Oxycodone is a phenantherne derivative with opioid analgesic activity similar to morphine but adverse effects are milder than those of morphine. Oxycodone is used to control moderate to severe pain, including postoperative, post extractional, and postpartum pain and other opiates such as morphine and codeine act as agonists at opiate receptors within the central nervous system (CNS).

Pharmacological Class: Opioid analgesic

• Moderate to Severe Pain

Oxycodone is a pure opioid agonist whose principal therapeutic action is analgesia. The mechanism of action of oxycodone involves: binding to mu-type opioid receptors, inhibition of adenylyl-cyclase and hyperpolarisation of neurons, and decreased excitability. However, binding to the opiate receptors in CNS causes an inhibition of ascending pain pathways, alteration of the perception and response to pain and produces generalized CNS depression.

• Initial dose in opioid-naive patients: 5 to 15 mg orally every 4 to 6 hours
• Initial dose for opioid-naive and opioid non-tolerant patients: 10 mg orally every 12 hours

• Oxycodone is well absorbed with an absolute bioavailability of 60%-87%. Volume of distribution is found to be 2.6 L/kg and plasma protein binding is 45%. A high fat meal can increase the absorption by 25%. Extensively metabolized to weaker and inactive metabolites and plasma half-life is 4.5 hours. Eliminated primarily in the urine as the parent compound and its metabolites 

• In patients with known hypersensitivity to oxycodone or aspirin
• In situations where opioids are contraindicated including patients with significant respiratory depression (in unmonitored settings or the absence of resuscitative equipment) and patients with acute or severe bronchial asthma or hypercarbia.
• In the setting of suspected or known paralytic ileus.

• Oxycodone is metabolized in part to oxymorphone via the cytochrome p450 isoenzyme CYP2D6. While this pathway may be blocked by a variety of drugs (e.g., certain cardiovascular drugs and antidepressants), such blockade has not yet been shown to be of clinical significance with this agent.
• Oxycodone enhances the neuromuscular blocking action of skeletal muscle relaxants and produces an increased respiratory depression.
• Mixed Agonist/Antagonist Opioid Analgesics (i.e., pentazocine, nalbuphine, butorphanol and buprenorphine) should be administered with caution to patients who have received or are receiving a course of therapy with a pure opioid agonist analgesic such as oxycodone hydrochloride tablets.
• Monoamine Oxidase Inhibitors (MAOIs) have been reported to intensify the effects of at least one opioid drug causing anxiety, confusion and significant depression of respiration or coma.

Common (affecting between 1 in 10 to 1 in 100)

• Nausea and vomiting
• Loss of appetite
• Dry mouth
• Stomach pain
• Flushing
• Sweating
• Weakness
• Headache
• Mood changes

Uncommon (affecting 1 in 100 to 1 in 1000)

• Spasm of a Bile Duct Tract
• Widening of Blood Vessels
• Head Pain
• Incomplete or Infrequent Bowel Movements
• Seizures
• Constipation

Very rare (affecting less than 1 in 10,000)

• Chest pain
• Irregular heartbeat
• Hives
• Rash
• Itching
• Swelling of face, tongue, throat, lips, eyes, feet, hands, ankles, or lower legs
• Difficulty breathing or swallowing
• Extreme drowsiness
• Lightheadedness when changing positions

• Should be given with caution or in reduced doses to patients with hypothyroidism, adrenocortical insufficiency, asthma or decreased respiratory reserve, renal or hepatic impairment, prostatic hyperplasia, hypotension, shock, inflammatory or obstructive bowel disorders, or myasthenia gravis. Dosage should be reduced in elderly or debilitated patients.
• Should be given with care to infants, especially neonates. Their use during labour may cause respiratory depression in the neonate.
• Discontinuation of therapy with Oxycodone should be carried out gradually in patients who may have developed physical dependence, to avoid precipitating withdrawal symptoms.
• As it causes drowsiness, driving or machinery should not be operated.

• Oxycodone is a strong opioid that acts at mu and kappa opioid receptors. It has a specific pharmacologic profile and greater analgesic potency to morphine. Oxycodone offers a fast onset of analgesia, controlling pain for 12 hours and providing clinically meaningful relief of moderate to severe pain and improving quality of life across a broad spectrum of pain types. It has relevant points of difference from other opioids and as such may be a suitable alternative to morphine.¹
• Analgesics for children with acute abdominal pain are often withheld for fear that they might mask physical examination findings and thus might be unsafe. Although early administration of buccal oxycodone provides a significant pain relief to children with acute abdominal pain, without adversely altering the clinical signs or obscuring the surgical diagnosis.²

• Riley J¹, Eisenberg E, et al. Curr Med Res Opin. 2008 Jan; 24(1):175-92.
• Kokki H¹, Lintula H, et al. Arch Pediatr Adolesc Med. 2005 Apr; 159(4):320-5.
• Drug Information System
• Druglib.com: http://www.druglib.com/druginfo/oxycodone/
• Medicinenet.com: http://www.medicinenet.com/oxycodone/article.htm