Which oxycodone is the best

Prior to initiating a strong opioid for chronic pain in particular, consider the following questions:. If a strong opioid is indicated, ensure the patient has a good understanding of the type of medicine to be used and the goals of treatment, i.

The patient should be made aware of the potential problems with strong opioids, including adverse effects, safety issues and the potential for dependency and misuse.

It is also recommended that an agreement is reached so that if the goals are not achieved, adverse effects are intolerable or there are concerns about misuse, the opioid will be discontinued. This should include guidance about management if the patient requests or presents for an early repeat, if the medicine is reported as lost or there is a request for an increase in dose. When a strong opioid is prescribed, ideally there should be one prescriber and one pharmacy involved.

Choose a low starting dose of a long-acting or extended release preparation of a strong opioid, usually morphine as the first-line choice. Most patients taking opioids will also require a laxative, and possibly an anti-emetic in the initial stages of treatment , as well as short-acting medicine for breakthrough pain.

It is recommended that the dose be slowly titrated over several weeks if required, with a clinical assessment prior to each increase in dose.

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In this article Why is oxycodone a problem? Appropriate indication for oxycodone Reducing oxycodone use How to discontinue oxycodone The role of strong opioids for chronic non-cancer pain References In this article.

Why is oxycodone a problem? What is the appropriate indication for oxycodone? When compared to morphine, oxycodone: Has no better analgesic efficacy Has a similar adverse effect profile May have more addictive potential 1,2 Is significantly more expensive Oxycodone should only be prescribed for the treatment of moderate to severe pain in patients who are intolerant to morphine and when a strong opioid is the best option.

What can General Practitioners do to reduce oxycodone use? Summary: management strategies for patients discharged on oxycodone When a patient is discharged from secondary care on oxycodone, a suggested management strategy is as follows: When the patient presents for a renewal of a prescription of oxycodone, assess their level of pain and consider whether a strong opioid is still required. If a strong opioid is no longer required, step down to a weaker opioid or to paracetamol.

Depending on the length of time the patient has been on oxycodone, a gradual tapering of the dose may be necessary. If a strong opioid is still required, consider changing the patient to morphine. Explain to the patient that morphine is equally effective, will not usually result in any other adverse effects and that it is the preferred option when strong opioids are used in general practice. Regularly reassess the patient and step-down treatment as appropriate.

Make sure the patient knows that oxycodone is a strong opioid Many patients are unaware and shocked to be told that oxycodone is a strong opioid similar to morphine, but milligram for milligram, twice as potent. Reassess why oxycodone was initially prescribed Establish the precise clinical problem for which oxycodone was initially prescribed, e.

What level of pain is the patient experiencing? Consider if oxycodone can be stopped If the pain has reduced and oxycodone is no longer required, stop or taper the dose next section. Consider switching the patient to morphine If a strong opioid analgesic is still indicated, consider switching the patient to morphine. Detecting aberrant drug taking behaviour Behaviours that may suggest the development of aberrant drug taking behaviour, such as overuse, hoarding, dependence and diversion, include: presenting early for repeats, loss of prescriptions or medicines or requests for an escalation in dose.

If an opioid is continued, establish a pattern of regular review Every patient prescribed a strong opioid analgesic on an ongoing basis requires regular review. How to discontinue oxycodone Abrupt cessation Patients who have been taking oxycodone at low doses e. Gradual dose reduction Patients who have been taking oxycodone for more than one to two weeks, or at high doses, should have the dose gradually tapered to avoid symptoms of opioid withdrawal.

Referral to addiction services In some situations it may be more appropriate to refer patients to a community based drug and alcohol programme, to withdraw from oxycodone. Patients who may benefit from referral include those who: 17 Are unable to be slowly tapered off oxycodone in general practice due to factors such as a lack of success with tapering, non-compliance with tapering, accessing opioids from other sources Are misusing oxycodone or other addictive substances including alcohol.

