Oxycodone

Therapeutic Indications for Oxycodone

Oxycodone is an opioid analgesic.  As the name suggests, this drug is widely used for pain management to relieve moderate to acute pain. Available in oral form as a solution, tablet, and capsule this drug belongs to the class of opioid agonists. This class of medicines alters the way the brain responds to pain. Depending on the severity of the condition, doctors prescribe this drug for a short period or for a prolonged duration.

Oxycodone falls under the category of controlled medications and comes with an FDA black box warning. This means healthcare professionals need to monitor the patient closely. Earlier, opioid drugs like oxycodone were in use only when absolutely needed, mainly to treat short-term pain.

Alterations to government rules and regulations coupled with tailored marketing strategies by companies have resulted in an exponential increase in oxycodone use in the last two decades. It is now widely used to treat patients with long-term chronic pain.

Oxycodone oral tablet is available as a generic drug as well as under the brand names of OxyContinOxaydo, Roxy band, and Roxicodone. Companies manufacture this drug in five forms for oral intake -solution, immediate-release capsule, extended-release capsule, immediate-release tablet, extended-release tablet. Healthcare providers most often prescribe oxycodone along with other pain-relieving medicines like acetaminophen.

Do I need a prescription?

Oxycodone is a prescription-only medication due to the need for specific dosage, schedule, duration, and management of side effects. Further, the risk of drug overdose/ abuse looms large. It is not possible to replenish the stock of this medicine using the same prescription. A new prescription is mandatory for oxycodone refills.

Dosage

The healthcare professional evaluates the complete medical profile of the patient and fixes dosage based on the extent of condition, age, reaction to the initial dosage and such other key factors.

Drug forms and strengths

• Oxycodone (generic form)as oral immediate-release tablet is available in strengths of 5 mg, 10 mg, 15 mg, 20 mg, 30 mg
• Oxycodone manufactured under brand name Oxaydo, the oral immediate-release tablet is available in strengths of  5 mg, 7.5 mg
• BrandRoxicodone, an oral immediate-release tablet is available in strengths of 5 mg, 15 mg, 30 mg
• Under brand name Roxybond, oxycodone is available as an oral immediate-release tablet in strengths of  5 mg, 15 mg, 30 mg
• As brand Oxycontin, Oxycodone is available as oral extended-release tablet form in strengths of  10 mg, 15 mg, 20 mg, 30 mg, 40 mg, 60 mg, 80 mg

General Guidelines

• Take the drug as per the schedule prescribed by the healthcare provider.
• Consume the tablets with or without food. Taking them with food may help reduce the chances of an upset stomach.
• Do not crush the immediate-release or extended-release tablet. Consume the tablet whole with enough water.
• Oxycodone tablets must be stored at room temperature in airtight containers away from sunlight.
• Oxycodone tablets must be stored in dry areas.

Dosage for pain management

Oxycodone immediate-release tablets

Adult dosage (ages 18–64 years): The dosage is fixed initially between 5mg to 15 mg to be consumed every 4 -6 hours. This is the dosage for those not on opioid medications in the past. During follow up consultations, the healthcare provider gradually increases the dosage based on the response.

Child dosage (ages 0–17 years): Children below 18 should not take this drug, as there is no sufficient proof regarding the safety of the drug for this age group.

Senior dosage (ages 65 years and older): Healthcare providers usually start oxycodone at a reduced dosage or prescribe a different dosing schedule for seniors. This is because of the inability of senior adults to process drugs efficiently, increasing the risk of side effects.

Oxycodone extended-release tablets

Adult dosage (ages 18–64 years): The initial dosage is set at 10 mg every 12 hours for oral intake. Doctors fix this dosage for those on opioid medications for the first time. The specialist tweaks the dosage after evaluating the response to the drug.

Child dosage (ages 11–17 years): Doctors do not prescribe Oxycodone extended-release tablets for children below the age of 11. Among the 11-17 age groups, only those that have been able to tolerate this medication for the initial few days are administered the drug. Healthcare providers fix the dosage based on the reactions/response.

Senior dosage (ages 65 years and older): For senior adults, doctors fix dosage according to their state of health and nature of side effects. The inability of senior adults to process this drug adequately has to be borne in mind before fixing the dosage. Therefore, to play it safe, the dosage is at a minimum.

Be careful about

• For patients of liver disease – doctors fix the dosage of extended-release oxycodone at a much lower dose. It is possible to adjust the dosage after analysis of response.
• Altering opioid therapy from one medication to another
• Cessation of Oxycodone medication suddenly could lead to withdrawal symptoms. Therefore, a gradual reduction in dosage of oxycodone is highly recommended to offset side effects such as agitation, restlessness, chills and excessive perspiration.

