OXYCODONE HYDROCHLORIDE

OXYCODONE HYDROCHLORIDE
(ox-i-koe'done)
OxyContin, Percolone, Endocodone, OxyFAST, Roxicodone
Classifications: narcotic (opiate) agonist; analgesic;
Therapeutic: narcotic analgesic
Prototype: Morphine
Pregnancy Category: B (D for prolonged use or use of high doses at term)
Controlled Substance: Schedule II

Availability

5 mg, 15 mg, 30 mg tablets

OxyContin: 10 mg, 20 mg, 40 mg, 80 mg, 160 mg sustained release tablets; 5 mg/5 mL, 20 mg/mL oral solution

Action

Semisynthetic derivative of an opium alkaloid with actions qualitatively similar to those of morphine. Binds with stereo-specific receptors in various sites of CNS to alter both perception of pain and emotional response to pain, but precise mechanism of action not clear.

Therapeutic Effect

Active against moderate to moderately severe pain. Appears to be more effective in relief of acute than long-standing pain.

Uses

Relief of moderate to moderately severe pain such as may occur with bursitis, dislocations, simple fractures and other injuries, and neuralgia. Relieves postoperative, postextractional, postpartum pain.

Contraindications

Hypersensitivity to oxycodone and principal drugs with which it is combined; bronchial asthma; pregnancy (category B); for prolonged use or high doses at term (category D); lactation, children <6 y.

Cautious Use

Alcoholism; renal or hepatic disease; viral infections; Addison's disease; cardiac arrhythmias; chronic ulcerative colitis; history of drug abuse or dependency; gallbladder disease, acute abdominal conditions; head injury, intracranial lesions; hypothyroidism; prostatic hypertrophy; respiratory disease; urethral stricture; older adult or debilitated patients; peptic ulcer or coagulation abnormalities (combination products containing aspirin).

Route & Dosage

Moderate to Severe Pain
Adult: PO 5–10 mg q6h prn; OxyContin can be dosed q8h
Child: PO 6–12 y, 1.25 mg q6h prn; ≥12 y, 2.5 mg q6h prn

Administration

Oral

Ensure that sustained release form is not chewed or crushed. It must be swallowed whole.
Store this DANGEROUS medication in a place inaccessible to children at 15°–30° C (59°–86° F). Protect from light.

Adverse Effects (≥1%)

CNS: Euphoria, dysphoria, light-headedness, dizziness, sedation. GI: Anorexia, nausea, vomiting, constipation, jaundice, hepatotoxicity (combinations containing acetaminophen). Respiratory: Shortness of breath, respiratory depression. Skin: Pruritus, skin rash. CV: Bradycardia. Body as a Whole: Unusual bleeding or bruising. Urogenital: Dysuria, frequency of urination, urinary retention.

Diagnostic Test Interference

Serum amylase levels may be elevated because oxycodone causes spasm of sphincter of Oddi. Blood glucose determinations: false decrease (measured by glucose oxidase-peroxidase method). 5-HIAA determination: false positive with use of nitroisonaphthol reagent (quantitative test is unaffected).

Interactions

Drug: Alcohol and other cns depressants add to CNS depressant activity. Herbal: St. John's wort may increase sedation.

Pharmacokinetics

Absorption: Readily from GI tract. Onset: 10–15 min. Peak: 30–60 min. Duration: 4–5 h. Distribution: Crosses placenta; distributed into breast milk. Metabolism: In liver. Elimination: Primarily in urine. Half-Life: 3–5 h.

Nursing Implications

Assessment & Drug Effects

Monitor patient's response closely, especially to sustained-release preparations.
Consult physician if nausea continues after first few days of therapy.
Note: Light-headedness, dizziness, sedation, or fainting appear to be more prominent in ambulatory than in nonambulatory patients and may be alleviated if patient lies down.
Evaluate patient's continued need for oxycodone preparations. Psychic and physical dependence and tolerance may develop with repeated use. The potential for drug abuse is high.
Lab tests: Check hepatic function and hematologic status periodically in patients on high dosage.
Be aware that serious overdosage of any oxycodone preparation presents problems associated with a narcotic overdose (respiratory depression, circulatory collapse, extreme somnolence progressing to stupor or coma).

Patient & Family Education

Do not alter dosage regimen by increasing, decreasing, or shortening intervals between doses. Habit formation and liver damage may result.
Avoid potentially hazardous activities such as driving a car or operating machinery while using oxycodone preparation.
Do not drink large amounts of alcoholic beverages while using oxycodone preparations; risk of liver damage is increased.
Check with physician before taking OTC drugs for colds, stomach distress, allergies, insomnia, or pain.
Inform surgeon or dentist that you are taking an oxycodone preparation before any surgical procedure is undertaken.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

(180)