oxycodone hydrochloride

(ox i koe' done)

Endocodone, M-oxy, OxyContin, Oxydose, OxyFAST, OxyIR, Percolone,
Roxicodone, Roxicodone Intensol, Supeudol (CAN)

Pregnancy Category C
Controlled Substance C-II

Drug class
Opioid agonist analgesic

Therapeutic actions
Acts as agonist at specific opioid receptors in the CNS to produce analgesia, euphoria,
sedation; the receptors mediating these effects are thought to be the same as those
mediating the effects of endogenous opioids (enkephalins, endorphins).

Indications
• Relief of moderate to moderately severe pain
• CR tablets: Management of moderate to severe pain when a continuous, around-
the-clock analgesic is needed for an extended period of time

Contraindications and cautions

• Contraindicated with hypersensitivity to opioids, diarrhea caused by poisoning
(before toxins are eliminated); pregnancy (readily crosses placenta; neonatal
withdrawal); labor or delivery (opioids given to the mother can cause respiratory
depression in neonate; premature infants are at special risk; may prolong labor);
bronchial asthma, COPD, cor pulmonale, respiratory depression, anoxia,
kyphoscoliosis, acute alcoholism, increased intracranial pressure, lactation.
• Use cautiously with acute abdominal conditions, CV disease, supraventricular
tachycardias, myxedema, seizure disorders, delirium tremens, cerebral
arteriosclerosis, ulcerative colitis, fever, Addison's disease, prostatic hypertrophy,
urethral stricture, recent GI or GU surgery, toxic psychosis, renal or hepatic
dysfunction.

Available forms
Tablets—5 mg; IR capsules—5 mg; IR tablets—15, 30 mg; CR tablets—10, 20, 40, 80,
160 mg; oral solution—5 mg/5 mL; solution concentrate—20 mg/ml

Dosages
Individualize dosage.
ADULTS
10–30 mg PO q 4 hr. OxyIR, OxyFAST, 5 mg q 3–6 hr. Controlled-release (OxyContin),
10–20 mg PO q 12 hr.
• Breakthrough pain: Immediate-release (OxyIR): 5 mg PO q 4 hr.
PEDIATRIC PATIENTS
Controlled-release is not recommended for pediatric patients. Regular and IR dosage
should be individualized based on patient's age and size.
GERIATRIC PATIENTS OR IMPAIRED ADULTS
Use caution. Respiratory depression may occur in the elderly, the very ill, those with
respiratory problems.

Pharmacokinetics
Route Onset Peak Duration
Oral 15–30 min 1 hr 4–6 hr

Metabolism: Hepatic; T1/2: 2–3 hr

Distribution: Crosses placenta; enters breast milk
Excretion: Urine

Adverse effects
• CNS: Light-headedness, dizziness, sedation, euphoria, dysphoria, delirium,
insomnia, agitation, anxiety, fear, hallucinations, disorientation, drowsiness,
lethargy, impaired mental and physical performance, coma, mood changes,
weakness, headache, tremor, seizures, miosis, visual disturbances
• CV: Facial flushing, peripheral circulatory collapse, tachycardia, bradycardia,
arrhythmia, palpitations, chest wall rigidity, hypertension, hypotension, orthostatic
hypotension, syncope, circulatory depression, shock, cardiac arrest
• Dermatologic: Pruritus, urticaria, edema, hemorrhagic urticaria (rare)
• GI: Nausea, vomiting, sweating (more common in ambulatory patients and those
without severe pain), dry mouth, anorexia, constipation, biliary tract spasm;
increased colonic motility in patients with chronic ulcerative colitis
• GU: Ureteral spasm, spasm of vesical sphincters, urinary retention or hesitancy,
oliguria, antidiuretic effect, reduced libido or potency
• Respiratory: Suppression of cough reflex, respiratory depression, apnea,
respiratory arrest, laryngospasm, bronchospasm
• Other: Physical tolerance and dependence, psychological dependence

Interactions
Drug-drug
• Increased likelihood of respiratory depression, hypotension, profound sedation or
coma in patients receiving barbiturate general anesthetics, protease inhibitors
Drug-lab test
• Elevated biliary tract pressure may cause increases in plasma amylase, lipase;
determinations for 24 hr after administration

Nursing considerations
Assessment
• History: Hypersensitivity to opioids, diarrhea caused by poisoning, pregnancy,
labor or delivery, bronchial asthma, COPD, cor pulmonale, respiratory depression,
kyphoscoliosis, acute alcoholism, increased intracranial pressure, acute abdominal
conditions, CV disease, myxedema, seizure disorders, cerebral arteriosclerosis,
ulcerative colitis, fever, Addison's disease, prostatic hypertrophy, urethral
 stricture, recent GI or GU surgery, toxic psychosis, renal or hepatic dysfunction,
lactation
• Physical: T; skin color, texture, lesions; orientation, reflexes, bilateral grip
strength, affect, pupil size; P, auscultation, BP, orthostatic BP, perfusion; R,
adventitious sounds; bowel sounds, normal output; frequency and pattern of
voiding, normal output; ECG; EEG; thyroid, liver, kidney function tests

Interventions
• Administer to nursing women 4–6 hr before the next feeding to minimize amount
in milk.
• Do not crush or allow patient to chew controlled-release preparations.
• Administer immediate-release preparations to cover breakthrough pain.
• OxyFAST and Roxicodone Intensol are highly concentrated preparations. Use
extreme care with these preparations.
• Keep opioid antagonist and facilities for assisted or controlled respiration readily
available during parenteral administration.
• Reassure patient about addiction liability; most patients who receive opiates for
medical reasons do not develop dependence syndromes.

Teaching points
• Take drug exactly as prescribed. Do not crush or chew controlled-release
preparations.
• Do not take any leftover medication for other disorders, and do not let anyone else
take the prescription.
• These side effects may occur: Nausea, loss of appetite (take with food, lie quietly,
eat frequent small meals); constipation (use a laxative); dizziness, sedation,
drowsiness, impaired visual acuity (avoid driving, performing other tasks that
require alertness, visual acuity).
• Report severe nausea, vomiting, constipation, shortness of breath, or difficulty
breathing.

Adverse effects in Italic are most common; those in Bold are life-threatening.