Chemical composition

Oxycodone is a white powder with no odor, soluble in alcohol as well as water. The ingredients in oxycodone are hypromellose butylated, hydroxytoluene (BHT), glycol 400, polyethylene oxide, polyethylene, magnesium stearate, titanium dioxide.

Mechanism of action

Oxycodone is a semi-synthetic opiate.  Opiates mimic the functions of endorphins, which are natural chemicals found in our brain.  These substances essentially reduce the pain messages conveyed from the body to the brain. Oxycodone works like the endorphins and reduces the amount of pain the brain perceives. Akin to the function of all opiates, Oxycodone too operates by tying itself to opioid receptors present in the spinal cord and brain. This results in pain reduction.

Contraindications

Oxycodone carries the risk of adverse interactions with other drugs and the presence of health conditions. Below is the list of some of the drug and health condition warnings:

Oxycodone comes with Food and Drug Administration (FDA) black box warnings.

Oxycodone carries the highest risk of addiction and abuse. This can result in death due to overdose. Due to this risk, the FDA has stipulated that the drug manufacturer enable a ‘Risk Evaluation and Mitigation Strategy (REMS) program’ that is the development of safety guidelines for the use of opioids.

Altered Breathing rate risk: Oxycodone carries a risk of causing changes to the normal breathing pattern. The risk is higher for elderly people over the age of 65. Consequently, patients must evaluate the risks before starting this medication.

Inadvertent Oxycodone intake can trigger adverse reactions that can even turn fatal for some people. Children and senior adults need to be especially careful with opiates. The advisory holds good for those who have never taken opiates in the past.

Facts on Oxycodone

• Oxycodone is a semi-synthetic opiate created first in 1916 from thebaine, a chemical found in poppy plants and related to other narcotic drugs, such as morphine and heroin.
• Oxycodone is one of the 12 most addictive drugs
• Oxycodone was born out of a need to find non-addictive alternatives to opioid medicines, in use commonly during World War 1. Despite efforts, even this drug has a grave risk for abuse and addiction.
• According to the National Institute on Drug Abuse (NIDA), The United States consumes nearly 81% of the world’s oxycodone.
• At higher doses oxycodone enables a euphoric feeling leading to a potential risk of abuse and addiction
• Sadly, large amounts of this drug are available to street users and hence the risk of abuse is high. There is a growing black market for oxycodone in the United states
• Oxycodone abuse can also lead to heroin abuse, as addicts find it easier to shift to heroin when oxycodone pills become too difficult to procure.
• Alarmingly, according to a statistic in 2014, in the United States alone, nearly 20,000 people died from an overdose of prescription opioid.
• The menace of opioid addiction is growing dangerously with an estimated 2.1 million people in America addicted to prescription painkillers.
• Chronic pain is the biggest struggle of close to 25.3 million Americans

Drug interactions

Some of the drugs indicated below can trigger major side effects if taken along with Oxycodone. These drugs will also lower the effectiveness of the drug.

• Anesthetic drugs can lower the effectiveness of oxycodone
• Benzodiazepines taken with oxycodone can increase drowsiness and also cause lowered or stopped breathing which can turn life-threatening
• Monoamine oxidase inhibitors (MAOIs) can cause agitation, confusion and even loss of consciousness when combined with oxycodone
• Caution with the use of muscle relaxants, hypnotics, and Antipsychotic drugs, anticholinergic drugs and antifungal drugs
• Few antibiotics taken along with oxycodone may merit closer monitoring of patients, as is the case with intake of HIV drugs and anticonvulsants
• Anti-arrhythmia drugs along with oxycodone also warrant a dose adjustment

Allergy warning

There is a serious allergy warning for oxycodone users. In the presence of the following symptoms, which could be a sign of allergy, it is advisable to stop taking the medication and consult the specialist immediately. Some symptoms are Hives, swelling of the throat and tongue and skin rash.

Alcohol interaction warning

Alcohol and oxycodone is a strict no-no. The side effects from this combo can turn life-threatening.

Oxycodone and certain health conditions

• Patients of liver and kidney issues could suffer from increased levels of oxycodone in the body if they take this drug.
• Patients of paralytic ileus should completely avoid oxycodone.
• Epileptics cannot take oxycodone; therefore inform the specialist about the existing medical condition.
• Pregnant women and breastfeeding mothers must check with the healthcare providers about the safety of oxycodone before beginning the medication
• Other medical conditions contraindicated for oxycodone are thyroid issues, Addison’s disease, adrenal gland issues, enlarged prostate, and gall bladder problems
• Those with breathing problems such as COPD (chronic obstructive pulmonary disease) or asthma should ideally ascertain if the drug is safe before taking it
• Similar advisory holds good for those with gastrointestinal problems as this drug can exacerbate bowel problems.

