Oxycodone overdose

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. 

The greatest long-term effect on health from oxycodone is addiction. NIDA warns that people who are addicted are at increased risk of overdose and death. 

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. 

A crossover study in 10 healthy subjects investigated the effect of oxycodone 500 micrograms/kg on the absorption kinetics of a simulated paracetamol overdose (5g). The maximum serum paracetamol level was reduced by 40%, the time to maximum level was increased by 68%, and the AUCq 8 was 27% lower, when compared with paracetamol alone. ... 

In an observational study in 1818 patients intended to discover whether the abuse potential of opioids matches the preference for non-therapeutic abuse in the real world, fentanyl, despite being predicted to have the greatest abuse potential, did not rank as high choice, owing to fear of toxicity and overdose hydrocodone and oxycodone were the drugs of choice in 75% of patients [10 ). 

Drug overdose Severe leukoencephalopa-thy occurred in a 46-year-old man after an overdose of oxycodone (35 x 10 mg tablets) and oxycontin (5 x 80 mg capsules) [154" ]. He developed respiratory depression, and brain imaging showed a non-vascular distribution of diffusion positive lesions in both cerebellar hemispheres and globi pallidi, with preserved cerebral perfusion. 

Although parenteral preparations of oxycodone exist, in the USA oral formulations only are available. Controlled-release forms must be swallowed whole so as not to interfere with the controlled-release mechanism chewing or cutting may lead to an overdose. Available oxycodone preparations are listed in Table 19.1. 

OxyContin (oxycodone hydrochloride controlled-release, Oxycodone CR) is an extended-duration oral opioid analgesic. It is formulated as a tablet with an outer more rapidly acting component and slower-release inner matrix that provides up to 12 hours of pain relief. Oxycodone CR offer prolonged and uniform analgesia avoiding trough effects observed with immediate-release oxycodone. Controlled-release oxycodone has abuse and diversion liability since the tablet can be easily crushed, and the entire 12 h dose administered nasally, leading to excessive acute effects and potential overdose [1]. 

Review of case reports has indicated that the risk of fatal overdose is further increased when oxycodone CR is abused concurrently with alcohol or other CNS depressants, including other opioids. 

Toxicity oxycodone CR consists of a dual-polymer matrix, intended for oral use only. Abuse of the crushed tablet poses a hazard of overdose and death. This risk is increased with concurrent abuse of alcohol and other substances. With parenteral abuse, the tablet excipients, especially talc, can be expected to result in local tissue necrosis, infection, pulmonary granulomas, and increased risk of endocarditis and valvular heart injury. 

In opioid-naive patients oxymorphone ER can be initiated in 5 mg tabs given every 12 hours. The usual titration for opioid-naive patients is to increase by 5-10 mg every 3-7 days. Oxymorphone ER should not be broken, chewed, dissolved, or crushed, because a rapid release and absorption of a potentially fatal dose of oxymorphone can occiu-. Oxymorphone ER should never be co administered with alcohol because there is a risk of increased plasma levels which can lead to potentially fatal overdose [5]. Patients currently treated with opioids yet having poor analgesic response or intolerability can be converted to oxymorphone ER. A conversion table has been developed to aid dose conversion from morphine, oxycodone, and hydrocodone to oxymorphone ER [1] (Table 25.1) To convert from oxymorphone IR to oxymorphone ER, one can add the total amount of oxymorphone IR and divide that dose into two separate doses of oxymorphone ER. 

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