OxycodoneRx

Trade Names: Roxicodone, Oxycodone immediate release (generic),  Oxycontin (extended release)

Drug Class: Narcotic analgesic

Preparations
Tablets (immediate release): 5-, 10-, 15- , 20-,  30 mg
Tablets (controlled release): 10-, 15-, 20-, 30-, 40-, 60-, 80 mg
Oral suspension: 5 mg/5 mL

Dose: immediate release: 5–10 mg three to four times daily; extended release: if opioid naive, 10 mg every 12 hours initially; if already on immediate release, divide total daily dose in half and administer every 12 hours sustained release.

Indications: Pain not controlled by nonopioid drugs; extended release  preparations are only indicated for patients with severe pain requiring round-the-clock pain control and should not be used as needed.

Mechanism of Action: Binds to opioid receptors in CNS

Contraindications: Hypersensitivity to oxycodone, substance abuse, respiratory depression

Precautions: Use caution in patients with hypersensitivity to other opioids, respiratory disease, or renal or hepatic impairment. Decrease dose with hepatic or renal impairment. Affects ability to operate machinery. May cause fatal respiratory depression. Interactions with CYP3A4 inhibitors.

Monitoring: Use the lowest dose necessary to control pain. Escalate dose only for uncontrolled pain.

Pregnancy Risk: C/D high doses (neonatal abstinence syndrome)

Adverse Effects
Common: Drowsiness, dizziness, constipation, dysphoria, nausea, pruritus
Less common: Rash, CNS stimulation, insomnia, hypotension, addiction, respiratory depression, overdose, death

Drug Interactions
CNS depressants: Increased CNS depression
MAOIs: Avoid
Cytochrome P450 3A4 inhibitors: CYP 3A inhibitors such as ritonavir, nelfinavir, ketoconazole and other azoles, trolandeomycin, erythromycin, clarithromycin, verapamil, diltiazem and nefazodone increase oxycodone concentrations and monitoring and dose adjustments are needed

Patient Instructions: Drug is addictive. Use only to control pain. Do not use with alcohol or other CNS depressants. Do not crush slow-release tablets.

Comments: Because of greater  risks, physicians prescribing extended release oxycodone need to receive training  per the REMS program instituted by the FDA  http://www.purduesrems.com/

Clinical Pharmacology: Oral absorption and hepatic metabolism by CYP3A4; urinary elimination as metabolites. Half-life of immediate release is 3 hours with duration of effect 3–6 hours.

Cost: $$