Roxicodone
oxybutynin
oxycodone hydrochloride
Pharmacologic class: Opioid agonist
Therapeutic class: Narcotic analgesic
Controlled substance schedule II
Pregnancy risk category B
FDA Box Warning
• Drug is opioid agonist and Schedule II controlled substance, with abuse potential similar to morphine. This potential must be considered when prescribing or dispensing drug.
• Extended-release tablets are indicated for managing moderate to severe pain when continuous, around-the-clock analgesia is needed for extended period of time. Extended-release tablets aren't intended for as-needed analgesia.
• Extended-release 80-mg tablets are for use only in opioid-tolerant patients. This strength may cause fatal respiratory depression when given to patients without previous opioid exposure.
• Instruct patients to swallow extended-release tablets whole. Caution them not to break, chew, or crush them, as this causes rapid release and absorption of potentially fatal dose.
Action
Unknown. Thought to interact with opioid receptor sites primarily in limbic system, thalamus, and spinal cord, blocking transmission of pain impulses.
Availability
Capsules (immediate-release): 5 mg
Solution (oral): 5 mg/5 ml
Tablets: 5 mg, 7.5 mg, 10 mg, 15 mg, 20 mg, 30 mg
Tablets (controlled-release): 10 mg, 15 mg, 20 mg, 30 mg, 40 mg, 60 mg, 80 mg
Indications and dosages
➣ Moderate to severe pain
Adults: 5 mg P.O. q 6 hours p.r.n., increased gradually to 10 to 30 mg q 6 hours p.r.n.
➣ Moderate or severe pain when continuous around-the-clock analgesia is needed
Adults: 10 mg P.O. (controlled-release) q 12 hours. For patients already taking opioids, use total oral oxycodone daily equianalgesic dosage and then round down to closest tablet strength. For breakthrough pain, give supplemental immediate-release doses.
Dosage adjustment
• Hepatic disease
• Renal impairment
• Debilitated or opioid-naive patients
Off-label uses
• Postherpetic neuralgia (controlled release form)
Contraindications
• Hypersensitivity to drug
• Paralytic ileus
• When opioids are contraindicated (as in respiratory depression, severe bronchial asthma, hypercarbia)
Precautions
Use cautiously in:
• head trauma; increased intracranial pressure (ICP); severe renal, hepatic, or pulmonary disease; hypothyroidism; adrenal insufficiency; urethral stricture; undiagnosed abdominal pain or prostatic hyperplasia; extensive burns; alcoholism
• history of substance abuse
• prolonged or high-dose therapy
• elderly or debilitated patients
• labor and delivery
• pregnant or breastfeeding patients
• children younger than age 18.
Administration
• Be aware that drug has high abuse potential.
• Know that controlled-release Oxy-Contin isn't indicated for p.r.n. pain control but is reserved for patients who need continuous, around-the-clock analgesia.
• Be aware that 80-mg controlled-release tablets are for opioid-tolerant patients only.
See Never break, crush, or let patient chew controlled-release forms. Otherwise, rapid release and absorption of potentially fatal dose may occur.
• Give Oxecta tablets whole. Don't crush or dissolve tablets or administer by nasogastric, gastric, or other feeding tubes, because this may cause obstruction of feeding tubes.
• When discontinuing, taper dosage gradually to prevent withdrawal symptoms.
Adverse reactions
CNS: dizziness, asthenia, drowsiness, euphoria, light-headedness, insomnia, confusion, anxiety, twitching, abnormal dreams and thoughts
CV: orthostatic hypotension, circulatory depression, bradycardia, shock
GI: nausea, vomiting, constipation, diarrhea, ileus, abdominal pain, dyspepsia, gastritis, anorexia
GU: urinary retention
Respiratory: apnea, respiratory depression, respiratory arrest
Skin: pruritus, sweating
Other: chills, fever, hiccups, physical and psychological drug dependence
Interactions
Drug-drug. Antihistamines, sedative-hypnotics: additive CNS depression
Barbiturates, protease inhibitors: increased respiratory and CNS depression
Opioid agonist-antagonists: precipitation of opioid withdrawal in physically dependent patients
Drug-diagnostic tests. Amylase, lipase: increased levels
Drug-behaviors. Alcohol use: additive CNS depression
Patient monitoring
See Monitor vital signs and respiratory status. Withhold drug in significant respiratory or CNS depression.
