Can a pregnant patient receive oxycodone (opioid analgesic)?

From the Guidelines

Oxycodone can be used in pregnant patients when the benefits outweigh the risks, but it should be prescribed with caution and for the shortest duration necessary, as recommended by the most recent guidelines 1. When considering the use of oxycodone in pregnant patients, it is essential to weigh the potential benefits against the risks, including the risk of neonatal opioid withdrawal syndrome and maternal physical dependence.

• The American Journal of Obstetrics and Gynecology recommends that nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen be used as first-line treatments for pain after a routine vaginal birth, unless contraindicated, and that a short course of low-dose opioids can be considered for severe pain that is not managed effectively by nonopioid options 1.
• For opioid-naïve women, NSAIDs and acetaminophen should be given as first-line treatments for pain after cesarean delivery, and the addition of opioids to the pain management regimen should be considered if pain persists 1.
• Long-term use of oxycodone during pregnancy should be avoided when possible, as it can lead to neonatal opioid withdrawal syndrome in the newborn, and if used near delivery, the baby may experience respiratory depression 1.
• Regular monitoring is essential, and the healthcare provider should discuss alternative pain management strategies, including non-opioid medications like acetaminophen, when appropriate.
• Pregnant patients taking oxycodone should be informed about potential risks, including maternal physical dependence and neonatal effects, and the decision to use oxycodone during pregnancy should be made collaboratively between the patient and healthcare provider after careful consideration of the specific clinical situation.

From the FDA Drug Label

8 USE IN SPECIFIC POPULATIONS

Pregnancy: May cause fetal harm. Prolonged use of opioid analgesics during pregnancy may cause neonatal opioid withdrawal syndrome Available data with oxycodone hydrochloride tablets in pregnant women are insufficient to inform a drug-associated risk for major birth defects and miscarriage.

Pregnant patients can receive oxycodone, but with caution.

• The FDA drug label warns that oxycodone may cause fetal harm and neonatal opioid withdrawal syndrome.
• Prolonged use during pregnancy is not recommended, unless the benefits outweigh the risks.
• Patients should be advised of the potential risk to the fetus and monitored for signs of neonatal opioid withdrawal syndrome 2.
• The drug label also states that oxycodone hydrochloride tablets are not recommended for use in pregnant women during or immediately prior to labor.

From the Research

Oxycodone Use in Pregnancy

• Oxycodone is commonly used by pregnant women for the treatment of pain, but its use in pregnancy has not been robustly evaluated 3.
• A retrospective cohort study found that oxycodone exposure was associated with a short period of gestation, preterm birth, and neonatal abstinence syndrome, which likely contributed to a longer period of hospitalization following birth 3.
• Another study found that over 50% of analgesics, including oxycodone, are in pregnancy category C, and even more are category D specifically in the third trimester, indicating potential risks to the fetus 4.

Risks and Benefits

• The use of oxycodone in pregnancy was not associated with an increased risk of congenital anomalies, but it was associated with a reduction in average length of gestation and birth weight 3.
• A review of analgesic use in pregnancy found that changes in renal filtration, cardiac output, plasma protein concentration, and plasma volume particularly affect analgesics, and dose adjustments may be necessary to maintain therapeutic concentrations in pregnant women 4.
• The benefits of oxycodone use in pregnancy must be weighed against the potential risks, and alternative treatments should be considered when possible 5.

Alternative Treatments

• Methadone and buprenorphine are commonly used to treat opioid use disorder in pregnancy, but naltrexone, an opioid antagonist, is also a viable option for some pregnant patients 6.
• A prospective cohort study found that naltrexone was well-tolerated by both mother and fetus, and newborn infants did not experience symptoms of neonatal abstinence syndrome if naltrexone medication-assisted treatment was maintained to delivery 6.
• Methadone used for the treatment of maternal pain resulted in a low incidence of neonatal abstinence syndrome, but infants were at risk for significant morbidity related to prematurity 7.