Makindo Medical Notes

⚠️ Warning: Oxycodone exposes patients and others to risks of opioid addiction, misuse, and overdose, which can be fatal. Prescribe only when benefits outweigh risks, and with clear monitoring in place.

📖 About

Always check the BNF link here before prescribing.

• 💊 Oxycodone is a strong opioid analgesic, similar to morphine.
• Often used as an alternative to morphine in renal impairment (eGFR <30 mL/min).
• Available in immediate-release (Oxynorm) and modified-release (OxyContin) forms.

⚙️ Mode of Action

• Semi-synthetic opioid → agonist at μ-opioid receptors in the CNS.
• Produces analgesia, sedation, respiratory depression, and euphoria.
• Reduces perception of breathlessness (used in palliative care for dyspnoea).

📋 Indications / Dose (palliative care, moderate–severe pain or dyspnoea)

• 🧮 Oxycodone is approximately twice as potent as morphine orally.
• Opioid-naïve, eGFR <30:
• PO: Oxycodone liquid 2.5 mg PRN, max hourly if needed.
• SC: Oxycodone injection 1.25 mg PRN, max hourly.
• Syringe driver: Oxycodone 5 mg + Midazolam 10 mg SC over 24 h (common end-of-life regimen).
• 💡 Always titrate to effect while monitoring for sedation/respiratory depression.

🚨 Overdose

• Features: pinpoint pupils, respiratory depression, reduced consciousness, hypotension.
• Management: airway + cardiorespiratory support, Naloxone (0.4–2 mg IV, repeat as necessary).

🔄 Interactions

• Metabolised by CYP3A4 → inhibitors (e.g. macrolides, azole antifungals, grapefruit juice) ↑ plasma levels.
• CYP3A4 inducers (e.g. rifampicin, carbamazepine, phenytoin) ↓ effect.
• Other CNS depressants (alcohol, benzodiazepines, gabapentinoids) ↑ risk of sedation/respiratory depression.

⛔ Contraindications

• Respiratory depression, severe COPD/asthma, hypoventilation.
• Paralytic ileus, delayed gastric emptying, chronic severe constipation.
• Acute severe asthma attack.

⚠️ Side Effects

• Severe respiratory and CNS depression → death if overdose.
• GI: constipation (common), abdominal pain, dyspepsia, nausea/vomiting.
• Neuropsychiatric: sedation, confusion, hallucinations (esp. in frail elderly).
• Dependence and withdrawal if stopped abruptly.
• 🚸 Accidental ingestion in children can be fatal.
• Pregnancy: risk of neonatal opioid withdrawal syndrome.

📝 Clinical Pearls

• Always co-prescribe a laxative (e.g. senna + docusate) to prevent opioid-induced constipation.
• Convert from morphine to oxycodone using oral morphine:oral oxycodone ≈ 2:1 ratio.
• In renal failure, oxycodone preferred over morphine, but accumulation still possible → monitor closely.
• Modified-release formulations (OxyContin) are for regular pain control, not breakthrough pain.
• Immediate-release (Oxynorm) should always be available alongside modified-release for breakthrough symptoms.

📚 References

• BNF – Oxycodone
• Oxford Handbook of Palliative Care