• Assess patient's pain level frequently.
• Monitor bowel and bladder function.
• Assess patient for anxiety, twitching, and other CNS symptoms.
• Closely monitor head-trauma patient. Drug may increase ICP while masking signs and symptoms.
• Carefully assess patient with acute abdominal pain. Drug may obscure diagnosis.
• Stay alert for drug hoarding, tolerance, and dependence.
Patient teaching
See Caution patient not to break, crush, chew, or dissolve controlled-release tablets. Warn him that doing so may cause rapid drug release and absorption (possibly fatal).
• Tell patient taking controlled-release form not to drive for 3 to 4 days after dosage increase, after consuming even a single alcoholic beverage, or if also taking antihistamines or other drugs that cause drowsiness.
• Tell patient to take Oxecta tablets whole.
See Instruct patient to promptly report adverse reactions, especially difficulty breathing or slow pulse.
• Advise patient not to drink alcohol.
• Tell patient not to be alarmed if controlled-release tablets appear in stools; drug has already been absorbed.
• Advise ambulatory patient to change position slowly, to avoid dizziness from orthostatic hypotension.
• Instruct patient to consult prescriber before taking other drugs.
• Caution patient to avoid driving and other hazardous activities, because drug may cause drowsiness or dizziness.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and behaviors mentioned above.
oxyCODONE
(ox-i-koe-done) oxycodone,Oxecta
(trade name),OxyCONTIN
(trade name),Oxy IR
(trade name),Oxyneo
(trade name),Roxicodone
(trade name),Supeudol
(trade name)Classification
Therapeutic: opioid analgesicsPharmacologic: opioid agonists
Indications
Action
Therapeutic effects
Pharmacokinetics
Time/action profile (analgesic effects)
| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| PO | 10–15 min | 60–90 min | 3–6 hr |
| PO-CR† | 10–15 min | 3 hr | 12 hr |
Contraindications/Precautions
Adverse Reactions/Side Effects
Central nervous system
- confusion (most frequent)
- sedation (most frequent)
- dizziness
- dysphoria
- euphoria
- floating feeling
- hallucinations
- headache
- unusual dreams
Ear, Eye, Nose, Throat
- blurred vision
- diplopia
- miosis
Respiratory
- respiratory depression (life-threatening)
Cardiovascular
- orthostatic hypotension
Gastrointestinal
- constipation (most frequent)
- dry mouth
- choking
- GI obstruction
- nausea
- vomiting
Genitourinary
- urinary retention
Dermatologic
- flushing
- sweating
Miscellaneous
- physical dependence
- psychological dependence
- tolerance
Interactions
Drug-Drug interaction
Use with caution in patients receiving MAO inhibitors (may result in unpredictable reactions—↓ initial dose of oxycodone to 25% of usual dose).Additive CNS depression with alcohol, antihistamines, and sedative/hypnotics.Administration of partial-antagonistopioid analgesics may precipitate withdrawal in physically dependent patients.Nalbuphine, buprenorphine, or pentazocine may ↓ analgesia.Potent CYP3A4 inhibitors including erythromycin, ketoconazole, itraconazole, voriconazole, or ritonavir may ↑ levels.Potent CYP3A4 inducers including rifampin, carbamazepine, and phenytoin may ↓ levels.Route/Dosage
Larger doses may be required during chronic therapyAvailability (generic available)
Nursing implications
Nursing assessment
- Assess type, location, and intensity of pain prior to and 1 hr (peak) after administration. When titrating opioid doses, increases of 25–50% should be administered until there is either a 50% reduction in the patient's pain rating on a numerical or visual analog scale or the patient reports satisfactory pain relief. A repeat dose can be safely administered at the time of the peak if previous dose is ineffective and side effects are minimal.
