Oxycodone

Oxycodone

[20mg tablets $1.00]

ADMINISTRATION ROUTES:

• PO, IV

ALTERNATIVE NAMES:

• Oxynorm, Oxycontin, Oxynorm oral solution

ICU INDICATIONS:

1. opioid analgesia

PRESENTATION AND ADMINISTRATION:

• IV:
  Oxynorm injection 10mg/ml and 20mg/ml vials
  Usually dilute to a concentration of 1mg/ml using compatible IV fluid and administer by direct IV injection
  Compatible in the following IV fluids:
  Normal saline, 5% dextrose, Water for injection
  Store at room temperature

• PO:
  Capsules:
  Oxynorm 5mg, 10mg and 20mg capsule
  Modified release tablets:
  Oxycontin 5mg (pale blue), Oxycontin 10mg (white), Oxycontin 20mg (pink), Oxycontin 40mg (yellow), Oxycontin 80mg (green)
  Oral solution:
  Oxynorm oral solution 5mg/5ml

DOSAGE:

• IV:
  1-10mg IV 4hourly (higher doses may be required)
• PO:
  Oxynorm:
  Initially 5-10mg 4-6 hourly
  Oxycontin:
  Dosage equivalent to oxynorm but sustained release (therefore administered only every 12 hours) Transferring patients between oral and parenteral oxycodone:
  The dose should be based on the following ratio: 2 mg of oral oxycodone is equivalent to 1 mg of parenteral oxycodone. It must be emphasised that this is a guide to the dose required. Inter-patient variability requires that each patient is carefully titrated to the appropriate dose.

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

• Dose in renal impairment [GFR (ml/min)]
  <10: avoid
  10-20: dose as in normal renal function
  >20-50: dose as in normal renal function
• Dose in renal replacement therapy
  CAPD: avoid
  HD: avoid
  CVVHDF: dose as in normal renal function

DOSAGE IN PAEDIATRICS:

• Oxynorm:
  0.1-0.2mg/kg 4-6 hourly
  
• Oxycontin:
  0.6-0.9mg/kg 12 hourly

CLINICAL PHARMACOLOGY:

• Oxycodone is a pure agonist opioid whose principal therapeutic action is analgesia.

CONTRAINDICATIONS:

1. hypersensitivity to oxycodone

WARNINGS

• Oxycodone should be used with extreme caution in patients with significant chronic obstructive pulmonary disease or cor pulmonale, and in patients having a substantially decreased respiratory reserve, hypoxia, hypercapnia, or pre-existing respiratory depression. OxyContin may cause hypotension. A study of OxyContin in patients with hepatic impairment indicates greater plasma concentrations than those with normal function. The initiation of therapy at 1/3 to 1/2 the usual doses and careful dose titration is warranted in such patients.

PRECAUTIONS

• General:
  Opioid analgesics have a narrow therapeutic index in certain patient populations, especially when combined with CNS depressant drugs, and should be reserved for cases where the benefits of opioid analgesia outweigh the known risks of respiratory depression, altered mental state, and postural hypotension.
  OxyContin and other morphine-like opioids have been shown to decrease bowel motility.
• Laboratory Tests: No tests indicated in addition to routine ICU tests
• Drug/Laboratory Test Interactions: None known

IMPORTANT DRUG INTERACTIONS FOR THE ICU

• CNS depression is more marked when oxycodone is administered with other CNS depressants

ADVERSE REACTIONS

• Body as a Whole:
  Pruritus, sweating, anorexia
• Cardiovascular:
  Postural hypotension
• Gastrointestinal:
  Constipation, nausea, vomiting, ileus, dry mouth, abdominal pain, gastritis
• Respiratory:
  Dyspnoea, hiccups, respiratory depression
• Nervous system:
  Somnolence, headache, confusion, convulsions.
• Renal:
  Urinary retention