Oxycodone
Oxycodone should be prescribed with caution if GFR < 30 mL/ min.
Oxycodone is contraindicated if GFR < 15 mL/min.
Available in four formulations. IR stands for immediate release i.e. fast-acting and CR stands for controlled release:
- OxyNorm™ (oxycodone IR) capsules: 5 mg, 10 mg, 20 mg.
- Oxycodone CR tablets: 10 mg, 20 mg, 40 mg, 80 mg to be taken 12 hourly.
- OxyContin™ (oxycodone CR) tablets: 5 mg only.
- OxyNorm™ (oxycodone IR) liquid: 5 mg/5 mL.
- Oxycodone injection: 10 mg/mL (in either 1 or 2 mL ampoules), 50 mg/mL.
Oxycodone is similar to morphine in its action and has a similar side effect profile. This drug is more expensive than morphine and there is no clinical evidence to support its use first line. Morphine therefore remains the drug of first choice.
The main indications for use at present are:
- Persistent hallucinations or other signs of morphine neurotoxicity.
- Evidence of morphine tolerance.
Note: When taken orally, oxycodone is more potent than morphine - 10 mg oral morphine @ 5 mg oral oxycodone.
- The dose should be titrated in the same way as morphine, however oxycodone IR is often given 6 hourly rather than 4 hourly.
- Usual starting dose is 2.5 - 5 mg 6 hourly.
- It is renally cleared and should be used with caution in renal impairment.
- Oxycodone capsules and OxyContin™ tablets must be swallowed whole and are not to be broken, chewed or crushed.
- Oxycodone CR tablets can be broken in half but must not be chewed or crushed.
- Not to be given rectally.
- Subcutaneous oxycodone is between 1.5 and 2 times more potent than oral. 10 mg oral oxycodone @ 5 - 7.5 mg subcutaneous oxycodone.
- If commencing a subcutaneous infusion, refer to the Syringe Driver Compatibility Chart.
- It may be necessary to
convert oxycodone to morphine and vice versa (no conversions however are completely reliable and patients should be monitored closely).
See:
Topic Code: 4060
