Head-to-head clinical analysis & difference comparison: details on mechanism of action, dosing, half-life, interactions, and maternal-fetal safety.
PERCOCET vs ANEXSIA 7.5/650
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 that inhibits ascending pain pathways and alters pain perception; acetaminophen inhibits cyclooxygenase (COX) enzymes, primarily in the CNS, reducing prostaglandin synthesis and fever.
Management of moderate to moderately severe pain (FDA-approved),Off-label: severe pain when other analgesics are inadequate (individualized use)
Management of acute pain severe enough to require an opioid analgesic 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 orally every 4 to 6 hours as needed; maximum 6 tablets per day.
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: Terminal half-life 3.8-7.2 hours (mean 5.6 h). Acetaminophen: 1.5-2.5 hours (therapeutic) but prolonged to >4 hours in overdose with hepatotoxicity risk.
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 liver glucuronidation (UGT1A1, UGT1A6, UGT1A9) and sulfation (SULT1A1, SULT1A3), with minor CYP2E1 oxidation.
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).
Hydrocodone: Renal elimination of metabolites (hydromorphone, norhydrocodone) and unchanged drug accounts for ~60-90% of clearance. Acetaminophen: ~85% of dose is excreted in urine as glucuronide and sulfate conjugates; 5-10% unchanged; 2-5% as mercapturate.
Oxycodone: 38–45% bound to albumin and alpha-1-acid glycoprotein. Acetaminophen: 10–25% bound to albumin (minimal).
Hydrocodone: ~36% bound to serum proteins. Acetaminophen: 10-25% bound (minimal binding).
Oxycodone: Vd approximately 2.6 L/kg (extensive tissue distribution). Acetaminophen: Vd approximately 0.9 L/kg (total body water).
Hydrocodone: Vd ~3-5 L/kg (wide distribution). Acetaminophen: Vd ~0.9-1.0 L/kg (primarily body water).
Oxycodone: oral bioavailability 60–87% (immediate-release). Acetaminophen: oral bioavailability 85–98% (first-pass metabolism minimal).
Oral: Hydrocodone ~70-80% (variable first-pass). Acetaminophen ~63-89% (mean 75-80%).
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.
Cr Cl <30 m L/min: contraindicated; Cr Cl 30-60 m L/min: maximum 3 tablets per day; given the hydrocodone component, avoid in severe renal impairment.
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; Child-Pugh Class B: reduce dose by 50% and monitor; Child-Pugh Class C: contraindicated due to hydrocodone.
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 in pediatric patients due to risk of respiratory depression; for ages <18, contraindicated.
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 with lowest effective dose, monitor for respiratory depression and constipation; maximum 4 tablets per day in patients >65 years.
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.
Risk of addiction, abuse, and misuse; life-threatening respiratory depression; accidental ingestion (especially in children) can be fatal; neonatal opioid withdrawal syndrome; cytochrome P450 3A4 interaction (concomitant use with CYP3A4 inhibitors may increase hydrocodone levels); risk of medication errors (confusion between different strengths).
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.
Addiction, abuse, and misuse; respiratory depression; neonatal opioid withdrawal syndrome; interactions with CNS depressants; risk of serotonin syndrome with serotonergic drugs; adrenal insufficiency; hypotension; seizures; gastrointestinal obstruction; severe cutaneous reactions (acetaminophen); hepatotoxicity (acetaminophen overdose); acute abdominal conditions; impaired mental/physical abilities; elderly/debilitated patients; renal/hepatic impairment.
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 (without monitoring or resuscitative equipment); known or suspected gastrointestinal obstruction (including paralytic ileus); hypersensitivity to hydrocodone or acetaminophen; use with 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 due to increased risk of acetaminophen hepatotoxicity and additive CNS depression. Grapefruit juice may increase hydrocodone absorption; consider avoiding. No other significant food interactions.
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. First trimester: Possible increased risk of cardiac defects with oxycodone. Second/third trimester: Chronic use may lead to neonatal opioid withdrawal syndrome; no clear teratogenicity. Acetaminophen is generally safe, but high doses may be hepatotoxic.
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.
Oxycodone: M/P ratio ~0.8-3; present in milk; risk of neonatal sedation. Acetaminophen: M/P ~0.8-1, low risk. Avoid due to oxycodone; consider alternative analgesic.
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 oxycodone in pregnancy may require increased dose; acetaminophen pharmacokinetics unchanged. Adjust based on pain control and withdrawal risk.
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.
Fixed-dose combination of hydrocodone bitartrate (7.5 mg) and acetaminophen (650 mg). Hydrocodone is a schedule II controlled substance with high abuse potential. Acetaminophen hepatotoxicity risk increases above 3 g/day; prescribe no more than 4 doses per day. Monitor for respiratory depression, especially in opioid-naïve patients. Avoid in severe hepatic impairment. Use with caution in patients with COPD, sleep apnea, or concurrent CNS depressants. Consider naloxone co-prescription if high opioid dose or concurrent benzodiazepine use.
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).
Take exactly as prescribed; do not increase dose or frequency.,Do not take with alcohol or other medications containing acetaminophen.,May cause drowsiness or dizziness; avoid driving or operating machinery until effects are known.,Store securely out of reach of children and others; dispose of unused tablets properly.,Seek emergency care for difficulty breathing, severe sedation, or signs of allergic reaction.,Do not abruptly stop after prolonged use; withdrawal symptoms may occur.
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 7.5/650, 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 7.5/650 is a Opioid Analgesic Combination that works by Hydrocodone is a mu-opioid receptor agonist that inhibits ascending pain pathways and alters pain perception; acetaminophen inhibits cyclooxygenase (COX) enzymes, primarily in the CNS, reducing prostaglandin synthesis and fever.. They differ in pharmacokinetic profiles, FDA-approved indications, and side effect profiles.
Potency comparisons between PERCOCET and ANEXSIA 7.5/650 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 7.5/650 is: 1 tablet orally every 4 to 6 hours as needed; maximum 6 tablets per day.. 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 7.5/650 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 7.5/650 is classified as Category C. FDA Category C. First trimester: Possible increased risk of cardiac defects with oxycodone. Second/third trimester: Chronic use may lead to neonatal opioid withdrawal syndrome; no . Always consult a maternal-fetal medicine specialist before taking either drug during pregnancy or lactation.