Oxycodone Hydrochloride

Drug Class: Oxycodone Hydrochloride > Oxycodone > Semi Synthetic Opioid > Opioids > Opioid Agonist > Analgesic.

Uses

Physicians usually prescribe oxycodone hydrochloride to treat moderate to moderately severe pain. This drug effectively reduces short-term postoperative pain or pain from acute trauma.

Other, off label uses for this medicine

Doctors normally use oxycodone hydrochloride to relieve acute pain but sometimes recommend oxycodone hydrochloride to treat long-term pain associated with cancer or other chronic illnesses.

General Drug Information

Oxycodone hydrochloride is an opioid pain reliever, sometimes called a narcotic.

Drug manufacturers offer oxycodone hydrochloride in tablets, capsules or solutions in immediate- or extended-release formulas for oral administration.

Extended-release oxycodone hydrochloride formulas reduce around-the-clock pain associated with some chronic conditions. These extended-release formulas are not for as-needed pain.

Brand name oxycodone hydrochloride products include OxyContin, Percodan, Percocet, Roxicet, Roxicodone and Tylox; some of these preparations contain oxycodone hydrochloride along with acetaminophen, ibuprofen or other analgesics.

Administration/Dosage

Physicians usually start patients on 5 to 15 mg of oxycodone hydrochloride every four to six hours as needed to control pain. Doctors will adjust dosages based on the severity of pain and the patient’s response to treatment for that pain.

Doctors will typically prescribe initial doses of extended-release varieties at 10 mg every 12 hours. Consumers who are accustomed to the effects of opioids may require larger doses.

Some patients may be sensitive to the effects of oxycodone hydrochloride. Doctors should consider lower dosages for elderly patients and those with impaired kidney or liver function.

Food does not affect the action of oxycodone hydrochloride; patients can take oxycodone hydrochloride with or without food.

Action

Oxycodone hydrochloride works with the central nervous system, or CNS, to dull the brain’s perception of pain. Oxycodone hydrochloride causes other CNS effects such as sedation, anti-anxiety and a pleasant feeling of euphoria.

All opioids, including oxycodone hydrochloride, can depress respiratory centers to decrease the brain’s drive to breathe. This action can cause slow, shallow or irregular breathing patterns. Additionally, oxycodone hydrochloride depresses the cough reflex, making the brain less concerned about the need to clear mucus and debris from the lungs.

Oxycodone hydrochloride increases the tone of smooth muscle groups throughout the body, making these muscles stiff and less functional. Smooth muscle groups are located in the urinary tract, skin, eyes, in intestinal muscles that propel stool through the digestive tract and in the organs of the biliary tract, including the ducts that control the flow of bile and pancreatic fluid into the small intestine.

Oxycodone hydrochloride can interact with the cardiovascular system to release histamines, responsible for itching, watery eyes and a stuffy or runny nose. Oxycodone hydrochloride causes vasodilation; this expansion of blood vessels results in lower blood pressure.

Warnings

Administration

Consumers are to swallow whole oxycodone hydrochloride tablets and capsules, and never chew, suck, crush, snort or inject these drugs. Improper administration may cause uncontrolled delivery of oxycodone and pose a significant health problem, including overdose and death.

Using oxycodone with alcohol, other opioids or illicit drugs further depresses the central nervous system, sometimes with dangerous results.

Tolerance and Dependence

When someone first starts taking opioids, his body is sensitive to the effects of oxycodone. Doctors refer to this as being “opioid-naïve.” Some forms of oxycodone, especially large single doses or controlled-release formulas, are not appropriate for opioid-naïve patients. A single dose greater than 40 mg of oxycodone, or a total daily dose of more than 80 mg, can be fatal in an opioid-naïve consumer.

As the consumer continues to use oxycodone at therapeutic doses, his body becomes more tolerant to the effects of opioids. Consequently, an opioid-tolerant person requires larger oxycodone doses more frequently to achieve the same effect.

Increased tolerance and high oxycodone doses raise the risk for serious side effects and toxic oxycodone overdose. Continued use at these high doses may cause some consumers to grow physically dependent on oxycodone and suffer withdrawal symptoms when he stops using this drug.

Respiratory Depression

Oxycodone hydrochloride can diminish the brain’s respiratory drive to the point of respiratory depression, a dangerous and life-threatening breathing condition. The slow, shallow and irregular breathing patterns associated with respiratory depression make it difficult for the lungs to exchange oxygen for carbon dioxide. Respiratory depression can result in oxygen starvation and toxic levels of carbon dioxide.

Elderly and debilitated patients, those with COPD and some types of heart disease face a higher risk for respiratory depression, as do those with diminished lung capacity, low oxygen or high carbon dioxide levels, or pre-existing respiratory depression.

