From the Guidelines
Alternatives to oxycodone for pain management include morphine, hydromorphone, and other opioids, as well as non-opioid options like acetaminophen, NSAIDs, and adjuvant medications. For moderate to severe pain, alternative opioids include morphine (starting at 15-30mg every 4 hours) 1, hydromorphone (2-4mg every 4-6 hours) 1, or tramadol (50-100mg every 4-6 hours) 1. Non-opioid medications are often preferred due to lower addiction risk and include:
- Acetaminophen (up to 3000mg daily divided into doses)
- NSAIDs like ibuprofen (400-800mg every 6-8 hours) or naproxen (250-500mg twice daily)
- Adjuvant medications such as gabapentin (starting at 300mg daily and titrating up) for neuropathic pain 1. Combination therapy often provides better pain relief with fewer side effects than high-dose single agents. Non-pharmacological approaches like physical therapy, acupuncture, cognitive behavioral therapy, and heat/cold therapy can also be effective components of pain management 1. The best alternative depends on the type and severity of pain, patient's medical history, and risk factors for medication side effects or dependency. According to the most recent study 1, pure agonists (such as morphine, oxycodone, oxymorphone, and fentanyl) are the most commonly used medications in the management of cancer pain. However, it's essential to consider the individual patient's needs and medical history when selecting an alternative to oxycodone. For example, patients with fluctuating renal function should use morphine, hydromorphone, hydrocodone, oxymorphone, and codeine with caution due to potential accumulation of renally cleared metabolites that may cause neurologic toxicity 1. In contrast, a randomized trial compared the efficacy of low-dose morphine to “weak opioids” (ie, codeine, codeine plus acetaminophen, or tramadol) for treating moderate-intensity cancer pain, and low-dose morphine had a significantly higher response rate and earlier onset of response compared with weak opioids 1. Therefore, morphine is a suitable alternative to oxycodone for pain management, especially for moderate to severe pain.
From the FDA Drug Label
Oxycodone hydrochloride tablets are indicated for the management of pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate Because of the risks of addiction, abuse, and misuse with opioids, even at recommended doses, reserve oxycodone hydrochloride tablets for use in patients for whom alternative treatment options (e.g., non-opioid analgesics or non-opioid combination products): Have not been tolerated, or are not expected to be tolerated, Have not provided adequate analgesia or are not expected to provide adequate analgesia.
The alternatives to oxycodone for pain management are:
- Non-opioid analgesics
- Non-opioid combination products 2
From the Research
Alternatives to Oxycodone for Pain Management
Alternatives to oxycodone for pain management include:
- Acetaminophen 3, 4
- Nonsteroidal anti-inflammatory drugs (NSAIDs) 3, 4
- Cyclooxygenase-2 (COX-2) inhibitors 3, 4
- Anticonvulsants such as gabapentin, pregabalin, lamotrigine, and carbamazepine 3
- Tricyclic antidepressants (TCAs) and selective serotonin and noradrenaline reuptake inhibitors (SNRIs) 3
- Tramadol, a central-acting oral analgesic with combined opioid and noradrenergic properties 4, 5
- Tapentadol, a central-acting oral analgesic with combined opioid and noradrenergic properties 3
- Targinact, a combination of the opioid agonist oxycodone and the opioid antagonist naloxone 3
Non-Pharmacological Alternatives
Non-pharmacological alternatives to oxycodone for pain management include:
- Deep brain stimulation (DBS) of the subthalamic nucleus (STN) 3
- Massage therapy (MT) 3
- Rehabilitative therapy and physical therapy 3
- Yoga 3
Combination Therapies
Combination therapies, such as co-administration of gabapentin and prolonged-release oxycodone, may also be effective in managing pain 6. However, the use of combination therapies should be tailored to the individual patient's needs and medical history.