What is the appropriate dosing for Oxycodone (OxyContin) and Acetaminophen (Tylenol), also known as Percocet (Oxycodone and Acetaminophen)?

From the Guidelines

Percocet should be dosed at the lowest possible effective dosage, with a starting dose of 5-10 MME (approximately 5-10 mg of oxycodone) every 4-6 hours as needed for pain, and the total daily dosage should not exceed 50 MME/day whenever possible. When prescribing Percocet, which contains oxycodone hydrochloride combined with acetaminophen, clinicians should consider the cumulative dosages of both medications to avoid toxic levels, especially in patients with renal or hepatic insufficiency 1. The maximum daily dose of acetaminophen should not exceed 4000 mg, but many clinicians recommend limiting it to 3000 mg daily.

Some key points to consider when dosing Percocet include:

• Starting with a low dose of 5-10 mg of oxycodone for opioid-naive patients and calibrating as needed based on pain severity and clinical factors such as renal or hepatic insufficiency 1
• Using caution when increasing opioid dosages and avoiding unnecessary dosage increases, as overdose risk increases with dosage 1
• Implementing additional precautions, including increased frequency of follow-up and offering naloxone and overdose prevention education, when the total opioid dosage reaches or exceeds 50 MME/day 1
• Carefully evaluating the decision to increase dosage after an individualized assessment of benefits and risks, weighing factors such as diagnosis, incremental benefits for pain and function relative to risks, and patient values and preferences 1

Common side effects of Percocet include constipation, nausea, sedation, and respiratory depression, and patients should use a stool softener preventatively to manage constipation. Due to its potential for dependence and respiratory depression, Percocet requires careful monitoring, especially in elderly patients or those with respiratory conditions. The medication works by binding to opioid receptors in the brain and spinal cord to reduce pain perception, while the acetaminophen component provides additional pain relief through different mechanisms.

It is essential to use Percocet for the shortest duration possible, typically 3-7 days for acute pain, to minimize risks of dependence. Clinicians should be aware of policies related to MME thresholds and associated clinical protocols established by their states, such as the requirement in Washington state to obtain consultation from a pain specialist before increasing long-term opioid therapy dosage to >120 MME/day 1.

From the FDA Drug Label

Concentration-Efficacy Relationships The minimum effective analgesic concentration will vary widely among patients, especially among patients who have been previously treated with potent agonist opioids The minimum effective analgesic concentration of oxycodone for any individual patient may increase over time due to an increase in pain, the development of a new pain syndrome, and/or the development of analgesic tolerance [see Dosage and Administration (2.1,2. 3)]

The appropriate dosing for Oxycodone and Acetaminophen is not explicitly stated in the provided text. However, the text does mention that the minimum effective analgesic concentration of oxycodone will vary widely among patients.

• The text does not provide a specific dose for Oxycodone and Acetaminophen.
• It is recommended to consult the Dosage and Administration section (2.1,2.3) for more information on dosing.
• The provided text does not contain information on Acetaminophen dosing. 2

From the Research

Dosing Information for Oxycodone and Acetaminophen

• The appropriate dosing for Oxycodone (OxyContin) and Acetaminophen (Tylenol), also known as Percocet (Oxycodone and Acetaminophen), can vary depending on the specific condition being treated and the individual patient's response to the medication 3, 4, 5, 6, 7.
• For moderate-to-severe pain, the fixed-dose combination of oxycodone and acetaminophen has been shown to be effective, with lower individual drug doses used due to their synergistic mechanisms of action 3.
• The mean daily dosage of oxycodone was approximately 40 mg in studies addressing the safety and efficacy of oxycodone for the treatment of non-cancer pain, with a low incidence of intolerable typical opiate side effects 4.
• In a study evaluating the effectiveness and safety of new oxycodone/acetaminophen formulations with reduced acetaminophen for the treatment of low back pain, the mean oxycodone/acetaminophen dose at the end of treatment was 8.2/325 mg TID 5.
• For acute postoperative pain, single dose oral oxycodone and oxycodone plus paracetamol (acetaminophen) have been shown to be effective, with oxycodone 10 mg plus paracetamol 650 mg providing good analgesia to half of those treated, comparable to commonly used non-steroidal anti-inflammatory drugs, with the benefit of longer duration of action 6.
• In a dental pain model, oxycodone 5 mg/ibuprofen 400 mg provided significantly greater analgesia compared with oxycodone 5 mg/acetaminophen 325 mg, hydrocodone 7.5 mg/acetaminophen 500 mg, and placebo, with a lower frequency of nausea and vomiting 7.

Specific Dosing Recommendations

• Oxycodone 5 mg/acetaminophen 325 mg: effective for moderate-to-severe pain, but with a higher incidence of nausea and vomiting compared to oxycodone 5 mg/ibuprofen 400 mg 7.
• Oxycodone 10 mg plus paracetamol 650 mg: provides good analgesia to half of those treated, comparable to commonly used non-steroidal anti-inflammatory drugs, with the benefit of longer duration of action 6.
• Oxycodone 7.5- and 10-mg/acetaminophen 325-mg (Percocet) formulations: effective for the treatment of low back pain, with a mean oxycodone/acetaminophen dose at the end of treatment of 8.2/325 mg TID 5.