at therapy initiation and dose titration. Use the lowest effective dose for the shortest duration.
Take exactly as prescribed; do not increase dose or frequency without consulting your doctor.,Avoid alcohol and other sedatives (e.g., benzodiazepines, muscle relaxants) as they increase risk of severe drowsiness and respiratory depression.,Do not drive or operate heavy machinery until you know how this medication affects you; it may cause dizziness or drowsiness.,Do not exceed 4,000 mg of acetaminophen per day from all sources; check over-the-counter medications for acetaminophen content.,Stop taking and seek immediate medical attention if you experience symptoms of liver damage: yellowing of skin/eyes, dark urine, abdominal pain.,Common side effects include constipation, nausea, vomiting, and drowsiness. Increase fluid and fiber intake to prevent constipation.,This drug has a high risk of addiction and dependence. Store securely out of reach of others. Do not share with others.,Do not suddenly stop taking after prolonged use; a gradual taper is needed to avoid withdrawal symptoms.,Contact your doctor if pain is not controlled or if you experience signs of allergic reaction (rash, swelling, trouble breathing).
Do not exceed 6 tablets per day due to acetaminophen content.,Avoid alcohol while taking this medication.,Do not drive or operate heavy machinery until you know how this medication affects you.,Take exactly as prescribed; do not share with others.,Seek emergency help if you experience difficulty breathing, severe drowsiness, or signs of allergic reaction.,Store securely out of reach of children and dispose of unused medication properly.
No interactions on record
No interactions on record
Explore head-to-head clinical comparisons of other medications in the same therapeutic classes.
Common clinical questions about PERCOCET vs ANEXSIA 7.5/325, answered by our medical review team.
PERCOCET is a Opioid Analgesic Combination that works by Oxycodone is a mu-opioid receptor agonist, inhibiting ascending pain pathways and altering pain perception and emotional response. Acetaminophen inhibits cyclooxygenase (COX) in the CNS, reducing prostaglandin synthesis and exerting analgesic and antipyretic effects.. ANEXSIA 7.5/325 is a Opioid Analgesic Combination that works by Hydrocodone is a mu-opioid receptor agonist, producing analgesia and euphoria. Acetaminophen inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis and providing analgesic and antipyretic effects.. They differ in pharmacokinetic profiles, FDA-approved indications, and side effect profiles.
Potency comparisons between PERCOCET and ANEXSIA 7.5/325 depend on the specific clinical indication. These are both Opioid Analgesic Combination agents and are not directly interchangeable by dose. A physician or clinical pharmacist should guide any therapeutic switching decisions.
The standard adult dose of PERCOCET is: One tablet (5 mg oxycodone/325 mg acetaminophen) every 6 hours as needed for pain; maximum 12 tablets per day.. The standard adult dose of ANEXSIA 7.5/325 is: 1 tablet (hydrocodone 7.5 mg / acetaminophen 325 mg) orally every 4 to 6 hours as needed for pain; maximum 6 tablets per day (hydrocodone 45 mg / acetaminophen 1950 mg).. Dosing should always be individualized based on indication, renal and hepatic function, age, and other patient factors.
No direct drug-drug interaction has been formally documented between PERCOCET and ANEXSIA 7.5/325 in current clinical databases. However, individual patient risk factors including other medications, organ function, and comorbidities should always be evaluated by a qualified healthcare provider.
The maternal-fetal safety profiles differ. PERCOCET is classified as Category C. Percocet (oxycodone/acetaminophen) is pregnancy category C prior to 30 weeks gestation and category D after 30 weeks. First trimester: No clear evidence of major malformations, but. ANEXSIA 7.5/325 is classified as Category C. FDA Category C (hydrocodone) and Category D (acetaminophen) in third trimester. First trimester: Acetaminophen associated with rare gastroschisis; hydrocodone risk of neural tube d. Always consult a maternal-fetal medicine specialist before taking either drug during pregnancy or lactation.