Dosing Oxycodone (OxyContin)
Oxycodone is an opioid drug that is commonly used in the management of moderate to severe pain. It is a semi-synthetic opioid that is available in different forms in treating pain. In this article, we shall review the different dosing strategies of oxycodone depending on the indications of its use.
Please note that any advice given in this article is for informational purposes only. We strongly recommend seeing your doctor or pharmacist before taking any medications.
Indications for Oxycodone use
Before discussing the dosage, it is worthwhile discussing the different indications for oxycodone use.
The primary use of oxcodone is for management of chronic pain. Chronic pain can occur in patients with a history of cancer, surgery and amputations. It should be used with caution, or ideally avoided in patients with a known allergy to opioids and patients with severe asthma (or breathing problems).
Dosage of Oxycodone
Oxycodone can be administered as a tablet or as an injection. The dosage depends on the age group of the patients.
The initial dose of oxycodone starts at 5 to 15mg every 4 to 6 hours (if immediate release tablets are prescribed) or 10mg twice daily (if controlled release tablets are used). Smaller doses may be used in patients who have never had oxycodone before. Once patients have been given the initial dose and tolerate it well, a maintenance dose is prescribed.
The maintenance dose of oxycodone depends on whether the drug is in an immediate release form or controlled release form. Immediate release oxycodone is prescribed at a maintenance dose of 10 to 30 mg 6 times a day (every 4 hours). Controlled release oxycodone is prescribed at 20mg and above depending on the clinical condition. For example, patients with cancer pain are prescribed controlled released oxycodone in doses up to 640mg. Average dose per day is around 100 mg.
In patients with cancer, breakthrough pain needs to be managed with additional doses of oxycodone. Breakthrough pain is one that occurs when the effect of the painkillers the patient is already on stops working for a short period of time. Immediate release forms of oxycodone are used in breakthrough pain.
Dosing based on age
In children, the dose of oxycodone depends on the age of the child. Children above the age of 1 year and under 50 kg are prescribed 0.05mg to 0.15mg/kg for every dose that is administered 4 to 6 times a day. In children above 1 year of age and over 50kg in weight, a higher dose of 5mg is prescribed 4 times a day. Depending on the response, the dose is increased to a 10 mg dose administered 6 times a day if needed.
In elderly individuals, over the age of 65yrs, immediate release oxycodone is prescribed at a dose of 2.5 mg 4 times a day orally. Once established on this, patients are switched to a maintenance dose as described in the previous section.
The dosage in hospitals is often prescribed by doctors and overseen by pharmacists. As a controlled drug, it is essential to be very careful and therefore the drugs are double checked before they are handed out. Once again, we would like to reiterate the importance of following the healthcare professional’s advice strictly when taking oxycodone.
Sometimes, the dose of oxycodone needs adjusting in the presence of kidney or liver disease. This is because prescribing the regular doses of oxycodone in patients with liver or kidney failure can result in toxicity of the drug and possibly serious side effects.
In patients with kidney disease, a dose adjustment is based on the function of the kidney. Kidney function is estimated using a measure called the creatinine clearance that measures the amount of creatinine (a product of metabolism in the body) that is excreted through the kidney. If the creatinine clearance is low, then dosage of oxycodone will need reducing.
In patients with liver disease, dose reduction must be done as well. It is recommended that the dose be reduced by one thirds to a half.
We previously mentioned dosing oxycodone to treat breakthrough pain. These doses are calculated as per the daily requirement of the patient, and are usually a quarter to a third of the daily dose.
Over time, patients can become dependent on oxycodone. Due to this, if a clinical decision is made to stop treatment, the dose must be gradually reduced i.e. tapered off over a matter of days to weeks.
Some patients who are on oxycodone may not get the same benefits as they did when they started treatment. In such a situation, another opioid may need to be prescribed. However, there remains a concern that tolerance can develop, so following the advice of the physician is important in this situation.
Modes of administration
Oxycodone can be administered as tablets, intravenous (through the veins), intramuscular (through the muscles) or subcutaneously (under the skin). In some cases, it is administered through the nose or through the rectal cavity. In these two cases, it is absorbed by the mucus layer that lies within. There is a small concern about the bioavailability through different routes, and this is taken into consideration during drug prescription.
Oxycodone is a popular, effective drug that is used in the management of chronic pain. The drug must be taken on prescription only as wrong dosing can cause serious side effects and can be potentially dangerous.
Further reading: nlm.nih.gov