Oxycodone

How it works

It is a mu-opioid receptor agonist (with some kappa activity) that reduces pain transmission and perception within the central nervous system.

Prescribing in practice

• Respiratory depression is the principal hazard and is increased by concomitant benzodiazepines, gabapentinoids and other CNS depressants, so combine with caution.
• Reduce doses in hepatic and renal impairment and in the elderly, and do not interchange immediate-release and modified-release preparations.
• It carries a risk of tolerance, dependence and misuse, so review regularly and taper rather than stop abruptly after prolonged use.

Monitoring

Monitor analgesic response, sedation, respiratory rate and bowel function, with closer review when titrating the dose or combining with other sedatives.

Counselling the patient

• This medicine can make you drowsy, so do not drive until you know how it affects you.
• Take a regular laxative to prevent constipation.
• Avoid alcohol and take only the dose prescribed.

Evidence & guidelines

Oxycodone is an established alternative strong opioid where morphine is unsuitable, consistent with NICE pain and palliative care guidance.