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OXYCODONE (PERCOCET, PERCODAN, TYLOX, ROXICET, OXYIR, OXYCONTIN)

Oxycodone is semi-synthetic opioid analgesic agonist with 2 active metabolites, noroxycodone and the more active oxymorphone which is ten times the potency of morphine. Its analgesic and sedation affect the central nervous system and smooth muscle organs. It is indicated for moderate to severe pain and produces an antipyretic effect (fever reducing).

The narcotic is available in combination in dosages of 2.5mg, 5mg, 7.5mg, and 10 mg with 325mg acetaminophen and 10mg with 650mg of acetaminophen. Percodan contains 4.5 mg of oxycodone and 325mg aspirin. Roxicet is an oral solution containing 5mg oxycodone and 325mg acetaminophen per 5cc (one teaspoonful) Roxilox tablets contain 5mg of oxycodone and 500mg acetaminophen , and Oxycontin, just the single component oxycodone in 10, 20, 30, 40, 50, 60, 80mg controlled released tablets,. Drug dependency and abuse is a potential problem with oxycodone along with psychic and physical dependency and is a class II drug. Tolerance may develop with repeated administration.

Drug interaction occurs with other opioid analgesics, anesthetics, tranquilizers, alcohol and other central nervous system depressants as they produce an additive depressive effect. It should only be administered to pregnant patients with extreme care when absolutely necessary as it may produce physical dependency in the neonate and cause respiratory depression in the newborn. The drug should not be used in nursing mothers or pediatric patients. Due to sedative properties, patients should be warned against operating machinery or driving until individual response is noted. Oxycodone may elevate intracranial pressure in patients with head injury or may obscure the diagnosis of various abdominal conditions and should not be taken unless advised by a physician.

Side effects may include dizziness, lightheadedness, nausea, vomiting, and constipation, skin rash and itching (pruritis) and some may be relieved or reduced by lying down. Overdose of oxycodone, depending upon severity and extent will cause respiratory depression, cyanosis( a bluish discoloration due to reduced oxygen perfusion), fatigue, sleepiness, stupor, coma, skeletal muscle flaccidity, cold clammy skin, bradycardia (reduced heart rate)hypotension , cardiac arrest and death.

Treatment of overdose is primarily focused upon establishing respiration, and opioid antagonist naloxone administered with gastric lavage for unabsorbed portions of the drug. Dosage should be titrated to severity of pain, with usual adult dose of one tablet every 6 hours as need for pain; the total daily dose of the acetaminophen component should not exceed 2600mg.

PERCODAN (OYXCODONE AND ASPIRIN), provides similar analgesic, antipyretic(fever reducing) and sedative effects as the prior medication with the added benefits of reducing inflammation due to its aspirin component. However, because of the aspirin, it can produce more gastric symptoms and is contraindicated in patients allergic to aspirin, the non-steroidal anti-inflammatory medications, or patients with asthma or on warfarin and various blood thinning medications.

The same interactions, pregnancy warnings, precautions, adverse reactions, abuse and overdose considerations apply to this as the acetaminophen combination drug.

REFERENCES

PDR, Physician’s Desk Reference 59, 2005

The Journal of the Florida Medical Association, PAIN MANAGEMENT, September 2006, Vol 90 #2

MPR, Monthly Prescribing Reference 2011 edition PAIN MANAGEMENT REFERENCE

COMMENTS

On occasion in patients with significant pain due to fractures or post-operative bone surgery, I have found the oxycodone medications well tolerated and produced desired results when used appropriately along with supportive conservative measures of ice, rest, and immobilization. When used in this short term setting I have found limited complications or untoward reactions such as nausea or constipation.



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