OXYCODONE Rx & Safety

OXYCODONE Rx & Safety
Oxycodone, alone and in combination with other analgesics, has been used for more than 80 years in the treatment of a variety of acute and chronic pain conditions. Compared with morphine, oxycodone has higher oral bioavailability and is considered twice as potent.

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CONTENTS

Commonsense Oxycodone Prescribing & Safety
By: Lee A. Kral, PharmD, BCPS; from Pain Treatment Topics, June 2007.

PDF available here for download: OxycodoneRxSafety.pdf (314 KB, 18 pp)

This peer-reviewed paper discusses the safe prescribing of both immediate release (IR) and long-duration controlled release (CR) formulations of oxycodone. Concerns about oxycodone diversion, misuse, and abuse have been justified; however, with proper prescribing, appropriate risk management, and effective patient education, it remains a useful analgesic option in the practice of pain management.

Oxycodone is a versatile oral opioid that is effective in treating many types of cancer and noncancer pain. Dosage forms are flexible and easily interchangeable, and it is not subject to significant alterations in pharmacokinetics. Oxycodone side effects are predictable and similar to other opioids, although it may be better tolerated than morphine in some patients. Generally, oxycodone is reserved for patients having intolerable adverse effects from morphine or other opioids that prevent adequate titration for desired analgesia. Its ultimate role depends on patient response, prescriber comfort in using the agent, and relative cost considerations.

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Patient Instructions Handout: Safely Taking Oxycodone

By: Lee A. Kral, PharmD, BCPS and Stewart B. Leavitt, MA, PhD; from Pain Treatment Topics, in English and Spanish, June 2007.

PDF available here for download: OxycodoneHandout.pdf (350 KB, 7 pp)

To assist healthcare providers in their vital patient-education responsibilities, these special 2-page, peer-reviewed “Patient Instructions” handouts on the safe use of oxycodone are available in English and Spanish. These can be downloaded and reproduced free of charge for distribution at the time oxycodone analgesia is prescribed. Ideally, these also would be used as discussion guides for face-to-face education of patients – and their families or caregivers. The emphasis of the handouts is on medication compliance and safety, to help prevent misuse and avoidable adverse events potentially associated with oxycodone analgesia therapy.

Of special importance, this handout describes warning signs of oxycodone overdose, and instructs family members or caregivers to immediately seek emergency assistance if any occur.

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Oxycodone: Pharmacological Profile and Clinical Data in Chronic Pain Management

By: F. Coluzzi and C. Mattia, in Minerva Anestesiologica, 71(7-8), 2005.

PDF available at: http://www.minervamedica.it/…R02Y2005N07A0451

(click on Full Article, 257 KB, 10 pp)

This review discusses oxycodone pharmacology, various formulations of oxycodone, and their application in chronic non-malignant as well as cancer-related pain. Research evidence is examined and synthesized. Controlled- or extended-release preparations are noted to provide a long duration of action, offering the advantage of longer dosing intervals, greater convenience, and sustained analgesic effect. The authors suggest that CR/ER oxycodone provides a rational alternative to CR morphine for the management of moderate to severe chronic pain conditions.

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Oxycodone: Prescribing Information / Package Inserts (PIs)

Oxycodone + Acetaminophen Capsules (Rev2005)

PDF available here for download: PI_Oxycodone-APAP_Capsules.pdf (60 KB, 5 pp)

Oxycodone HCL Tablets (Rev2005)

PDF available here for download: PI_OxycodoneHCL_Tablets-30mg.pdf (234 KB, 2 pp)

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Criteria for Use of Controlled-Release Oxycodone

By: Francine Goodman, PharmD, BCPS; William N. Jones, BSc, MSc; and Peter Glassman, MBBS, MSc. Washington, DC: Pharmacy Benefits Management Strategic Healthcare Group and the Medical Advisory Panel, Veterans Health Administration, Department of Veterans Affairs. Revised July 2003.

PDF available here: VA_UseCriteria_CR-Oxycodone.pdf (145 KB, 7 pp)

In this evidence-based guidance document from the U.S. Department of Veterans Affairs, the authors examine indications, dosing, adverse effects, and relative costs of controlled-release oxycodone for moderate to severe pain. They conclude that CR oxycodone is an effective agent that might be reserved for patients who require continuous, around-the-clock opioid analgesia for an extended period of time AND who cannot tolerate other, less expensive oral opioid analgesics, such as generic morphine CR/SR or methadone.

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Safety and Efficacy of Controlled-Release Oxycodone: A Systematic Literature Review

By: D. Gary Rischitelli, MD, JD, MPH, and Sean H. Karbowicz, PharmD. Pharmacotherapy. 2002;22(7):898-904. Available from Medscape Today.

HTML document at: http://www.medscape.com/viewarticle/439812 (Access checked 5/16/07)

To determine whether CR oxycodone offers greater clinical benefits than other available opioids and to justify the significantly greater cost of the brand-name oxycodone product, a systematic review of 16 clinical trials was undertaken. The authors concluded that immediate-release and controlled-release preparations of oxycodone have similar efficacy and comparable side effect profiles. CR oxycodone has the advantage of less frequent dosing; however, other agents may be dosed infrequently and at lower costs. For patients requiring a controlled-release opioid treatment, generic CR morphine or methadone could be considered, because they appear to be as effective as CR oxycodone at lower cost. However, CR oxycodone may be more appropriate for some patients, particularly if they cannot tolerate other controlled-release or long-acting opioid analgesics.