Oxycodone dosage

Oxycodone, a controlled-release dosage form, is sometimes crushed by abusers to get the full 12-hour effect almost immediately. Snorting or injecting the crushed tablet can lead to overdose and death. 

Adults 10 to 30 mg every 4 hours (5 mg every 6 hours for OxylR, oxycodone IR capsules, Oxydose, and OxyPAST) as needed. Individualize dosage. More severe pain may require 30 mg or more every 4 hours. If the pain increases in severity, analgesia is not adequate, or tolerance occurs, a gradual increase in dosage may be required. 

CR tablets, 80 and 160 mg, are for use only in opioid-tolerant patients requiring daily oxycodone equivalent dosages of at least 160 mg for the 80 mg tablet and at least 320 mg for the 160 mg tablet. Take care in the prescribing of these tablet strengths. Instruct patients against use by individuals other than the patient for whom it was prescribed, as such inappropriate use may have severe medical consequences, including death. 

Do not use oxycodone in children. Safe dosage of codeine has not been established for children younger than 3 years of age. Safety and efficacy have been established with remifentanil from birth to 12 years of age in maintenance of general anesthesia. 

Dosages and routes of administration Oxycodone is given by mouth in single doses of 5-10 mg or as controlled release preparations with doses of 40 mg (Cairns, 2001). Rectal administration is also possible. Oral formulations often contain combinations with paracetamol or acetylsalicylic acid. 

Gabrail NY, Dvergsten C, Ahdieh H. Establishing the dosage equivalency of oxymorphone extended release and oxycodone controlled release in patients with cancer pain a randomized controlled study. CurrMed Res Opin. 2004 20 911-918. 

Oxycodone can be addictive when taken in dosages higher than those prescribed by a doctor or when taken for nonmedical purposes (i.e., recreational drug use). For these reasons, people with a prior history of other drug abuse may be advised not to take oxycodone. 

Hallucinations have been described after the use of morphine in various dosage forms in one series, patients experienced adequate pain relief and no further hallucinations or nightmares when changed to oxycodone (540). Delusions and hallucinations have been reported in a patient who was also taking dosulepin (541). Restlessness, vomiting, and disorientation were described in two male patients over 60 years of age taking modified-release morphine for relief of pain in advanced cancer (542). 

Heroin can be snorted, smoked, and given intravenously. Complications of heroin use include overdoses, anaphylactic reactions to impurities, nephrotic syndrome, septicemia, endocarditis, and acqnired immunodeficiency. Oxycodone, a controUed-release dosage form, is sometimes crushed by abusers to get the full 12-hour effect almost immediately. Snorting or injecting the crushed tablet can lead to overdose and death. 

In end-stage cirrhosis, reduced clearance and prolonged half-life of oxycodone may necessitate dosage reduction (SEDA-22, 101). 

A man with advanced multiple sclerosis found that when he began to take fluoxetine 20 mg daily for depression he needed to increase his analgesic dosage of oxycodone (for painful muscle spasms) about fourfold, from 65 to 75 mg daily to about 250 to 275 mg daily. ... 

Oxycodone is structurally similar to codeine while pharmacodynamically comparable to morphine in onset and duration of action. It is approximately 1.5 times more potent than morphine with equivalent effectiveness in equianalgesic dosages. Oxycodone has high oral bioavailability (60%) compared with morphine (20-30%), which is the most notable difference between these drugs. It also explains why oxycodone has a rapid analgesic onset and onset-to-peak effect. In clinical practice oxycodone does not release significant amounts of histamine and may cause less sedation than equivalent doses of morphine. 

Oxycodone and its metabolites are eliminated by the kidneys. Dosage adjustments are required in patients with moderate to severe liver and kidney dysfunction, although to a lesser extent than with morphine. No dosing decrements are required in the elderly except for those who are debilitated. 

OxyContin tablets are designed to provide controlled delivery of oxycodone over 12 hours. Oxycodone release from OxyContin tablets is pH-independent. Oxycodone is well absorbed from OxyContin tablets with an oral bioavailability of 60% to 87%. The relative oral bioavailability of OxyContin to immediate-release oral dosage forms is 100%. Steady-state levels are achieved within 24-36 hours in normal volunteers after repeated dosing in pharmacokinetic studies. 

For the symptomatic relief of moderate to moderately severe pain, hydrocodone should be administered in the smallest dose as infrequently as possible to achieve the desired treatment effect and minimize the development of tolerance and dependence. The usual adult dosage is 5 to 10 mg PO every 4 to 6 hours as necessary, with manufacturer recommendations on maximum daily total doses of 60 mg when combined with acetominophen and 37.5 mg when combined with ibuprofen. Unlike when used as an antitussive, where the recommended dose for children 6 to 12 years of age is 2.5 mg PO every 4 to 6 hours as necessary with a daily maximum of 15 mg, there is no consensus pediatric recommendation for the use of hydrocodone bitartrate as an analgesic agent. Additionally, in both cases, there are no data on the efficacy and safety of its use in children under 6 years of age. However, some authors and clinicians recommend an analgesic pediatric starting dose, based on the hydrocodone component of various preparations, of 0.1 mg/kg every 4 to 6 hours as needed, similar to the pediatric dose of oxycodone. 

Observational studies In patients with moderate to severe cancer pain taking OxyContin (controlled-release oxycodone hydrochloride), adverse reactions occurred in 25% in the first week and the incidence gradually fell with time, to 12% in the 8th week [132 ]. The most common adverse effects reported in the first week were constipation (26%), nausea (13%), vomiting (6.2%), dizziness (5%), and lethargy (3.7%). Other effects included dysuria, fatigue, headache, pruritus, and thirst. There was a similar pattern at 8 weeks. Five patients had delusions after dosage reduction or withdrawal, and another had delirium on days 2 and 3. The authors suggested that the adverse effects of OxyContin could be reduced with preventive medication. 

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