Oxycodone: Difference between revisions

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{{MedTemplate

| generic = Oxycodone

| generic = Oxycodone (hydrochloride)

| brand = OxyContin

| brand = OxyContin (ER), Roxicodone (IR), Oxaydo (IR abuse-deterrent), Xtampza ER (abuse-deterrent ER)

| structure =

| classes = Opioid, Analgesic

| classes = [[:Category:Opioid analgesics|Opioid analgesic (semi-synthetic)]], [[:Category:Schedule II controlled substances|Schedule II controlled substance]], [[:Category:Analgesics|Analgesic]]

| ~~mechanism~~ = Mu-opioid ~~receptor agonist~~

| uses = <vote slug="moderate-severe-acute-pain-use">Moderate to severe acute pain (FDA)</vote>, <vote slug="post-surgical-pain-use">Postoperative pain (FDA)</vote>, <vote slug="cancer-pain-use">Cancer pain (FDA)</vote>, <vote slug="severe-chronic-pain-use">Severe chronic pain unresponsive to non-opioid alternatives (FDA, with the CDC opioid prescribing guidance constraints)</vote>

~~| uses =~~

| starting_dose = IR opioid-naive: 5-10 mg PO every 4-6 hours as needed. ER opioid-naive: '''10 mg PO every 12 hours (lowest available)'''; titrate slowly to clinical effect

| starting_dose =

| preparations = IR tablets 5, 7.5, 10, 15, 20, 30 mg; IR oral solution 5 mg/5 mL; concentrated solution 20 mg/mL; OxyContin ER tablets 10, 15, 20, 30, 40, 60, 80 mg; Xtampza ER capsules

| preparations =

| fda_max = No fixed ceiling; titrate to clinical effect and tolerability with CDC opioid prescribing guidance constraints on morphine-milligram-equivalent (MME) totals

| ~~routes =~~

| pill_id =

~~| onset~~ =

| routes = Oral

| ~~duration~~ =

| onset = 10-30 minutes (IR)

| ~~halflife~~ =

| duration = 4-6 hours (IR); 12 hours (ER)

| ~~bioavailability~~ =

| halflife = 3-5 hours (IR); 4.5 hours (ER)<ref name="oxycontin-label">FDA Prescribing Information, OxyContin (oxycodone hydrochloride extended-release), Purdue Pharma, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/022272s033lbl.pdf</ref>

| ~~pregnancy~~ =

| bioavailability = ~60-87% (oral; high and more consistent than codeine or hydrocodone, making efficacy less CYP2D6-genotype-dependent)<ref name="oxycontin-label" />

| ~~legal~~ =

| pregnancy = Chronic third-trimester exposure produces neonatal opioid withdrawal syndrome and respiratory depression at delivery.{{citation needed}}

~~| intro~~ =

| legal = [[USLegal:Schedule II|Schedule II controlled substance]] in US<ref name="oxycontin-label" />

| ~~pharmacokinetics~~ =

| mechanism = <vote slug="oxycodone-mech-claim">Semi-synthetic μ-opioid receptor agonist, intermediate in potency between hydrocodone and morphine. Metabolized via CYP3A4 N-demethylation to noroxycodone (largely inactive) and via CYP2D6 O-demethylation to oxymorphone (active, more potent at μ). Unlike codeine and hydrocodone, oxycodone itself is largely the analgesic agent, so efficacy is less CYP2D6-genotype-dependent than for codeine.</vote> CYP3A4 inhibitors (ketoconazole, ritonavir, clarithromycin, grapefruit juice) substantially raise plasma exposure. OxyContin's 2010 reformulation introduced an abuse-deterrent matrix that resists crushing and dissolution, a major harm-reduction intervention. CPIC provides CYP2D6 genotype-guided opioid selection guidance<ref name="cpic-opioid-cyp2d6">CPIC Guideline for CYP2D6, OPRM1, and COMT and Opioid Use, 2021. https://cpicpgx.org/guidelines/cpic-guideline-for-codeine-and-cyp2d6/</ref>.

~~| pharmacodynamics~~ =

| ~~indications~~ =

| ~~dosing~~ =

| ~~effects~~ =

| ~~contraindications =~~

~~| interactions =~~

~~| pregnancy_details =~~

~~| monitoring~~ =

~~| counseling~~ =

~~| anecdotes =~~

~~| seealso =~~

~~| references~~ =

}}

== References ==

[[Category:Opioid analgesics]]

[[Category:Schedule II controlled substances]]

[[Category:Analgesics]]

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