What is the proper use of Percocet (oxycodone/acetaminophen)?

From the Guidelines

Percocet, a combination of oxycodone and acetaminophen, should only be used as prescribed by a healthcare provider for the management of moderate to severe pain when other treatments are inadequate, with the goal of minimizing risks and improving quality of life. The proper use of Percocet involves taking the medication exactly as prescribed, with food if it causes stomach upset, and never crushing or breaking extended-release formulations.

Key Considerations

• The typical adult dosage ranges from 2.5-10 mg oxycodone/325-650 mg acetaminophen every 4-6 hours as needed for pain, not exceeding 4000 mg of acetaminophen daily 1.
• Treatment should be as brief as possible to minimize risks, including physical dependence, addiction, and potentially fatal respiratory depression, especially when combined with alcohol or other central nervous system depressants.
• Common side effects include drowsiness, dizziness, nausea, constipation, and respiratory depression.
• Store the medication securely away from others, particularly children, and properly dispose of unused medication.
• Never share Percocet with others, even if they have similar symptoms, as this is illegal and dangerous.

Evidence-Based Recommendations

• Nonopioid therapies, such as acetaminophen and NSAIDs, should be maximized before considering opioid therapy, as they are at least as effective as opioids for many common acute pain conditions 1.
• Opioid therapy, including Percocet, should be prescribed at the lowest effective dose and for no longer than the expected duration of pain severe enough to require opioids 1.
• Multimodal pain management, including the use of different classes of analgesic medications, should be considered to improve analgesia while reducing individual class-related side effects 1.

Important Warnings

• Percocet carries significant risks, including physical dependence, addiction, and potentially fatal respiratory depression, especially when combined with alcohol or other central nervous system depressants.
• Acetaminophen, a component of Percocet, can cause liver toxicity, and the FDA has limited the maximum amount of acetaminophen in prescription products to 325 mg per tablet, capsule, or other dosage unit 1.

From the FDA Drug Label

2 DOSAGE AND ADMINISTRATION

2.1 Important Dosage and Administration Instructions

Ensure that patients receive the following information to ensure safe use:

• Take tablets whole, one at a time, with enough water to ensure complete swallowing immediately after placing in the mouth [see Patient Counseling Information (17)].
• Do not break, chew, crush, or dissolve oxycodone hydrochloride tablets [see Patient Counseling Information (17)].
• Do not administer tablets via nasogastric, gastric, or other feeding tubes as it may cause physical withdrawal symptoms due to rapid release of the opioid.

Proper use of Percocet (oxycodone/acetaminophen) includes:

• Taking the tablets whole with enough water to ensure complete swallowing
• Not breaking, chewing, crushing, or dissolving the tablets
• Not administering the tablets via nasogastric, gastric, or other feeding tubes
• Following the prescribed dosage and administration instructions
• Monitoring for signs of addiction, abuse, and misuse
• Storing the medication securely and disposing of unused tablets properly 2
• Reading the Medication Guide and following the instructions provided by the healthcare provider 2
• Informing the healthcare provider of any history of substance abuse or mental illness 2

From the Research

Proper Use of Percocet

Percocet is a combination medication containing oxycodone and acetaminophen, used to manage moderate to severe pain. The proper use of Percocet involves following the prescribed dosage and usage instructions provided by a healthcare professional.

• Dosage: The recommended dosage of Percocet varies depending on the individual's pain level and medical history. According to 3, a low-dose combination of oxycodone with acetaminophen can be effective in managing moderate pain, with almost 97% of patients who reported relief of pain receiving 1.61 ± 0.67 doses of oxycodone 5 mg combined with 325 mg of acetaminophen.
• Administration: Percocet should be taken orally, with or without food, as directed by a healthcare professional.
• Pain Management: Percocet is used to manage moderate to severe pain, including musculoskeletal pain, osteoarthritis, and chronic musculoskeletal pain. As stated in 4, the combination of oxycodone and paracetamol has a synergistic mechanism of action, making it useful for moderate-to-severe pain and for nonresponders to NSAIDs or paracetamol alone.

Important Considerations

When using Percocet, it is essential to consider the following:

• Oxycodone is a semi-synthetic opioid that can be habit-forming, and its use should be monitored closely by a healthcare professional. As mentioned in 5, oxycodone has been prescribed in many immediate-release formulations, including Percodan, Percocet, Tylox, Roxicodone, and Toxicet.
• Acetaminophen is a common ingredient in many over-the-counter medications, and exceeding the recommended dosage can lead to liver damage. According to 6, a single dose of oxycodone/ibuprofen 5 mg/400 mg provided better analgesia than low-dose oxycodone or ibuprofen administered alone in most trials.
• Patients should inform their healthcare professional about any medical conditions, allergies, or medications they are currently taking before using Percocet. As noted in 7, oxycodone/acetaminophen resulted in slightly greater pain relief than acetaminophen alone in patients with acute musculoskeletal pain refractory to oral ibuprofen, but this was associated with more medication-related adverse events.