ADMINISTRATION ROUTES:
PO, IV
ALTERNATIVE NAMES:
Oxynorm, Oxycontin, Oxynorm oral solution
ICU INDICATIONS:
- Opioid analgesia
PRESENTATION AND ADMINISTRATION:
IV:
Oxynorm injection 10 mg/mL and 20 mg/mL vials
Usually dilute to a concentration of 1 mg/mL using compatible IV fluid and administer by direct IV injection
Compatible in the following IV fluids: 0.9% saline, 5% dextrose, water for injection
Store at room temperature
PO:
Capsules:
Oxynorm 5mg, 10 mg and 20 mg capsule
Modified release tablets:
Oxycontin 5mg (pale blue), Oxycontin 10 mg (white), Oxycontin 20 mg (pink), Oxycontin 40 mg (yellow), Oxycontin 80 mg (green)
Oral solution:
Oxynorm oral solution 5mg/5 mL
DOSAGE:
IV:
1 - 10 mg IV 4 hourly
PO:
Oxynorm:
5 - 10 mg PO 4 - 6 hourly
Oxycontin:
5 - 10 mg PO BD
Dosage equivalent to oxynorm but sustained release
Transferring patients between oral and parenteral oxycodone:
The dose should be based on the following ratio: 2 mg of oral oxycodone is equivalent to 1 mg of parenteral oxycodone. This is a guide. Variability requires that dosage is carefully titrated to suit each individual patient.
See Appendix 6 Opioid Dose Equivalance for more details.
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
Dose in renal impairment
| GFR (ml/min) | DOSE |
|---|---|
| <10 | Avoid |
| 10-20 | Dose as in normal renal function |
| >20-50 | Dose as in normal renal function |
Dose in renal replacement therapy
| MODALITY | DOSE |
|---|---|
| CAPD | Avoid |
| HD | Avoid |
| CVVHDF | Dose as in normal renal function |
DOSAGE IN PAEDIATRICS:
Oxynorm:
0.1 - 0.2 mg/kg 4-6 hourly
Oxycontin:
0.6 - 0.9 mg/kg BD
CLINICAL PHARMACOLOGY:
Oxycodone is a pure agonist opioid whose principal therapeutic action is analgesia.
CONTRAINDICATIONS:
- Hypersensitivity to oxycodone
WARNINGS:
Oxycodone should be used with extreme caution in patients with significant chronic obstructive pulmonary disease or cor pulmonale, and in patients having a substantially decreased respiratory reserve, hypoxia, hypercapnia, or pre-existing respiratory depression.
OxyContin may cause hypotension.
A study of OxyContin in patients with hepatic impairment indicates greater plasma concentrations than those with normal function. The initiation of therapy at 1/3 to 1/2 the usual doses and careful dose titration is warranted in such patients.
PRECAUTIONS:
General:
Opioid analgesics have a narrow therapeutic index in certain patient populations, especially when combined with other CNS depressant drugs, and should be reserved for cases where the benefits of opioid analgesia outweigh the known risks of respiratory depression, altered mental state, and postural hypotension.
OxyContin and other morphine-like opioids have been shown to decrease bowel motility.
Laboratory Tests:
No tests indicated in addition to routine ICU tests
Drug/Laboratory Test Interactions:
None known
IMPORTANT DRUG INTERACTIONS IN ICU:
CNS depression is more marked when oxycodone is administered with other CNS depressants.
ADVERSE REACTIONS:
Body as a Whole:
Pruritus, sweating, anorexia
Cardiovascular:
Postural hypotension
Gastrointestinal:
Constipation, nausea, vomiting, ileus, dry mouth, abdominal pain, gastritis
Respiratory:
Dyspnoea, hiccups, respiratory depression
Nervous System:
Somnolence, headache, confusion, convulsions
Renal:
Urinary retention