NSAIDs Oxycodone

Clinically important, potentially hazardous interactions with aspirin, boswellia, ciprofibrate, diuretics, methotrexate, NSAIDs, oxycodone hydrochloride, salicylates, tacrine, tacrolimus, urokinase... 

Low-dose opioid analgesics (e.g., oxycodone) may be useful for patients who experience no relief with acetaminophen, NSAIDs, intraarticular injections, or topical therapy. 

Acute pain is managed with either nonopioids such as acetaminophen, NSAIDs, or, when severe, opioids such as meperidine, morphine, methadone, hydromor-phone, fentanyl, or sufentanil (Golianu et ah, 2000). The latter are generally used parenterally, and when the patient is converted to oral analgesics, agents such as codeine, oxycodone, and hydrocodone are often used. 

Consider other NSAIDs or COX-2 inhibitors (it not contraindicated) or oral oxycodone (Roxicodone), morphine (Duramorph), or advance to higher level of care (parenteral analgesia and/or pain-management specialist). 

Oxycodone PO 5-10 mg q 3-5 h Controlled release, 10-20 mg q 12 h Use in moderate/severe pain Most effective when used with NSAIDs or aspirin or acetaminophen Use immediate-release product with controlled-release product to control "breakthrough" pain in cancer patients... 

NSAIDs are often administered with opioids because they usually reduce the opioid requirements and some of the opioid-induced Averse effects. Enhanced pain relief has been reported with various combinations including dextromethorphan with ketorolac or tenoxicam, oxycodone with ibuprofen, and tramadol with ketorolac without increased adverse effects. See also coxibs , (p.l79). However, cases of respiratory depression have been reported, see Morphine below. Myoclonus has been reported with high does of morphine administered with NSAIDs, see C3pioids Morphine + Miscellaneous , p.l90. 

Oxycodone compounds that are combined with aspirin, acetaminophen, or ibuprofen are limited in dose by the amount of the non-opioid component. These combination products provide enhanced analgesic effect with fewer opioid side effects, and possibly better compliance because the patient does not need two separate medications. Use of oxycodone alone may be advantageous in those patients who are at risk for toxicity from NSAIDs or acetaminophen. The maximum daily dose of acetaminophen is 4000 mg in a person with no liver impairment. 

Combination medications, including opioid plus NSAID preparations, are more effective than either drug alone for relief of acute pain, including post-surgical pain (1 ]. Vicoprofen", hydrocodone plus ibuprofen, was developed in 1997. Combunox , oxycodone plus ibuprofen, was developed in 2001 and approved for use in 2004 [2]. Reprexain also was marketed in 2004, while Ibudone was released in 2006. These combination medications were approved for use for approximately 7-10 days for relief of acute moderate... 

Absolute contraindications for both opioids and NSAIDS include hypersensitivity reactions, such as development of shortness of breath, severe rash, etc. Oxycodone and hydrocodone are contraindicated in patients with risk for significant respiratory depression. Because of the inhibition of GI motility by narcotic medications, oxycodone and hydrocodone are contraindicated in the setting of paralytic ileus. 

Combination opioids and NSAIDs are provided in oral preparations. Vicoprofen is supplied as 7.5 mg hydrocodone plus 200 mg ibuprofen tablets. For acute moderate to severe pain 1 tablet should be taken every 4-6 hours. Ibudone is supplied as a 10 mg/200 mg tablet, while Reprexain is manufactured as 2.5 mg, 5 mg or 10 mg/200 mg combination tablets. Each is commonly prescribed as 1 tablet every 4-6 hours for acute moderate to severe pain. Combunox is 5 mg oxycodone and 400 mg ibuprofen, every 6 hours, with a maximum of four tablets daily. Combunox may offer advantages over other preparations since it contains a higher dose of ibuprofen (400 mg) equivalent to doses commonly prescribed for acute pain. It is recommended that therapy be limited to 7-10 days or less. 

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