Codeine vs. Hydrocodone: 6 Differences To Consider
Key takeaways:
Codeine and hydrocodone (Hysingla ER) are opioid medications that treat pain and relieve cough. Codeine is a natural opioid made from the opium poppy plant, while hydrocodone is semisynthetic.
Codeine and hydrocodone both have a risk of dependence. But codeine is more likely to cause shortness of breath, while hydrocodone is more likely to be misused.
Codeine and hydrocodone are both central nervous system (CNS) depressants, and they shouldn’t be taken together. Doing so may result in serious side effects, such as slowed breathing. It may also increase your risk of opioid overdose.
Table of contents
Codeine and hydrocodone (Hysingla ER) are opioid medications typically prescribed to treat pain. You may also find them as active ingredients in some prescription cough medications.
These medications share several similarities, but they also have key differences. For example, they’re made differently, vary in potency, and come in different dosage forms and combinations. They also may have different side effects.
Read on to explore six key differences between codeine and hydrocodone.
1. They’re both opioids, but they’re made differently
Codeine and hydrocodone are both opioid medications. But they’re not one and the same. They’re different types of opioids. Opioids are either naturally derived from the opium poppy plant or made from chemicals in a lab.
Codeine is an example of a natural opioid. It’s made using opium from the poppy plant. Morphine is another example of a natural opioid. Opioids that come naturally from the poppy plant are also called opiates.
Lab-made opioids, on the other hand, may be synthetic or semisynthetic. Synthetic opioids are composed entirely from human-made chemicals. Semisynthetic opioids are made in a lab using materials from natural opioids.
Pain alternatives: Opioids are typically prescribed for pain when other medications haven’t worked. This guide provides details on opioid alternatives to treat pain.
How do you use Narcan? Learn how to administer this life-saving opioid overdose treatment with this Narcan dosage guide.
Habit-forming medications: Opioids aside, learn about other medications that are likely to cause dependence.
Hydrocodone is a semisynthetic opioid made from codeine. Other examples of semisynthetic opioids are oxycodone (Roxicodone, OxyContin) and hydromorphone (Dilaudid). Fentanyl and methadone (Methadose) are well-known fully synthetic opioids.
Good to know: Opioids and opiates both bind to opioid receptors in your brain. This can produce several effects, including blocking pain signals and the urge to cough. It can also induce feelings of pleasure, well-being, and relaxation.
2. They come in different formulations
There are several versions of codeine and hydrocodone. They’re both available as stand-alone medications, and they’re also frequently combined with other drugs.
Codeine combination products include:
Codeine / acetaminophen / butalbital / caffeine (Fioricet with Codeine)
Codeine / chlorpheniramine (Tuxarin ER)
Codeine / pseudoephedrine / triprolidine (Triacin-C)
Hydrocodone combination products include:
Hydrocodone / acetaminophen (Anexsia, formerly known as Vicodin and Norco)
Hydrocodone / homatropine (Hycodan)
The table below details the different dosage forms available for codeine and hydrocodone. It includes stand-alone and combination products.
Dosage form | Codeine | Hydrocodone |
|---|---|---|
Immediate-release tablet | ✔ | ✔ |
Immediate-release capsule | ✔ | ✔ |
Oral solution | ✔ | ✔ |
Oral syrup | ✔ | ✔ |
Extended-release suspension | ✔ | |
Extended-release tablet | ✔ | ✔ |
Extended-release capsule | ✔ |
3. Hydrocodone is usually reserved for moderate-to-severe pain
Opioids are typically prescribed to treat pain that’s not relieved by other pain medications, such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin). But some opioids are more potent than others.
As mentioned earlier, hydrocodone is a semisynthetic opioid made from codeine. Synthetic and semisynthetic opioids are generally stronger than natural opioids. Hydrocodone is about 6 times as strong as codeine.
Codeine may be used to treat mild-to-moderate pain. Because hydrocodone is a stronger opioid, it’s typically reserved for moderate-to-severe pain.
4. They’re both controlled substances, but they’re not always in the same schedule
Codeine and hydrocodone are both controlled substances. This means that they have the potential for misuse and can cause dependence. Controlled substances are regulated by the Drug Enforcement Administration (DEA) and have restrictions on how they’re filled.
The DEA classifies controlled substances into five categories based on their likelihood of misuse and dependence. They range from Schedule 1 to Schedule 5. Medications in Schedule 5 are the least likely to cause dependence or be misused. Schedule 1 medications have the highest potential for misuse and dependence.
Hydrocodone falls into the Schedule 2 category. Schedule 2 medications have a high potential for misuse and dependence but have acceptable medical uses when taken as directed.
