Author: Nancy Swezey, RN

Percocet is a pain medication used to treat moderate to severe pain that alternative methods cannot manage. It is a combination of oxycodone, an opioid, and acetaminophen. Acetaminophen is a non-narcotic medication for pain and fevers you probably know by its brand name, Tylenol. Percocet is a Schedule II controlled substance for its high risk for dependency and misuse.

Percocet Dosage

Percocet is a medication you take by mouth, in pill or liquid form. All Percocet tablets have 325 milligrams (mg) of acetaminophen and varying doses of oxycodone, ranging from 2.5-10 mg each.¹

There is no maximum dose for the oxycodone component of Percocet. There is, however, a maximum dose of acetaminophen, which is 4 grams, or 4000 mg per day. Therefore, your daily Percocet dose should never exceed that amount of acetaminophen. Prescribers are aware of this limitation and should dose accordingly.¹

The recommended starting dose for Percocet is 1-2 tablets of the lowest dose (2.5 mg/325 mg) every 4-6 hours as needed for pain.¹

Percocet Side Effects

Percocet comes with many possible side effects, which can vary from person to person. Common side effects of Percocet include:¹

• Constipation
• Nausea and vomiting
• Sleepiness
• Headache
• Dizziness
• Abdominal pain

More severe side effects of Percocet are also possible, but less common. If you experience any of these, you may need emergency medical help as they can be a sign of a severe allergic reaction or overdose. These include:¹

• Trouble breathing or shortness of breath
• Rapid heart rate
• Chest pain
• Tongue, face, or throat swelling
• Excessive tiredness
• Light-headedness or dizziness when standing or changing positions
• Weakness
• Irritability
• Difficulty moving or walking
• Muscle stiffness
• Confusion or delirium
• High temperature or fever

Percocet and Respiratory Depression

A major concern for Percocet and other opioids is their effect on your breathing. Respiratory depression is perhaps the most feared side effect of Percocet and other opioids. Your body and brain are in a feedback loop where your body signals your brain to breathe and your brain triggers your body’s breathing. Opioids affect the brain in such a way that your brain is not stimulated to breathe the way it normally is. This reduction in the drive to breathe can lead to very slow or shallow breathing, and in cases of overdoses, cessation of breathing.¹

When you breathe slower, the carbon dioxide you normally exhale accumulates, which can exacerbate sedation caused by Percocet. For this reason, people with breathing problems, including asthma and chronic sleep apnea, should avoid Percocet or speak to their provider about safe dosing.¹

Percocet and Reproduction

Long-term use of Percocet can affect your libido and your reproductive function. Pregnant women are advised against taking Percocet while pregnant or breastfeeding unless absolutely necessary, as the effects on the fetus or baby, and the woman’s reproductive function, are not fully understood. Babies born to mothers who continuously used Percocet during pregnancy can go into withdrawal once they are born. This is a life-threatening condition if not acknowledged or treated.¹

Percocet Overdose

Symptoms of Percocet overdose include:¹

• Respiratory depression (loss of drive to breathe, slow and shallow breathing)
• Extreme sleepiness, even stupor or coma
• Limp muscles
• Cold, clammy skin
• Constricted “pinpoint” pupils
• Dilated, large pupils in overdoses with oxygen deprivation
• Slow heart rate
• Low blood pressure
• Blockage in your breathing airway
• Snoring

Percocet overdose is a potentially fatal medical emergency and should be treated as such.

Risk for Percocet Overdose

You are at higher risk of Percocet overdose if you take other medications or substances that have similar depressive effects to Percocet on your central nervous system.¹

These include:

• Benzodiazepines (Klonopin, Xanax, Valium, etc.) and other anxiety medications
• Sleep medications
• Antipsychotics
• Muscle relaxers
• Alcohol

It is important to discuss all of the medications and supplements that you take with your doctor, as even some over-the-counter medications contain alcohol or other ingredients that can exacerbate the effects of Percocet.

Your substance use history may also increase your risk for overdose. If you have a history of opioid misuse, opioid overdose, or using other medications that depress your central nervous system, your doctor may discuss prescribing you naloxone, better known by its brand name Narcan, in addition to Percocet. All of these factors put you at a higher risk for overdose. Narcan is a rescue drug that can save your life if you overdose. It rapidly unbinds Percocet from its receptors and puts you into withdrawal^.1

Percocet Withdrawal

If you have been taking Percocet consistently even for only a few weeks, you may be dependent, meaning that you would go into withdrawal without it. It is important that you not abruptly stop Percocet without discussing it with your prescriber. If you want to and are ready to stop taking Percocet, your provider can help you taper off the medication to mitigate withdrawal symptoms and prevent any dangerous outcomes.¹

Opioid withdrawal symptoms include:

• Aches and pains
• Muscle tension or twitching
• Irritability and restlessness
• Anxiety
• Lack of sleep
• Diarrhea
• Sweating
• Fast heart rate
• Shakiness
• Nausea and vomiting

Warnings About Percocet

If you have a condition that requires treatment with Percocet, you must take precautions to ensure your safety.

