Strong Opioid Analgesic — Step 3 WHO Ladder Pregnancy: Use only if benefit outweighs risk — neonatal opioid withdrawal syndrome.

Oxycodone

Brand names: OxyNorm (immediate-release), OxyContin (modified-release)

Adult dose

Dose: Immediate-release (OxyNorm): 5mg every 4–6h; titrate to pain; usual range 5–20mg every 4h. Modified-release (OxyContin): total 24h requirement divided BD. Opioid-naive: 10mg BD starting dose.

Route: Oral / IV / SC

Frequency: Every 4–6 hours (IR oral); twice daily (MR oral); continuous infusion (SC/IV)

Max: No ceiling in cancer pain — titrate to effect

Schedule 2 Controlled Drug. Oxycodone to oral morphine equivalence: 1mg oxycodone = 1.5–2mg morphine (oxycodone is approximately 1.5× more potent). Preferred over morphine in moderate renal impairment (eGFR 30–60) as oxymorphone and noroxycodone metabolites accumulate less than morphine-6-glucuronide. OxyContin tablets must not be crushed.

Paediatric dose

Dose: 0.1 mg/kg

Route: Oral

Frequency: Every 4–6 hours

Max: 5mg per dose (opioid-naive children)

BNFc: 1 month–11 years: 100–200 micrograms/kg every 4h. 12–17 years: 5–10mg every 4–6h. Seek specialist paediatric pain team opinion.

Dose adjustments

Renal

eGFR 30–60: preferred over morphine — reduce dose by 25–50%. eGFR <30: avoid or use with extreme caution; consider alfentanil or hydromorphone instead.

Hepatic

Severe hepatic impairment: reduce initial dose by 50%; titrate carefully.

Paediatric weight-based calculator

Patient weight (kg)

BNFc: 1 month–11 years: 100–200 micrograms/kg every 4h. 12–17 years: 5–10mg every 4–6h. Seek specialist paediatric pain team opinion.

Clinical pearls

Opioid equivalence conversion: IV/SC oxycodone to oral oxycodone = divide by 2 (oral bioavailability ~60–87%); oral oxycodone to oral morphine = multiply by 1.5–2
Antidote: naloxone — same as morphine. For oxycodone OD: naloxone infusion may be needed as OxyContin MR tablets continue releasing drug after ingestion
Preferred over morphine in eGFR 30–60 — less M6G-equivalent accumulation; still caution below eGFR 30
OxyContin abuse deterrent formulation available (Targinact = oxycodone + naloxone) — naloxone prevents gut opioid effects reducing constipation

Contraindications

Respiratory depression
Paralytic ileus
MAOIs within 14 days
Hypersensitivity to oxycodone

Side effects

Constipation (universal)
Nausea, vomiting
Sedation
Respiratory depression
Pruritus
Urinary retention
Dependence and tolerance
Hyperalgesia (high doses)

Interactions

MAOIs — avoid
CNS depressants, benzodiazepines — additive respiratory depression
CYP3A4 inhibitors (ketoconazole, clarithromycin) — increase oxycodone levels
CYP3A4 inducers (rifampicin, carbamazepine) — reduce oxycodone levels

Monitoring

Pain score
Sedation
Respiratory rate
Bowel function
24h opioid consumption (breakthrough dose frequency)

Reference: BNFc; BNF 90; NICE NG31; Palliative Care Formulary (PCF6). Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Morphine (Oral) · Strong Opioid Analgesic — Step 3 WHO Ladder

Pathways