CLINICAL USE

Opioid analgesic for moderate to severe pain

DOSE IN NORMAL RENAL FUNCTION

Oral: 5 mg 4–6 hourly; usual maximum dose 400 mg dailyM/R: 10 mg 12 hourly; usual maximum dose 200 mg 12 hourlyIV: 1–10 mg every 4 hours SC: initially 5 mg every 4 hours SC infusion: initially 7.5 mg over 24 hours

PHARMACOKINETICS

  • Molecular weight                           :351.8
  • %Protein binding                           :45
  • %Excreted unchanged in urine     :
  • <10           :
  • Volume of distribution (L/kg)       :1.2–6.31
  • half-life – normal/ESRD (hrs)      :2–4 (4.5, M/R)/3–5 (5.5 M/R)

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

  • 20 to 50     : Dose as in normal renal function
  • 10 to 20     : Dose as in normal renal function
  • <10           : Start with small doses.

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD                :Unknown dialysability. Dose as in GFR <10 mL/min
  • HD                     :Unknown dialysability. Dose as in GFR <10 mL/min
  • HDF/high flux   :Dialysed. Dose as in GFR
  • <10           : mL/min
  • CAV/VVHD      :Unknown dialysability. Dose as in normal renal function

    IMPORTANT DRUG INTERACTIONS

    Potentially hazardous interactions with other drugs

  • Anti-arrhythmics: delayed absorption of mexiletine
  • Antidepressants: CNS excitation or depression with MAOIs – avoid concomitant use; possible CNS excitation or depression with moclobemide; increased sedative effects with tricyclics
  • Antivirals: concentration possibly increased by ritonavirSodium oxybate: enhanced effect of sodium oxybate – avoid concomitant use

    ADMINISTRATION

    Reconstition

    –

    Route

    Oral, IV, IM, SC

    Rate of Administration

    Infusion over 24 hours

    Comments

    Dilute to a concentration of 1 mg/mL with glucose 5% or sodium chloride 0.9%

    OTHER INFORMATION

    Has been used in CKD 5 patients; start with lowest dose and gradually increase dose according to responseLimited accumulation of metabolites in renal failure compared with morphineIncreased volume of distribution in renal failure(Kirvela M, Lindgren L, Seppala T, et al. The pharmacokinetics of oxycodone in uremic patients undergoing renal transplantation. Journal of Clinical Anaesthesia. 1996; 8: 13–18.)2 mg of oral oxycodone is approximately equivalent to 1 mg of parenteral oxycodone

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