- Patients taking controlled-release tablets may also be given supplemental short-acting opioid doses for breakthrough pain.
- An equianalgesic chart (see ) should be used when changing routes or when changing from one opioid to another.
- Assess BP, pulse, and respirations before and periodically during administration. If respiratory rate is <10/min, assess level of sedation. Physical stimulation may be sufficient to prevent significant hypoventilation. Dose may need to be decreased by 25–50%. Initial drowsiness will diminish with continued use.
- Prolonged use may lead to physical and psychological dependence and tolerance. This should not prevent patient from receiving adequate analgesia. Most patients who receive oxycodone for pain do not develop psychological dependence. Progressively higher doses may be required to relieve pain with long-term therapy.
- Assess bowel function routinely. Prevention of constipation should be instituted with increased intake of fluids and bulk, and laxatives to minimize constipating effects. Stimulant laxatives should be administered routinely if opioid use exceeds 2–3 days, unless contraindicated.
- Lab Test Considerations: May ↑ plasma amylase and lipase levels. If an opioid antagonist is required to reverse respiratory depression or coma, naloxone is the antidote. Dilute the 0.4-mg ampule of naloxone in 10 mL of 0.9% NaCl and administer 0.5 mL (0.02 mg) by direct IV push every 2 min. For children and patients weighing <40 kg, dilute 0.1 mg of naloxone in 10 mL of 0.9% NaCl for a concentration of 10 mcg/mL and administer 0.5 mcg/kg every 2 min. Titrate dose to avoid withdrawal, seizures, and severe pain.
Potential Nursing Diagnoses
Acute pain (Indications)Chronic pain (Indications)
Risk for injury (Side Effects)
Implementation
- high alert: Accidental overdose of opioid analgesics has resulted in fatalities. Before administering, clarify all ambiguous orders; have second practitioner independently check original order and dose calculations.
- Do not confuse short-acting oxycodone with long-acting Oxycontin. Do not confuse oxycodone with hydrocodone. Do not confuse Oxycontin with MS Contin.
- Explain therapeutic value of medication prior to administration to enhance the analgesic effect.
- Regularly administered doses may be more effective than prn administration. Analgesic is more effective if given before pain becomes severe.
- Coadministration with nonopioid analgesics may have additive analgesic effects and may permit lower doses.
- Oxycodone should be discontinued gradually after long-term use to prevent withdrawal symptoms.
- Oral: May be administered with food or milk to minimize GI irritation.
- Administer solution with properly calibrated measuring device.
- Controlled Release: Take 1 tablet at a time. Swallow controlled-release tablet whole; do not crush, break, or chew. Taking broken, chewed, crushed or dissolved controlled-release tablets leads to rapid release and absorption of a potentially fatal dose of oxycodone. Advise patients not to pre-soak, lick, or wet controlled-release tablets prior to placing in the mouth. Take each tablet with enough water to ensure complete swallowing immediately after placing in mouth. Dose should be based on 24-hr opioid requirement determined with short-acting opioids then converted to controlled-release form.
- Do not use Oxceta for administration via nasogastric, gastric or other feeding tubes as it may cause obstruction of feeding tubes.
Patient/Family Teaching
- Instruct patient on how and when to ask for and take pain medication.
- Advise patient that oxycodone is a drug with known abuse potential. Protect it from theft, and never give to anyone other than the individual for whom it was prescribed.
- Medication may cause drowsiness or dizziness. Advise patient to call for assistance when ambulating or smoking. Caution patient to avoid driving and other activities requiring alertness until response to medication is known.
- Advise patients taking Oxycontin tablets that empty matrix tablets may appear in stool.
- Advise patient to make position changes slowly to minimize orthostatic hypotension.
- Advise patient to avoid concurrent use of alcohol or other CNS depressants with this medication.
- Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications.
- Encourage patient to turn, cough, and breathe deeply every 2 hr to prevent atelectasis.
- Advise patient to notify health care professional if pregnancy is planned or suspected, or if breast feeding.
Evaluation/Desired Outcomes
- Decrease in severity of pain without a significant alteration in level of consciousness or respiratory status.