Hypotension

Oxycodone hydrochloride causes vasodilation and can cause hypotension in those already having trouble controlling their blood pressure, either because they have lost a lot of blood or because they have taken another drug that lowers blood pressure. Physicians should administer oxycodone hydrochloride with care to patients who are in shock, since the vasodilation caused by this drug can decrease the amount of blood pumped by the heart and further reduce blood pressure in these patients.

Use in Patients with Increased Intracranial Pressure and Head Injury

Respiratory depression and opioids both increase the intracranial fluid pressure surrounding the brain. Head injury, brain tumors and pre-existing high intracranial pressure enhance these effects. Furthermore, oxycodone can cause drowsiness and pinpoint pupils in a way that hides the presence or progression of a head injury.

Precautions

Oxycodone can make the consumer feel dizzy, lightheaded or drowsy. Opioids, including oxycodone, can impair physical and mental performance. A consumer should not operate a motor vehicle or heavy machinery until he knows how oxycodone affects him.

Contraindications

Healthcare providers should not administer oxycodone in situations where opioid analgesics are inappropriate, such as in patients suffering from severe asthma, high carbon dioxide levels or in those showing signs of respiratory depression in unmonitored settings or in locations without resuscitative equipment.

Individuals with a known or suspected hypersensitivity to oxycodone or other opioids should not use products containing this drug.

Special Risk Groups

Patients with biliary tract disease, including pancreatitis, should not use oxycodone as this drug can reduce the production of bile and pancreatic juices and cause painful spasms affecting the duct controlling the flow of these secretions.

Patients with intestinal blockage, especially paralytic ileus, should not use oxycodone because this medication may prolong the obstruction. Oxycodone can obscure the diagnosis and healing process of some abdominal conditions.

Elderly and debilitated patients should use oxycodone with caution, as should those with severe kidney or liver problems, Addison’s disease and some types of thyroid, prostate and urinary problems.

Physicians should exercise caution when prescribing oxycodone for patients with CNS depression, severe mental disorders and to severe alcoholics or those suffering from delirium tremens, otherwise known as “DTs.”

Oxycodone can aggravate convulsive conditions and may induce or worsen seizures in some settings.

Pregnancy, Labor and Delivery, Breastfeeding

Oxycodone hydrochloride is an FDA Pregnancy Category B, there are no studies to show oxycodone poses a risk to a pregnant woman or a fetus. Physicians, however, recommend pregnant women use oxycodone only when the benefits clearly outweigh the risks.

Opioids, including oxycodone, cross the placental barrier from the mother to the unborn baby. Babies born to women who take oxycodone during pregnancy may suffer respiratory depression and withdrawal symptoms during the first days of life. Unlike adult withdrawal syndrome, withdrawal may be fatal in a newborn. Neonatal withdrawal symptoms include excessive crying, irritability, increased stools, hyperactive reflexes and rapid breathing.

Oxycodone may prolong labor by temporarily reducing the strength, frequency and duration of contractions. Babies born to women who receive oxycodone during labor may suffer respiratory depression after delivery; labor and delivery staff should be prepared to administer naloxone or other drugs to the newborn to reverse the effects of respiratory depression.

Scientists can detect low levels of oxycodone in human milk; a mother may pass oxycodone to her breastfeeding baby. Oxycodone levels in the nursing baby depend largely on the dosage the mother takes, the amount of milk the infant consumes and the rate at which the baby metabolizes and eliminates oxycodone. There is a serious risk for adverse effects in infants who breastfeed from women taking oxycodone, including respiratory depression, sedation and withdrawal symptoms when the mother stops taking oxycodone or when the baby stops breastfeeding.

Drug Interactions

Taking oxycodone hydrochloride along with other CNS depressants increase the risk for respiratory depression, hypotension, profound sedation or coma. Other CNS depressants include alcohol, other opioids, sedatives, general anesthetics, anti-nausea and vomiting drugs, anti-psychotic medications and tranquilizers.

Oxycodone hydrochloride can enhance the effects of muscle relaxants to increase the risk for respiratory depression.

Some medications can block the effects of oxycodone to reduce its analgesic effects and cause withdrawal symptoms in opioid-dependant individuals. Examples of these drugs include pentazocine, nalbuphine, butorphanol and buprenorphine.

Patients should not use oxycodone within 14 days of using an MAOI; dangerous side effects could occur, including anxiety, confusion, significant respiratory depression or coma.

Oxycodone can interact with CYP3A inducers and inhibitors in unsafe or dangerous ways. CYP3A inhibitors may prolong the effects of oxycodone, while CYP3A inducers can reduce the analgesic effects of oxycodone and cause withdrawal symptoms in opioid-dependent consumers.

