From the FDA Drug Label
Oxycodone hydrochloride tablets may cause severe hypotension including orthostatic hypotension and syncope in ambulatory patients. There is increased risk in patients whose ability to maintain blood pressure has already been compromised by a reduced blood volume or concurrent administration of certain CNS depressant drugs (e.g., phenothiazines or general anesthetics) [see Drug Interactions (7)] .
Inform patients that oxycodone hydrochloride tablets may cause orthostatic hypotension and syncope. Instruct patients how to recognize symptoms of low blood pressure and how to reduce the risk of serious consequences should hypotension occur (e.g., sit or lie down, carefully rise from sitting or lying position) [see Warnings and Precautions (5. 9)] .
Yes, oxycodone can cause hypotension, including orthostatic hypotension and syncope, especially in patients with compromised ability to maintain blood pressure or those taking certain CNS depressant drugs 1, 1, 1.
From the Research
Yes, oxycodone (OxyContin) can cause hypotension (low blood pressure). This side effect is more common when starting the medication, increasing the dose, or in patients who are elderly, debilitated, or have underlying cardiovascular issues. Oxycodone causes hypotension through its action on opioid receptors that can lead to peripheral vasodilation and decreased sympathetic tone. The risk is higher with intravenous administration or when combined with other medications that lower blood pressure such as antihypertensives, benzodiazepines, or alcohol.
Key Points to Consider
- Patients should be monitored for symptoms of hypotension including dizziness, lightheadedness, or fainting, especially when initiating therapy.
- Those taking oxycodone should change positions slowly (from lying to sitting, or sitting to standing) to minimize orthostatic hypotension.
- If severe hypotension occurs, patients should seek immediate medical attention as dose adjustment or alternative pain management strategies may be necessary. According to the most recent study 2, oxycodone has been extensively studied as a therapeutic analgesic for acute and chronic neuropathic pain, and its pharmacology and neurobiology have been well characterized. However, the study also highlights the potential for abuse and the importance of monitoring patients for signs of hypotension and other adverse effects.
Recommendations for Clinical Practice
- Clinicians should carefully evaluate patients for underlying cardiovascular risk factors before initiating oxycodone therapy.
- Patients should be educated on the risks of hypotension and the importance of reporting symptoms promptly.
- Alternative pain management strategies should be considered for patients who experience severe hypotension or other adverse effects while taking oxycodone. The study by 3 also suggests that high-dose oxycodone can induce respiratory depression and brain hypoxia, which can be life-threatening. Therefore, it is essential to monitor patients closely and adjust the dose or switch to alternative pain management strategies as needed.
Additional Considerations
- The risk of hypotension is higher with intravenous administration of oxycodone, and patients should be closely monitored in this setting.
- Combining oxycodone with other medications that lower blood pressure can increase the risk of hypotension, and patients should be advised to avoid such combinations whenever possible. Overall, while oxycodone can be an effective analgesic for patients with acute and chronic pain, clinicians must be aware of the potential risks of hypotension and take steps to minimize these risks and ensure patient safety.