What is the recommended initial dose of Oxycodone (oxycondone hydrochloride) for a 71-year-old female with acute intertrochanteric hip fracture and moderate to severe pain?

Oxycodone Dosing for Elderly Patient with Hip Fracture

For a 71-year-old female (52 kg) with an acute intertrochanteric hip fracture and moderate to severe pain, the recommended initial dose of oxycodone is 2.5-5 mg orally every 4-6 hours as needed, with careful monitoring for respiratory depression and sedation.

Initial Dosing Considerations

Age and Weight Considerations

• For elderly patients (>70 years), oxycodone dosing should be reduced due to:
  • Decreased renal function
  • Increased sensitivity to opioid effects
  • Higher risk of respiratory depression
  • Higher risk of delirium 1

Recommended Initial Dosing

• Start with 2.5-5 mg oral oxycodone every 4-6 hours as needed 2
• This is lower than the standard adult starting dose (5-15 mg) recommended in the FDA label
• Titrate based on individual response, balancing pain control with side effects

Multimodal Pain Management Approach

First-Line Treatments (Before Opioids)

1. Acetaminophen:

   • Regular IV acetaminophen every 6 hours 1
   • Strongly recommended as first-line treatment

2. Consider Regional Anesthesia:

   • Peripheral nerve blocks are strongly recommended for hip fractures 1
   • Reduces preoperative and postoperative opioid requirements

3. NSAIDs:

   • Consider adding if no contraindications 1
   • Monitor for renal effects, especially in elderly

Opioid Use Guidelines

• Use oxycodone only for breakthrough pain 1
• Administer for the shortest period at the lowest effective dose
• Immediate-release formulations are preferred over extended-release 1

Monitoring and Titration

Monitoring Parameters

• Respiratory rate and sedation level (most critical)
• Pain scores at rest and with movement
• Mental status (watch for delirium)
• Constipation

Dose Titration

• Reassess efficacy and side effects every 60 minutes after oral administration 3
• If pain remains uncontrolled after 2-3 cycles, consider:
  • Increasing dose by 25-50% if no adverse effects
  • Changing to alternative pain management strategy
  • Consulting pain specialist

Special Considerations for Elderly Patients

Risk Factors to Assess

• Renal function (may require dose reduction)
• Hepatic function (primary site of oxycodone metabolism)
• Concurrent CNS depressants
• History of respiratory conditions
• Cognitive status

Common Pitfalls to Avoid

1. Overdosing: Starting with standard adult doses in elderly patients
2. Underdosing: Inadequate pain control can delay mobilization and recovery
3. Fixed schedules: Using around-the-clock dosing when PRN dosing may be sufficient
4. Prolonged use: Most patients with acute fracture pain require opioids for only 3-4 days 4

Practical Recommendations

• Liquid oral formulations may be easier to administer and allow for more precise dosing
• Avoid modified-release opioid preparations in acute settings 1
• Implement non-pharmacological measures (immobilization, ice packs) 1
• Plan for opioid weaning as soon as pain improves
• When pain requirements decrease, wean opioids first, then NSAIDs, then acetaminophen 1

By following these guidelines, you can effectively manage this elderly patient's hip fracture pain while minimizing the risks associated with opioid therapy.