Opioid withdrawal symptoms Abrupt cessation of any strong opioid can produce extremely unpleasant and distressing withdrawal symptoms, depending on the dose and the length of time the medicine has been used for. The role of strong opioids for chronic non-cancer pain The use of strong opioids for chronic non-cancer pain is controversial and there is limited quality evidence to support or oppose their use for this type of pain.

Ensure there has been an adequate trial of other treatments The WHO analgesic ladder provides a step-wise approach to analgesia for the management of pain Figure 3. Consider if a strong opioid is indicated and appropriate for the patient Prior to initiating a strong opioid for chronic pain in particular, consider the following questions: Have I identified the cause of the pain?

What am I trying to achieve? Is this what the patient wants? To what extent are psychosocial factors contributing to the pain level and how can these factors be addressed? Is there evidence that a particular medicine will help this type of pain? Are there non-pharmacological alternatives? Do the potential benefits outweigh the harms of the treatment? Check if the patient has a history of addictive behaviour, alcohol or medicine misuse.

If the patient has a current or past history of a psychological problem, a strong opioid may not be appropriate. Have I provided effective education about the most appropriate way to use analgesics? Have I considered how long a strong opioid may be required for? Have I made a plan for follow up? Reach an agreement with the patient regarding a trial of strong opioid analgesic If a strong opioid is indicated, ensure the patient has a good understanding of the type of medicine to be used and the goals of treatment, i.

Start with an appropriate dose and slowly titrate as required Choose a low starting dose of a long-acting or extended release preparation of a strong opioid, usually morphine as the first-line choice. Check that the goals of treatment agreed initially are being achieved and that a strong opioid is still the most appropriate medicine for the patient. Within-subject comparison of the psychopharmacological profiles of oral oxycodone and oral morphine in non-drug-abusing volunteers.

Psychopharm ; Canadian guideline for safe and effective use of opioids for chronic noncancer pain. Clinical summary for family physicians.

Part 1: general population. UK has more information about the law on drugs and driving. Talk to a doctor or pharmacist if you're unsure whether it's safe for you to drive while taking oxycodone. If you take recreational drugs, such as cannabis, cocaine and heroin, while you're taking oxycodone, you're more likely to get the serious side effects of oxycodone including breathing difficulties, muscle stiffness, low blood pressure and seizures or fits.

Some recreational drugs, such as cannabis, will also increase oxycodone side effects and make you feel sleepy and dizzy. Taking heroin while you're taking prescribed oxycodone is especially dangerous. You're more likely to get all the side effects of oxycodone, including addiction. Tell your doctor if you take recreational drugs while you're taking oxycodone. Page last reviewed: 17 October Next review due: 17 October Oxycodone On this page About oxycodone Key facts Who can and cannot take oxycodone How and when to take it Taking oxycodone with other painkillers Side effects How to cope with side effects Pregnancy and breastfeeding Cautions with other medicines Common questions.

About oxycodone Oxycodone is an opiate painkiller. Oxycodone is also known by the brand names Oxynorm and OxyContin. Help us improve our website Can you answer a quick question about your visit today? Oxycodone works by stopping pain signals travelling along the nerves to the brain.

Oxycodone liquid and capsules work in 30 to 60 minutes but wear off after 4 to 6 hours. It's possible to become addicted to oxycodone, but your doctor will explain how to reduce the risks of becoming addicted.

If you need to take oxycodone for more than a few weeks, your treatment plan may include details of how and when to stop taking this medicine. The most common side effects of oxycodone are constipation, feeling sick and feeling sleepy.

Oxycodone can be taken by adults and children aged 1 month and older. Tell your doctor before starting this medicine if you: have ever had an allergic reaction to oxycodone or any other medicine have lung problems, asthma or breathing difficulties have an addiction to alcohol have a head injury or condition which causes seizures or fits have an underactive thyroid gland hypothyroidism have kidney or liver problems have an enlarged prostate have low blood pressure hypotension have a mental health condition which is affected by certain medicines have had recent stomach surgery or bowel problems are trying to get pregnant, are already pregnant or if you're breastfeeding.

