oxycodone hydrochloride: clinical use

Prescribing considerations

• Agree treatment goals, review points and a discontinuation plan before starting.
• Assess respiratory risk, frailty, renal and hepatic function, bowel function, sleep apnoea, mental health and substance use history.
• Review concurrent opioids, sedatives and medicines affecting CYP3A4 or CYP2D6.
• Repeated use can cause tolerance, physical dependence and opioid use disorder; abrupt withdrawal after sustained use can cause withdrawal symptoms.

Contraindications and cautions

• Hypersensitivity to oxycodone or formulation excipients.
• Severe respiratory depression with hypoxia or hypercapnia.
• Severe obstructive pulmonary disease, cor pulmonale or severe bronchial asthma where specified by the product licence.
• Paralytic ileus; some formulations additionally contraindicate acute abdomen, delayed gastric emptying or chronic constipation.
• Product-specific restrictions apply in hepatic impairment and for excipients such as soya lecithin.

Monitoring

• Pain relief, function and continued clinical need.
• Sedation, respiratory rate and signs of opioid toxicity, particularly after initiation or interacting-medicine changes.
• Constipation, nausea, urinary retention and other opioid adverse effects.
• Signs of tolerance, withdrawal, misuse, dependence or opioid use disorder.
• New or worsening sleep-related breathing problems.
• Renal and hepatic status where clinically relevant.

Clinical pharmacology

Oxycodone is a semisynthetic opioid agonist acting mainly through mu-opioid receptors. It is metabolised predominantly by CYP3A4, with a smaller CYP2D6 contribution, and is eliminated mainly in urine.

Formulation and product differences

• Immediate-release capsules and oral solutions provide relatively rapid systemic exposure; concentrated and standard oral liquids need different measuring devices.
• Prolonged-release tablets must be swallowed whole, not divided, chewed or crushed.
• Injection concentrate is for intravenous or subcutaneous injection or infusion by trained professionals and may require dilution according to its SmPC.
• Licensed indications and minimum approved age differ between selected products.

Capsule

Route: Oral

Strengths: 5 mg, 10 mg, 20 mg

Modified-release tablet

Route: Oral

Strengths: 5 mg, 10 mg, 15 mg, 20 mg, 30 mg, 40 mg, 60 mg, 80 mg, 120 mg