Oxycodone hydrochloride can interact with anticholinergics, which also work on smooth muscle groups but in a different way. Taking oxycodone along with an anticholinergic can result in urinary retention and severe constipation that could cause the dangerous type of bowel obstruction, paralytic ileus.

Side effects

All medications, including oxycodone, can cause side effects in some consumers. The most frequently reported side effects are lightheadedness, dizziness, sedation, nausea and vomiting. Other non-serious adverse effects include constipation, itching, skin rash, euphoria and its emotional opposite, dysphoria.

Serious adverse effects include respiratory depression, CNS depression, hypotension, paralytic ileus, seizures, cardiac arrest, opioid dependence and addiction.

In many cases, physicians can reduce the severity of these adverse reactions by starting the patient on a lower initial dose, then increasing dosages until the doctor establishes a balance between analgesia and side effects. Some of the non-serious side effects will fade as the patient becomes more tolerant to the effects of oxycodone.

Overdose

Oxycodone overdose is a serious and sometime fatal medical emergency. Overdose from prescription painkillers, including oxycodone, claim the lives of about 15,000 Americans annually. Oxycodone overdose requires immediate medical care.

Emergency room visits for problems involving oxycodone more than doubled in just four years, rising from an estimated 41,700 visits to the ER in 2004 to 105,200 patients requiring emergency help for oxycodone problems in 2008.

Symptoms of oxycodone overdose include respiratory depression, extreme sleepiness that progresses to stupor or coma, limp skeletal muscles, pinpoint pupils and cold, clammy skin. Sometimes the victim will have a slow heartbeat and hypotension. In cases of extreme overdose, the individual will have breathing that pauses or stops completely, collapse of the circulatory system or a stopped heartbeat. Death may occur.

Emergency treatment for oxycodone hydrochloride overdose focuses on maintaining respiration: emergency department personnel will establish an airway or place the patient on a ventilator to help him breathe. Nurses may start intravenous fluids to manage blood pressure and administer medicine.

Nurses may pump the stomach or introduce charcoal to absorb excess oxycodone. Physicians may administer naloxone or nalmefene to reverse the effects of respiratory depression if the patient shows signs of this dangerous complication. Nurses and doctors will perform CPR and other life-saving measures as necessary.

Abuse

Drug abusers have been targeting oxycodone for its euphoric effects since the early 1960s. Many recreational users swallow oxycodone tablets whole. To achieve a more powerful and immediate effect, some drug abusers chew the tablet or crush it before swallowing, snorting or injecting the product.

The DEA classifies oxycodone hydrochloride as a class II drug, meaning it poses a relatively high risk for abuse. According to the DEA, oxycodone became “the most frequently encountered pharmaceutical drug by law enforcement” in 2009, with oxycodone use increasing across all ethnic and economic groups.

To reduce this risk for abuse, oxycodone hydrochloride is available only with a prescription.

Withdrawal

Recreational use and long-term therapeutic use increase the consumer’s risk for becoming dependent on opioids and suffering withdrawal symptoms when he stops using oxycodone abruptly.

Symptoms of oxycodone withdrawal can be flu-like and include abdominal cramps, nausea and vomiting, diarrhea, stuffy or runny nose, chills, watery eyes, sweating, weakness, joint pain and muscle aches. The individual may feel restless, irritable or anxious, and have trouble sleeping. Other symptoms include yawning, pinpoint pupils, backache and increased blood pressure, respiratory rate or heart rate.

To avoid these symptoms, long-term oxycodone consumers should taper use rather than discontinuing this drug abruptly.

Detox

Overpowering and persistent withdrawal symptoms prevent many individuals from quitting oxycodone hydrochloride at the appropriate time. Many healthcare institutions now offer detoxification services to help people overcome oxycodone withdrawal symptoms. Detoxification specialists administer drugs to lower oxycodone levels along with multiple medications to ease withdrawal symptoms.

Rapid detox offers a more humane and efficient treatment for opioid dependence. During rapid detox, doctors sedate and anesthetize patients before administering the standard detoxification and anti-withdrawal drugs. Rapid detox patients doze in a comfortable “twilight sleep” for a few hours during the detoxification process, rather than battling detoxification for days using other procedures.

Storage

Caregivers should store oxycodone tablets at temperatures ranging between 59 and 86 degrees Fahrenheit, away from light. Consumers should protect oxycodone capsules and oral solutions from moisture.

Miscellaneous information

Drug manufacturers sometimes combine oxycodone hydrochloride with acetaminophen, ibuprofen or other non-opioid analgesics to relieve pain more completely than either medicine could alone.