What is the maximum daily dose of oxycodone (opioid analgesic)?

Maximum Daily Dose of Oxycodone

There is no upper limit to the maximum daily dose of oxycodone for cancer pain management, as long as side effects can be controlled. 1

Dosing Guidelines

Initial Dosing

• For immediate-release formulations: Start with 5-10 mg every 4-6 hours 2
• For controlled-release formulations: Start with 10-20 mg every 12 hours 2

Dose Titration

• Titration should be based on pain control and side effects
• The CDC recommends careful reassessment before increasing total opioid dosage to ≥50 MME/day (approximately 33 mg of oxycodone) 2
• Oxycodone has a conversion factor of 1.5 to morphine milligram equivalents (MME), meaning 10 mg of oxycodone = 15 MME 2

Dosing Frequency

• While controlled-release oxycodone is designed for twice-daily dosing, clinical practice shows that 67% of chronic pain patients may require more frequent dosing (typically three times daily) for optimal pain control 3
• Median total daily dose in clinical practice is approximately 80 mg, regardless of dosing frequency 3

Special Considerations

Breakthrough Pain

• Breakthrough doses should be approximately 10% of the total daily dose 2
• If more than 4 breakthrough doses per day are necessary, the baseline opioid treatment should be adjusted 2
• Patients who have uncontrolled pain can take a rescue dose every hour for up to 4 hours before consulting a physician 1

Special Populations

• Elderly patients may require lower doses due to altered pharmacokinetics 2
• No dose reduction is needed in moderate hepatic or renal failure 4

Common Pitfalls and Caveats

1. Misconception about ceiling effect: Unlike some opioids, pure agonists like oxycodone do not have a ceiling effect for analgesia 1

2. Side effect management: The most common side effects are nausea, constipation, and drowsiness 4. These should be anticipated and managed proactively rather than limiting effective doses.

3. Opioid rotation: If side effects become intolerable despite management, switching to another opioid may allow for adequate analgesia with fewer adverse effects 2

4. Tolerance and dependence: Tolerance and physical dependence are not significant problems in patients with cancer pain when properly managed 1

5. Dosing frequency: While controlled-release formulations are designed for twice-daily dosing, clinical evidence shows many patients require three-times-daily dosing for optimal pain control 3

6. Formulation integrity: Controlled-release tablets must be taken whole and must not be broken, chewed, or crushed, as this could lead to rapid release and absorption of a potentially fatal dose 4

For non-cancer pain, more conservative dosing approaches are typically recommended, with careful consideration of risk-benefit ratios as doses increase beyond 50 MME/day (approximately 33 mg oxycodone daily) 2, 5.