Side effects

Side effects of oxycodone can manifest as mild ones that even disappear in a few days to weeks. The side effects may be different for adults and children. Children may portray worsening of side effects sooner than adults may. Watch out for fever in children. However, once the treatment of oxycodone has begun, it is important to carefully watch the side effects and take adequate care depending upon the severity. Some of the commonly occurring side effects of oxycodone are:

• Dry mouth, fatigue
• Constipation
• Headache
• Feeling dizzy
• Drowsiness
• Itching

Serious side effects

A qualified healthcare professional should attend to serious side effects immediately.

• Fainting
• Slow breathing
• Dropping blood pressure
• Agitation
• Restlessness
• Seizures
• Breathlessness

What to Do If You Skip a Dose?

Do not worry if you skip a dose. Just take it as soon as it occurs to you. Do not take the missed dose if it is close to the schedule of the next dose. It is not a good idea to take a double dose to compensate for the missed one.

Generic brand names of Oxycodone

Generic name: Oxycodone Hydrochloride

Brand name: Oxycontin Percodan, Endodan, Roxiprin, Percocet, Endocet, Roxicet and OxyContin.

Different manufacturing companies of oxycodone

Some of the Oxycodone manufacturing companies worldwide are:

• Sanofiactive ingredient solutions
• Alkaloida Chemical Company
• Chattem Chemicals Inc.
• Johnson Matthey Inc.
• Mallinckrodt Chemical Inc.
• Macfarlan Smith Limited
• Siegfried USA Inc.
• Penick Corp
• Temad Co.
• Arevipharma
• Rusan Pharma Ltd.
• Saneca Pharmaceuticals

Substitutes for Oxycodone

To the question, if opioids are a better option compared to pain relievers, healthcare specialists note that the choice of taking opioid drugs over pain relievers will depend upon the medical condition, nature of side effects. In many cases, pain relievers may be a better choice compared to opioids.

A study published in the Journal of the American Medical Association, which studied pain management of acute pain in 416 emergency room patients, found that opioid drugs did not score higher than non-opioid painkillers to merit its use.

Some of the substitutes for Oxycodone are:

Corticosteroids: Corticosteroids have the ability to reduce inflammation and aid pain relief. They also are capable of controlling immune cell activity, therefore are increasingly in use to treat chronic pain in patients with back injuries, cancer, arthritis.

Some of the steroids used are prednisone and dexamethasone.  Consider the side effects of long-term steroid use, for instance, weakened immune system, weight gain, and high blood pressure before choosing this line of treatment.

Antidepressants: Antidepressants are in use as substitutes to manage pain. In this field are Tricyclic antidepressants like nortriptyline (Pamelor), amitriptyline (Elavil) imipramine (Tofranil),  that are able to effectively treat pain in patients. SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors) have also demonstrated efficacy in treating long-term pain, although healthcare professionals need more evidence to this benefit.

Non-steroidal anti-inflammatory drugs (NSAIDs): NSAIDs, or non-steroidal anti-inflammatory drugs-Advil, Motrin, Aleve, and Excedrin available over the counter work well in the management of pain. Ibuprofen, naproxen, or aspirin are in use as good substitutes for pain management.

Tylenol that has Acetaminophen as an active ingredient is another substitute for opioid drugs which effectively addresses pain. Tylenol is available over the counter. Acetaminophen does not cause side effects like NSAIDs, but in high doses could cause liver damage.

Anti-epileptic drugs

The more recent drugs used to treat epilepsy like gabapentin (Neurontin) and pregabalin (Lyrica), are in use to manage chronic pain.  Patients report a mixed benefit – some patients have recorded a huge difference in pain reduction while others have found no relief. The link is still unclear although researchers are exploring this class of drugs for their role in pain relief.

References
https://www.healthline.com/health/oxycodone-oral-tabl
https://www.webmd.com/drugs/2/drug-1025-5278/oxycodone-oral/oxycodone-oral/details
https://www.fda.gov/drugs/drugsafety/postmarketdrugsafetyinformationforpatientsandproviders/ucm207173.htm
https://www.getsmartaboutdrugs.gov/drugs/oxycodone
https://www.drugbank.ca/drugs/DB00497

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