Should I add OxyContin (oxycodone) to the patient's regimen given their frequent use of prn (as needed) oxy (oxycodone) 5 times daily?

Converting PRN Oxycodone to Scheduled OxyContin

Yes, you should add OxyContin (extended-release oxycodone) to the patient's regimen since they are consistently using immediate-release oxycodone 5 times daily. This conversion from PRN to scheduled dosing is appropriate for patients with consistent opioid needs.

Rationale for Converting to Scheduled Dosing

When a patient requires PRN opioid medication consistently (5 times daily in this case), this indicates a pattern of continuous pain that would benefit from around-the-clock coverage rather than treating pain after it occurs. The FDA label for oxycodone specifically states:

• "Patients with chronic pain should have their dosage given on an around-the-clock basis to prevent the reoccurrence of pain rather than treating the pain after it has occurred" 1
• "For control of severe chronic pain, oxycodone should be administered on a regularly scheduled basis" 1

Implementation Plan

1. Calculate total daily oxycodone usage:

   • Determine the current dose and frequency of PRN oxycodone
   • Calculate the 24-hour total oxycodone requirement

2. Convert to extended-release formulation:

   • Divide the total daily dose into two equal doses of OxyContin (given every 12 hours)
   • Reduce the initial calculated dose by 25-50% to account for incomplete cross-tolerance if switching between different opioids 2

3. Maintain breakthrough coverage:

   • Continue a reduced amount of immediate-release oxycodone for breakthrough pain
   • Prescribe at approximately 10-15% of the total daily extended-release dose

Monitoring and Follow-up

• Assess pain control, functional status, and side effects within 24-72 hours after initiating OxyContin
• Monitor closely for respiratory depression, especially within the first 24-72 hours of therapy 1
• Adjust dosage based on efficacy and tolerability

Important Considerations

• Risk assessment: Before initiating extended-release opioid therapy, assess the patient's risk for opioid misuse, abuse, and addiction
• Medication safety: Counsel the patient about proper storage and disposal of OxyContin to prevent diversion
• Regular reassessment: Schedule regular follow-up visits to evaluate continued need for opioid therapy

Common Pitfalls to Avoid

• Underdosing: Inadequate conversion can lead to poor pain control and continued PRN use
• Overdosing: Excessive initial dosing can cause respiratory depression
• Abrupt discontinuation: Never stop OxyContin abruptly as this can precipitate withdrawal
• Missing breakthrough coverage: Always provide immediate-release opioid for breakthrough pain when using extended-release formulations

Converting from frequent PRN dosing to scheduled extended-release formulation with breakthrough coverage represents better pain management practice and may improve the patient's quality of life by providing more consistent pain control.