Oxycodone

How it works

Oxycodone is a potent agonist principally at mu-opioid receptors, inhibiting ascending pain pathways and modifying the perception of pain.

Prescribing in practice

• As with all strong opioids the key hazard is dose-related respiratory depression and sedation — titrate to effect, avoid concurrent sedatives where possible, and ensure naloxone and monitoring are available.
• Oxycodone is metabolised hepatically and partly renally excreted, so reduce dosing and extend intervals in hepatic or renal impairment and in the elderly.
• Anticipate and manage opioid constipation, nausea and the risk of dependence; switch to non-opioid analgesia as pain improves.

Monitoring

Monitor pain score, sedation level, respiratory rate and bowel function, with closer observation after dose changes or in organ impairment.

Counselling the patient

• This is a strong painkiller for after your operation — take it as prescribed and step down as pain eases.
• It can cause drowsiness and constipation; do not drive while affected.
• Report excessive sleepiness or slow breathing immediately.

Evidence & guidelines

Oxycodone is an established strong opioid for acute post-operative pain within multimodal analgesia.