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Oxycodone
Pronunciation
U.S. Brand Names
Generic Available
Canadian Brand Names
Synonyms
Pharmacological Index
Use
Restrictions
Pregnancy Risk Factor
Contraindications
Warnings/Precautions
Adverse Reactions
Overdosage/Toxicology
Drug Interactions
Stability
Mechanism of Action
Pharmacodynamics/Kinetics
Usual Dosage
Dietary Considerations
Monitoring Parameters
Reference Range
Mental Health: Effects on Mental Status
Mental Health: Effects on Psychiatric Treatment
Dental Health: Local Anesthetic/Vasoconstrictor Precautions
Dental Health: Effects on Dental Treatment
Patient Information
Nursing Implications
Dosage Forms
References

Pronunciation
(oks i KOE done)

U.S. Brand Names
OxyContin®; OxyIR™; Percolone™; Roxicodone™

Generic Available

No


Canadian Brand Names
Supeudol®

Synonyms
Dihydrohydroxycodeinone; Oxycodone Hydrochloride

Pharmacological Index

Analgesic, Narcotic


Use

Dental: Treatment of postoperative pain

Medical: Management of moderate to severe pain, normally used in combination with non-narcotic analgesics


Restrictions

C-II


Pregnancy Risk Factor

B/D (if used for prolonged periods or in high doses at term)


Contraindications

Hypersensitivity to oxycodone or any component


Warnings/Precautions

Use with caution in patients with hypersensitivity reactions to other phenanthrene derivative opioid agonists (morphine, hydrocodone, hydromorphone, levorphanol, oxycodone, oxymorphone); respiratory diseases including asthma, emphysema, COPD, or severe liver or renal insufficiency; some preparations contain sulfites which may cause allergic reactions; dextromethorphan has equivalent antitussive activity but has much lower toxicity in accidental overdose; tolerance or drug dependence may result from extended use


Adverse Reactions

>10%:

Cardiovascular: Hypotension

Central nervous system: Fatigue, drowsiness, dizziness

Gastrointestinal: Nausea, vomiting

Neuromuscular & skeletal: Weakness

1% to 10%:

Central nervous system: Nervousness, headache, restlessness, malaise, confusion

Gastrointestinal: Anorexia, stomach cramps, xerostomia, constipation, biliary spasm

Genitourinary: Ureteral spasms, decreased urination

Local: Pain at injection site

Respiratory: Dyspnea, shortness of breath

<1%: Mental depression, hallucinations, paradoxical CNS stimulation, increased intracranial pressure, skin rash, urticaria, paralytic ileus, histamine release, physical and psychological dependence


Overdosage/Toxicology

Symptoms of overdose include CNS depression, respiratory depression, miosis

Treatment: Naloxone 2 mg I.V. (0.01 mg/kg for children) with repeat administration as necessary up to a total of 10 mg


Drug Interactions

CYP2D6 enzyme substrate

Increased toxicity: CNS depressants, monoamine oxidase inhibitors, general anesthetics, and tricyclic antidepressants may potentiate the effects of opiate agonists; dextroamphetamine may enhance the analgesic effect of opiate agonists


Stability

Tablets should be stored at room temperature.


Mechanism of Action

Binds to opiate receptors in the CNS, causing inhibition of ascending pain pathways, altering the perception of and response to pain; produces generalized CNS depression


Pharmacodynamics/Kinetics

Onset of pain relief: Oral: Within 10-15 minutes

Peak effect: 0.5-1 hour

Duration: 4-5 hours; up to 12 hours for controlled release

Metabolism: In the liver

Elimination: In urine


Usual Dosage

Oral:

Children:

6-12 years: 1.25 mg every 6 hours as needed

>12 years: 2.5 mg every 6 hours as needed

Adults: 5 mg every 6 hours as needed

Controlled release: Adults: 10 mg every 12 hours around-the-clock

Dosing adjustment in hepatic impairment: Reduce dosage in patients with severe liver disease


Dietary Considerations

Alcohol: Additive CNS effect, avoid use


Monitoring Parameters

Pain relief, respiratory and mental status, blood pressure


Reference Range

Blood level of 5 mg/L associated with fatality


Mental Health: Effects on Mental Status

Drowsiness and dizziness are common; may cause nervousness, restlessness or confusion; may rarely cause depression or hallucinations


Mental Health: Effects on Psychiatric Treatment

Psychotropics may alter the analgesic effects of opioids; monitor for change in pain relief


Dental Health: Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions


Dental Health: Effects on Dental Treatment

1% to 10% of patients experience dry mouth


Patient Information

If self-administered, use exactly as directed (do not increase dose or frequency); may cause physical and/or psychological dependence. While using this medication, do not use alcohol and other prescription or OTC medications (especially sedatives, tranquilizers, antihistamines, or pain medications) without consulting prescriber. Maintain adequate hydration (2-3 L/day of fluids unless instructed to restrict fluid intake). May cause hypotension, dizziness, drowsiness, impaired coordination, or blurred vision (use caution when driving, climbing stairs, or changing position - rising from sitting or lying to standing, or when engaging in tasks requiring alertness until response to drug is known); nausea, vomiting or dry mouth (frequent mouth care, small frequent meals, chewing gum, or sucking lozenges may help); constipation (increased exercise, fluids, or dietary fruit and fiber may help - if constipation remains an unresolved problem, consult prescriber about use of stool softeners). Report persistent dizziness or headache; excessive fatigue or sedation; changes in mental status; changes in urinary elimination or pain on urination; weakness or trembling; blurred vision; or shortness of breath. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to be pregnant. If you are breast-feeding, take medication immediately after breast-feeding or 3-4 hours prior to next feeding.


Nursing Implications

Observe patient for excessive sedation, respiratory depression, implement safety measures, assist with ambulation


Dosage Forms

Capsule, as hydrochloride, immediate release (OxyIR™): 5 mg

Liquid, oral, as hydrochloride: 5 mg/5 mL (500 mL)

Solution, oral concentrate, as hydrochloride: 20 mg/mL (30 mL)

Tablet, as hydrochloride: 5 mg

Endocodone®: 5 mg

Percolone™: 5 mg

Roxicodone™: 10 mg, 30 mg

Tablet, controlled release, as hydrochloride (OxyContin®): 10 mg, 20 mg, 40 mg, 80 mg


References

"Drugs for Pain," Med Lett Drugs Ther, 1998, 40(1033):79-84.

Kalso E and Vainio A, "Morphine and Oxycodone Hydrochloride in the Management of Cancer Pain," Clin Pharmacol Ther, 1990, 47(5):639-46.

Turturro MA and O'Toole KS, "Oxycodone-Induced Pulmonary Edema," Am J Emerg Med, 1991, 9(2):201-3.


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