oxycodone hydrochloride

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. CR (OxyContin), 10–20 mg PO q 12 hr.

·        Breakthrough pain: Immediate-release (OxyIR): 5 mg PO q 4 hr.

PEDIATRIC PATIENTS

CR 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, or those with respiratory problems.

Pharmacokinetics

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

Metabolism: Hepatic; T_1/2: 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; LFTs, renal and thyroid 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 CR preparations.

·        Administer immediate-release preparations to cover breakthrough pain.

·        WARNING: OxyFAST and Roxicodone Intensol are highly concentrated preparations. Use extreme care with these preparations.

·        WARNING: 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.

·        You may experience these side effects: 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.