Codeine is a little different. It’s classified as a Schedule 2 medication when it’s the only active ingredient in the medication. But combination codeine products are in the Schedule 3 category. For example, codeine / acetaminophen tablets are in Schedule 3. But stand-alone codeine tablets are in Schedule 2.
5. Their side effects generally overlap — but not always
Codeine and hydrocodone are both central nervous system (CNS) depressants. This means they reduce activity in your brain and spinal cord. CNS depressants tend to have similar side effects.
Similar side effects between codeine and hydrocodone
Common codeine side effects and hydrocodone side effects include:
Sleepiness
Dizziness
Nausea
Vomiting
Constipation
In rare cases, codeine and hydrocodone may cause more serious side effects. These include slowed and shallow breathing, which can be life-threatening. Dangerously low blood pressure is also possible.
What’s more, stopping codeine or hydrocodone suddenly after taking the medication long term may result in withdrawal symptoms.
Different side effects between codeine and hydrocodone
Between the two, codeine may be more likely to cause:
Lightheadedness
Shortness of breath
6. Hydrocodone is more likely to be misused than codeine
Codeine and hydrocodone are both controlled medications with a potential for misuse. But hydrocodone is more likely to be misused than codeine. It’s more potent overall.
While codeine is classified as having a high potential for misuse only if it’s a single-drug medication, hydrocodone has a high potential for misuse whether it’s alone or combined with another medication.
Do codeine and hydrocodone have any similarities?
Yes. There are several similarities between codeine and hydrocodone. Both medications:
Are opioids.
Can treat pain and relieve cough.
Are available in several oral dosage forms.
Can be found in certain combination pain and cough medications.
Have similar common side effects, such as sleepiness and constipation.
Are controlled substances.
Have a risk for misuse and can cause dependence.
Frequently asked questions
If you have a codeine allergy, it’s a good idea to avoid taking hydrocodone. This is because codeine and hydrocodone belong to the same chemical group. As discussed earlier, hydrocodone is made in a lab using chemicals obtained from codeine. If you’re allergic to codeine, you may also have a negative reaction to hydrocodone.
No. You shouldn’t take hydrocodone and codeine together. Doing so can result in a serious drug interaction. Codeine and hydrocodone are both opioid medications and CNS depressants. On their own, they may cause side effects such as sleepiness and low blood pressure. And the risk is even higher if they’re combined. They can also cause more serious side effects, such as trouble breathing, and increase your risk of an opioid overdose.
The bottom line
Codeine and hydrocodone (Hysingla ER) are prescription opioid medications. Hydrocodone is a stronger (more potent) opioid compared with codeine. It’s typically prescribed to treat moderate-to-severe pain, while codeine treats mild-to-moderate pain. Both medications are controlled substances that have the potential for misuse and may cause dependence. However, hydrocodone is more likely to be misused than codeine.
Codeine and hydrocodone are chemically related. So if you have a codeine allergy, you may also be allergic to hydrocodone. Codeine and hydrocodone are also both central nervous system (CNS) depressants, and they shouldn’t be taken together. Doing so can increase your likelihood of serious risks and side effects, including overdose.
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References
Alvogen. (2021). Hydrocodone bitartrate tablet, extended release [package insert].
Centers for Disease Control and Prevention. (2024). Commonly used terms.
Coates, S., et al. (2023). Hydrocodone, oxycodone, and morphine metabolism and drug-drug interactions. The Journal of Pharmacology and Experimental Therapeutics.
Cofano, S., et al. (2024). Hydrocodone. StatPearls.
Dowell, D., et al. (2022). CDC clinical practice guideline for prescribing opioids for pain — United States, 2022. Centers for Disease Control and Prevention.
Lannett Company. (2024). Codeine sulfate tablet [package insert].
National Institute of Diabetes and Digestive and Kidney Diseases. (2020). Hydrocodone. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. National Library of Medicine.
Peechakara, B. V., et al. (2024). Codeine. StatPearls.
Preferred Pharmaceuticals. (2023). Acetaminophen and codeine phosphate tablet [package insert].
ScienceDirect. (n.d.). Hydrocodone.
Shafi, A., et al. (2022). Synthetic opioids: A review and clinical update. Therapeutic Advances in Psychopharmacology.
Turturro, M. A., et al. (1991). Hydrocodone versus codeine in acute musculoskeletal pain. Annals of Emergency Medicine.
U.S. Drug Enforcement Administration. (n.d.). Drug scheduling.
U.S. Drug Enforcement Administration. (n.d.). Drug Fact Sheet: Hydrocodone.
U.S. Food and Drug Administration. (2025). Orange Book: Approved drug products with therapeutic equivalence evaluations.
