Oxycodone Overview and Dosage Guidelines

Oxycodone

• Oxycodone is an opioid used for severe acute and chronic pain.

• Pregnancy: Oxycodone may cause respiratory depression in newborns and withdrawal effects in neonates.

• Breastfeeding: Occasional oxycodone doses are considered safe for breastfeeding mothers. Repeated doses in preterm infants or those under 4 weeks old should be monitored for adverse drug reactions and sedation.

Dosage

• Acute Pain:

  • IV: 0.5-2 mg every 3-5 minutes. Dose adjustments are needed for patients older than 70 years.
  • SC:
    • Below 40 kg: 7.5-12.5 mg every 2 hours.
    • 40-60 kg: 5-10 mg every 2 hours.
    • 60-70 kg: 2.5-7.5 mg every 2 hours.
    • 70-85 kg: 2.5-5 mg every 2 hours.
    • Above 85 kg: 2-3 mg every 2 hours.
  • PO: 5-15 mg every 4 hours for adults.

• Chronic Cancer Pain:

  • PO: 2.5-5 mg every 4-6 hours.
  • Maintenance:
    • PO: Half of the total daily amount every 12 hours.
    • SC Infusion: Half of the total daily oral amount every 24 hours.

• Chronic Non-Cancerous Pain:

  • PO: 5-10 mg twice daily (start with 5 mg for opioid-naïve patients or elderly). Review every 2 weeks.
  • Poor Response: If pain is not adequately controlled with greater than 30 mg daily, the dosage should be slowly tapered down and discontinued .
  • Rectal: 30 mg every 6-8 hours as needed.

Side Effects

• Sedation
• Dizziness
• Headache
• Orthostatic hypotension
• Itch
• Dry mouth
• Urinary retention
• Miosis (excessive pupil constriction)
• Respiratory depression (dose-related)
• Constipation
• Nausea
• Vomiting
• Altered mood state (e.g., confusion)
• Opioid-induced hyperalgesia
• Dyspepsia (indigestion)
• Flushing (due to histamine release)
• Anaphylaxis
• Seizure

Practice Points

• Renal Impairment:

  • CrCl 10-30 mL/min: Initially ¾ of the normal dose.
  • CrCl < 10 mL/min: ¾ of the normal daily dose.
  • CrCl > 30 mL/min: Monitor the patient's response and adjust dosage accordingly.

• Acute Pain (1-12 years): Avoid giving a total daily dosage exceeding 50 mg (consider lower doses in elderly patients). Taper down slowly and discontinue medication if daily dosages exceed 30 mg.

• Acute Pulmonary Edema: 1-5 mg IV (1 mg for elderly).

• Renal Impairment:

  • CrCl 10-50 mL/min: ½ - ¾ of the daily dose.
  • CrCl < 10 mL/min: Consult a specialist for guidance and dosage adjustment..

• General Precautions:

  • Oxycodone may make you feel drowsy and dizzy; avoid driving and operating machinery until you know you're affected.
  • Avoid alcohol consumption as it may enhance the effects of oxycodone.
  • If you experience difficulty staying awake or feel excessively sleepy, stop taking the medication and consult your doctor immediately.
  • Stand up and alter posture gradually, as abrupt changes can lead to dizziness.
  • Regular dental checkups are recommended as prolonged use can increase the risk of dry mouth and dental caries.
  • Aim for adequate hydration.
  • Consider using laxatives, such as Coloxyl with Senna, to prevent constipation.
  • Provide take-home naloxone education and access.

Drug Interactions

• Rifampicin: Increases buprenorphine metabolism.

Contraindications/Complications

• Combination Use: Combining oxycodone with benzodiazepines and gabapentinoids should be avoided due to an increased risk of central nervous system (CNS) side effects and respiratory depression.
• Ileus: Oral administration is associated with limited drug absorption in patients with ileus. Parenteral routes are preferred.

Monitoring

• Blood pressure
• Respiratory function
• Regular dental checkups
• Liver enzyme levels
• Regular fall risk assessment

Notes

Peak analgesia from oxycodone can be expected after:

• Conventional PO Liquid: 60 minutes.
• SC: 50-90 minutes.

Pediatric Dosing

• 60 kg: 10 mg three times daily.
• 30-60 kg: 5 mg three times daily.
• 20-30 kg: 2.5 mg three times daily.
• 15-20 kg: 2 mg 2-3 times daily.
• 10-15 kg: 1 mg 2-3 times daily.

Special Considerations

• Chemotherapy-Induced Nausea/Vomiting: PO/IV 10 mg three times daily (max 30 mg daily).
• Gastric Stasis: For patients weighing over 20 kg, PO/IV/IM 5–10 mg three times daily.
• Intubation of the Intestine: For patients over 20 kg, IV 10-20 mg as a single dose.
• Renal Impairment: For patients with CrCl < 10 mL/min, consult a specialist for guidance on dosage adjustment.