Introduction

Oxycodone is a potent opioid analgesic prescribed for the management of moderate to severe pain. As a semi-synthetic derivative of thebaine, an opiate alkaloid found in the Persian poppy, it has been utilized in clinical settings since its development in 1916. Oxycodone functions by binding to specific receptors in the brain and spinal cord, altering the perception and response to pain. Given its efficacy, it is often prescribed when other pain relief measures are inadequate.

Available Formulations

Oxycodone is available in various formulations to cater to different therapeutic needs:

• Immediate-Release Tablets: Designed for rapid pain relief, these tablets typically begin to alleviate pain within 15 to 30 minutes, with effects lasting up to 4 to 6 hours.

• Extended-Release Tablets (e.g., OxyContin): Formulated for chronic pain management, these tablets release oxycodone gradually over 12 hours, providing sustained relief.

• Combination Products: Oxycodone is often combined with other analgesics to enhance pain relief:

  • With Acetaminophen (Paracetamol): This combination targets multiple pain pathways, offering enhanced analgesia.

  • With Ibuprofen: Combining oxycodone with ibuprofen provides both opioid and non-opioid pain relief mechanisms.

  • With Naloxone: This formulation aims to reduce the risk of opioid-induced constipation and deter misuse by causing withdrawal symptoms if tampered with.

Indications for Use

Oxycodone is prescribed for:

• Acute Pain: Such as post-surgical pain or injury-related pain where short-term opioid therapy is appropriate.

• Chronic Pain: In conditions like cancer-related pain or severe osteoarthritis, where continuous pain management is necessary.

Dosage and Administration

Dosage should be individualized based on patient needs, pain severity, and prior analgesic treatment experience. It is imperative to follow the prescribing healthcare provider’s instructions meticulously. Typical dosing guidelines include:

• Immediate-Release Tablets: Administered every 4 to 6 hours as needed for pain.

• Extended-Release Tablets: Taken every 12 hours, with or without food. These tablets must be swallowed whole to prevent rapid release and absorption of a potentially fatal dose.

Potential Side Effects

Like all medications, oxycodone may cause side effects. Common adverse reactions include:

• Gastrointestinal: Constipation, nausea, vomiting.

• Central Nervous System: Drowsiness, dizziness, lightheadedness.

• Dermatologic: Itching, sweating.

Less common but serious side effects may encompass:

• Respiratory Depression: Slowed or shallow breathing, which can be life-threatening.

• Hypotension: Low blood pressure leading to dizziness or fainting.

• Allergic Reactions: Rash, swelling, severe dizziness, or difficulty breathing.

If any severe side effects or signs of an allergic reaction occur, seek immediate medical attention.

Drug Interactions

Oxycodone can interact with various medications, potentially altering its effects or increasing the risk of adverse reactions:

• Central Nervous System Depressants: Concurrent use with benzodiazepines, other opioids, muscle relaxants, or alcohol can enhance sedative effects and increase the risk of respiratory depression.

• Monoamine Oxidase Inhibitors (MAOIs): Using oxycodone with MAOIs or within 14 days of stopping MAOIs can result in severe and unpredictable reactions.

• Cytochrome P450 Enzyme Interactions: Drugs that inhibit or induce CYP3A4 or CYP2D6 enzymes can affect oxycodone metabolism, leading to altered plasma concentrations.

It is essential to inform the prescribing healthcare provider of all medications, supplements, and herbal products being taken to assess potential interactions.

Warnings and Precautions

• Addiction, Abuse, and Misuse: Oxycodone carries a significant risk for addiction, even at prescribed doses. Misuse can lead to overdose and death. Assess each patient’s risk before prescribing and monitor regularly for signs of misuse or addiction.

• Life-Threatening Respiratory Depression: Serious, life-threatening, or fatal respiratory depression may occur. Monitor patients closely, especially upon initiation or following a dose increase.

• Accidental Ingestion: Accidental ingestion, especially by children, can result in a fatal overdose. Store oxycodone securely and out of reach of children.

• Neonatal Opioid Withdrawal Syndrome: Prolonged use during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated.

• Interactions with Alcohol: Instruct patients not to consume alcoholic beverages or use prescription or non-prescription products containing alcohol while on oxycodone therapy.