ox-i-KOE-done
Therapeutic Classification: opioid analgesics
Pharmacologic Classification: opioid agonists, opioid agonists nonopioid analgesic combinations
High Alert
Absorption: Well absorbed from the GI tract.
Distribution: Widely distributed to tissues.
Protein Binding: 38–45%
Half-Life: 2–3 hr.
(analgesic effects)
| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| PO | 10–15 min | 60–90 min | 3–6 hr |
| PO-ER‡ | 10–15 min | 3 hr | 12 hr |
‡Extended release.
Contraindicated in:
Use Cautiously in:
Avoid chronic use; prolonged use of opioids during pregnancy can result in neonatal opioid withdrawal syndrome
;CV: orthostatic hypotension
Derm: flushing, sweating
EENT: blurred vision, diplopia, miosis
Endo: adrenal insufficiency
GI: constipation, choking, dry mouth, GI obstruction, nausea, vomiting
Neuro: confusion, sedation, dizziness, dysphoria, euphoria, floating feeling, hallucinations, headache, unusual dreams
Resp: RESPIRATORY DEPRESSION (INCLUDING CENTRAL SLEEP APNEA AND SLEEP-RELATED HYPOXEMIA)
Misc: allodynia, opioid-induced hyperalgesia,
physical dependence
,psychological dependence
, toleranceDrug-drug:
Use with benzodiazepines or other CNS depressants, including other opioids, nonbenzodiazepine sedative/hypnotics, anxiolytics, general anesthetics, muscle relaxants, antipsychotics, and alcohol, may cause profound sedation, respiratory depression, coma, and death; reserve concurrent use for when alternative treatment options are inadequate.
CYP3A4 inhibitors, including ritonavir, ketoconazole, itraconazole, fluconazole, clarithromycin, erythromycin, nefazodone, diltiazem, verapamil, nelfinavir, and fosamprenavir, ↑ levels and risk of opioid toxicity; careful monitoring during initiation, dose changes, or discontinuation of the inhibitor is recommended.
Hepatic Impairment
Assess BP, HR, and respiratory rate before and periodically during administration. If respiratory rate <10/min, assess level of sedation. Physical stimulation may be sufficient to prevent significant hypoventilation. Dose may need to be ↓ by 25–50%. Initial drowsiness will ↓ with continued use. Monitor for respiratory depression, especially during initiation or following dose ↑; serious, life-threatening, or fatal respiratory depression may occur. May cause sleep-related breathing disorders (central sleep apnea, sleep-related hypoxemia).
Geri: Assess older adults and pediatric patients frequently; more sensitive to the effects of opioid analgesics and may experience side effects and respiratory complications more frequently.Assess risk for opioid addiction, abuse, or misuse prior to administration. Abuse or misuse of extended-release preparations by crushing, chewing, snorting, or injecting dissolved product will result in uncontrolled delivery of oxycodone and can result in overdose and death. Abuse deterrent: Xtampza ER and Oxycontin are abuse deterrent formulations that are difficult to crush and if crushed result in a gel.
Lab Test Considerations:
Toxicity and Overdose:
Advise patient to notify health care provider if pregnancy is planned or suspected or if breastfeeding. Inform patient of potential for neonatal opioid withdrawal syndrome with prolonged use during pregnancy. Monitor neonate for signs and symptoms of withdrawal symptoms (irritability, hyperactivity and abnormal sleep pattern, high-pitched cry, tremor, vomiting, diarrhea, failure to gain weight); usually occur the first days after birth. Monitor infants exposed to oxycodone through breast milk for excess sedation and respiratory depression. Doses <60 mg/day of the IR formulation are unlikely to result in clinically relevant exposure in breastfed infants. Chronic use may ↓ fertility in women and men.
NDC Code