Oxycodone

Indications

  • Moderate to severe pain

Adverse effects

See Adverse effects

Starting dose

Acute pain

S/C

  • 2.5-5 mg every 2 hours

Oral

  • Do not use controlled release tablets for treatment of acute pain, see practice considerations.
  • Immediate release oral product, initially 2.5–5 mg every 4 hours (start with 2.5 mg in those >70 years); titrate dose according to response and sedation score, see respiratory depression. More frequent administration and/or higher doses may be required for severe acute pain.

Chronic cancer pain

  • Initial dosing

    • Immediate release oral product, 2.5–5 mg every 4 hours in opioid-naive patients. If previously on opioids, consider equianalgesic dose of oxycodone (see Opioid Comparative Information Table). Do not use controlled release tablet for initial stabilisation.
    • Titrate doses to effect, and when stable calculate 24‑hour oxycodone requirement for maintenance dosing.

  • Maintenance dosing

    • Oral controlled release tablet, total daily dose as determined for conventional product; give up to half total daily dose every 12 hours. Titrate dose depending on response.
    • SC infusion, calculate the 24‑hour oral dose of oxycodone and give half this amount by SC infusion over a 24‑hour period. Titrate dose depending on response.

Chronic non-cancer pain (adult)

  • Involve a specialist pain team in assessing and managing the patient.
  • Avoid opioid analgesia if at all possible; maximise non-opioid analgesia and non-pharmacological therapies.

Changing route

  • Parenteral/oral, the variability of oxycodone's oral bioavailability (approximately 50–90%) requires the initial conversion to be conservative; titrate subsequent doses according to response:

    • IV/SC to oral, assume 1 mg IV/SC = 1 mg oral.
    • oral to IV/SC, assume 2 mg oral = 1 mg IV/SC.

Changing opioid

  • 15–20 mg oral oxycodone is approximately equianalgesic to 20–40 mg oral morphine or 10 mg SC morphine. When changing drugs, start at lower than the calculated equianalgesic dose and titrate to response.

Counselling

  • Do not break, crush or chew controlled release tablets, swallow whole tablet

Precautions

Renal

  • Although renal impairment does not result in significant accumulation of active metabolites, the concentration of oxycodone may increase. Reduce initial dose if CrCl < 30mL/minute.

Hepatic

  • Avoid in severe hepatic impairment. Avoid fixed-dose combination with naloxone in any patient with liver impairment.

Practice considerations

  • oxycodone may be tried as an alternative opioid for patients intolerant of morphine
  • do not use controlled release tablets for acute pain as slow onset and offset make rapid, safe titration impossible
  • suppositories have slower onset and longer effect than conventional tablets; they may be useful for patients unable to swallow

Fixed-dose combination with naloxone (Targin®)

  • naloxone is intended to reduce opioid-induced GI adverse effects such as constipation; will only relieve opioid induced constipation
  • naloxone will not be metabolised in patients with liver impairment thus negating the analgesic effect of the oxycodone; contraindicated even in mild liver impairment

Available products

Immediate release preparations

  • oxycodone capsules (Oxynorm®) 5 mg, 10 mg, 20 mg
  • oxycodone tablets (Endone®) 5 mg
  • oxycodone liquid (Oxynorm® liquid) 5 mg in 5 ml

Controlled release preparations

  • Oxycontin® 10 mg, 15 mg, 20 mg, 30 mg, 40 mg, 80 mg

Combination oxycodone/naloxone preparation

  • Targin® 2 mg/1.25 mg; 5 mg/2.5 mg; 10 mg/5 mg; 15 mg/7.5 mg; 20 mg/10 mg; 30 mg/15 mg; 40 mg/20 mg; 60 mg/30 mg; 80 mg/40 mg