Oxycodone
Mechanism :
Oxycodone is an opioid analgesic. The precise mechanism of the analgesic action is unknown. However, specific CNS opioid receptors for endogenous compounds with opioid like activity have been identified throughout the brain and spinal cord and play a role in the analgesic effects of this drug
Indication :
- Management of moderate to severe pain
Contraindications :
It is contraindicated in patients with known hypersensitivity to oxycodone, or in any situation where opioids are contraindicated. This includes patients with significant respiratory depression (in unmonitored settings or the absence of resuscitative equipment) and patients with acute or severe bronchial asthma or hypercarbia. It is also contraindicated in paralytic ileus.
Dosing :
Oral
Children:
0.05-0.15 mg/kg/dose every 4-6 hours as needed.
Adults:
Initial 5 mg every 6 hours as needed and can increase to 10-30 mg.
Adverse Effect :
Respiratory depression, circulatory depression, hypotension, shock, angina, bradycardia, cardiac arrhythmias, dry mouth, palpitation, constipation, visual disturbances, dizziness, seizures, coma, dysphoria, euphoria, mental clouding, nervousness, restlessness, sedation, faintness, urinary retention, oliguria, pruritus, urticaria, nausea, vomiting, weakness, syncope.
Interaction :
Neuromuscular Blocking Agents: Oxycodone, as well as other opioid analgesics, may enhance the neuromuscular, blocking action of skeletal muscle relaxants and produce an increased degree of respiratory depression.
CNS Depressants: Patients receiving narcotic analgesics, general anesthetics, phenothiazines, other tranquilizers, sedative-hypnotics or other CNS depressants (including alcohol) concomitantly with oxycodone hydrochloride tablets may exhibit an additive CNS depression. Interactive effects resulting in respiratory depression, hypotension, profound sedation, or coma may result if these drugs are taken in combination with the usual dosage of oxycodone hydrochloride tablets. When such combined therapy is contemplated, the dose of one or both agents should be reduced.
Mixed Agonist/Antagonist Opioid Analgesics: Agonist/antagonist analgesics (i.e., pentazocine, nalbuphine, butorphanol and buprenorphine) should be administered with caution to patients who have received or are receiving a course of therapy with a pure opioid agonist analgesic such as oxycodone hydrochloride tablets. In this situation, mixed agonist/antagonist analgesics may reduce the analgesic effect of oxycodone hydrochloride tablets and/or may precipitate withdrawal symptoms in these patients.
Monoamine Oxidase Inhibitors (MAOIs): MAOIs have been reported to intensify the effects of at least one opioid drug causing anxiety, confusion and significant depression of respiration or coma. The use of oxycodone hydrochloride tablets is not recommended for patients taking MAOIs, or within 14 days of stopping such treatment.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
20-50 | Dose as in normal renal function |
10-20 | Dose as in normal renal function |
<10 | Start with small doses. |
Dose in Patients undergoing Renal Replacement Therapies
CAPD | Unknown dialysability. Dose as in GFR<10 mL/min |
HD | Unknown dialysability. Dose as in GFR<10 mL/min |
HDF/High flux | Dialysed. Dose as in GFR<10 mL/ min |
CAV/VVHD | Unknown dialysability. Dose as in normal renal function |
Hepatic Dose :
The dose should be reduced to 33 to 50% of normal dose and be titrated carefully.