Oxycodone comes as: capsules — these contain 5mg, 10mg or 20mg of oxycodone slow-release tablets — these contain 5mg, 10mg, 15mg, 20mg, 30mg, 40mg, 60mg, 80mg or mg of oxycodone liquid — this contains 5mg of oxycodone in 5ml or 10mg of oxycodone in 1ml of liquid. Important Do not break, crush, chew or suck oxycodone slow-release tablets.

How often will I take it? How often you take it depends on the type of oxycodone that you've been prescribed: capsules — usually 4 to 6 times a day slow-release tablets — usually 1 to 2 times a day liquid — usually 4 to 6 times a day You can take oxycodone at any time of day, but try to take it at the same time every day and space your doses evenly.

Will my dose go up or down? What if I forget to take it? This will depend on which type of oxycodone you're taking. Never take 2 doses at the same time to make up for a forgotten one. What if I take too much? Urgent advice: Call now if:. Go to Where to store oxycodone If you're prescribed oxycodone, it's really important that you: store it properly and safely at home keep it out of the sight and reach of children do not give your medicine to anyone else return any unused oxycodone to a pharmacy so it can be thrown away safely.

Common side effects Common side effects happen in more than 1 in people. Talk to a doctor or pharmacist if these side effects bother you or do not go away: constipation feeling or being sick nausea or vomiting stomach discomfort feeling sleepy or tired feeling dizzy and a sensation of spinning vertigo confusion headaches itchiness or rash Serious side effects Serious side effects happen in less than 1 in people.

Call a doctor if you have: muscle stiffness feel dizzy, tired and have low energy — this could be a sign of low blood pressure hypotension. Immediate action required: Call if:. Serious allergic reaction In rare cases, it's possible to have a serious allergic reaction anaphylaxis to oxycodone. Information: You can report any suspected side effect using the Yellow Card safety scheme. Visit Yellow Card for further information.

What to do about: constipation — try to include more high-fibre foods in your diet such as fruits, vegetables and cereals. Try to drink several glasses of water each day. If you can, it may also help to do some gentle exercise.

Ask your doctor about medicine to help prevent or treat constipation caused by oxycodone. Ensure the tablets or capsules are swallowed whole with a glass of water. This side effect should usually wear off after a few days.

Talk to a doctor about taking anti-sickness medicine if it carries on for longer. Talk to a doctor if they carry on for longer.

Your dose may need to be adjusted. It may be best not to drink alcohol while taking oxycodone as this can make headaches worse. It's safe to take an everyday painkiller such as paracetamol or ibuprofen. Talk to a doctor if headaches last longer than a week or are severe. Check with the pharmacist to see what type is suitable for you. If symptoms do not go away or they get worse, talk to a doctor as you may need to try a different painkiller. Oxycodone and breastfeeding Oxycodone is not usually recommended if you're breastfeeding.

Non-urgent advice: Tell your doctor if you're:. Tell a doctor before you start taking oxycodone if you are taking any medicines: to help you sleep for depression or mental health problems — some types cannot be taken with oxycodone for high blood pressure hypertension to help stop you feeling or being sick vomiting , such as domperidone or metoclopramide to treat symptoms of an allergy such as antihistamines to reduce tension or anxiety for an infection to control seizures of fits due to epilepsy Mixing oxycodone with herbal remedies and supplements It's not possible to say that oxycodone is safe to take with herbal remedies and supplements.

Important: Medicine safety Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements. How does oxycodone work? Oxycodone is from a group of medicines called opiates, or narcotics. How long does it take to work? How long will I take it for? Can I become addicted to oxycodone?

How will I know if I'm addicted? These include: feeling agitated, anxious or nervous panic attacks difficulty sleeping shaking pins and needles ringing in the ears sweating Talk to a doctor if you're worried about addiction or if you want to know more about how to prevent withdrawal symptoms.

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