• Take it exactly as prescribed. Try to take the minimum dose for the shortest period of time to avoid the risks of heavy, long-term use.
• Do not share or sell your medication. Not only is it illegal to do so, but it could also be dangerous. Percocet may not be appropriate based on a person’s previous health history and current medication regimen.
• Keep your medication secured in a place where you can monitor it. Accidental ingestion by children or others can lead to a fatal overdose.
• Do not stop taking Percocet without discussing it with your doctor. You may need to taper off to avoid withdrawal.
• Dispose of your medication through a medication take back program or by flushing it down the toilet. Do not dispose of it in a place that may lead to accidental ingestion.
• Percocet can make you dizzy, lightheaded, and drowsy. For this reason, you shouldn’t drive or do anything else that requires your full faculties to carry out.
• Be mindful of Percocet’s high risk as a habit-forming drug. Even if you take Percocet as prescribed, you are still at risk of developing dependence and habits of misuse.

Considerations Before Taking Percocet

Certain conditions may preclude you from being able to tolerate Percocet at all and usually require consideration of alternatives:¹

• People with any severe problems breathing, asthma, chronic bronchitis, emphysema, or any other lung issue may want to reconsider before taking Percocet because of the risk for respiratory depression.
• People with intestinal narrowing or blockages or pancreatic and other abdominal conditions should be mindful that Percocet can either worsen these issues or compromise monitoring and treatment of them by your doctor.
• People with a history of allergic reactions to oxycodone or acetaminophen should be careful. Your allergic reaction can worsen over time, and these medications should be avoided completely if you have ever had a reaction.

Other conditions may not preclude you from taking Percocet, but the conditions themselves or the medications to manage them may alter the course of your treatment. It is important to discuss with your doctor if you have a history of the following:¹

• Seizures
• Head trauma
• Liver, kidney, or thyroid disease
• Problems with urination
• Gallbladder problems
• History of substance use disorder or mental illness
• Current or recent pregnancy

These conditions can compromise your ability to metabolize and clear both the opioid and acetaminophen components of Percocet. Similarly, if you are elderly, your metabolic functions may not be as optimized as younger, healthier patients, and you are probably more sensitive to medication like Percocet, requiring a lower dose.

Percocet and Other Drugs

Vicodin vs. Percocet

Vicodin and Percocet are both combinations of opioid and non-opioid pain relief medications. Like Percocet, Vicodin is one of the most commonly prescribed pain relief medications. They are dosed almost the same, initially between 5-10 mg.

Both Vicodin and Percocet are also found to have nearly identical outcomes in terms of their effectiveness in treating acute pain. However, studies suggest that you may feel more side effects with Percocet, and at a greater magnitude than Vicodin when comparing them at equal doses. For example, pupil constriction was greater in those who took Percocet than Vicodin, and people reported feeling dizzier, more “drug high,” and less in control of the mind and body on 10 mg Percocet, then 10 mg Vicodin.²

Percocet vs. Norco

Norco is a brand name for a drug with an identical chemical makeup to Vicodin, and it thus has the same comparative features with Percocet that Vicodin does.

Percocet and Opioid Use Disorder

Misuse of Percocet can lead to an opioid use disorder. Opioid use disorder is a condition of ongoing precarious use of opioids that has a significantly negative impact on your quality of life. You could be diagnosed with opioid use disorder if you have experienced at least two of the following in a 1-year period:³

• Taking more medication than intended
• Desiring to stop or slow down and an inability to do so
• Excessive time spent finding, using, or recovering from opioid use
• Cravings for opioids
• Failure to meet school, home, or work responsibilities related to your use
• Continuous use despite social and interpersonal problems related to your use
• Giving up social, professional, or recreational activities because of your use
• Patterns of finding yourself in physically precarious situations related to your use
• Continuing use despite physical or mental problems caused by overuse
• Experiencing opioid tolerance or needing higher doses to achieve the same effect

If you are concerned about opioid use disorder or Percocet misuse, call 800-934-1582(Who Answers?) to speak with a treatment specialist.

Resources

1. Endo Pharmaceuticals Inc. (2019). Percocet-oxycodone hydrochloride and acetaminophen tablet. Malvern, PA.
2. Zacny, J. P., & Gutierrez, S. (2008). Subjective, psychomotor, and physiological effects profile of hydrocodone/acetaminophen and oxycodone/acetaminophen combination products. Pain Medicine, 9(4), 433-443.
3. Diagnostic and statistical manual of mental disorders: DSM-5. (Fifth edition.). (2013). American Psychiatric Association.