Pediatric Dosing for Oxycodone
The recommended pediatric oral dosing for oxycodone is 0.05-0.15 mg/kg every 4-6 hours for moderate to severe pain. 1
Dosing Guidelines
Oxycodone is a semi-synthetic opioid analgesic that can be used for moderate to severe pain in pediatric patients when appropriate. The dosing should follow these parameters:
- Route of administration: Oral only (IV formulation not available for pediatrics)
- Dosage: 0.05-0.15 mg/kg per dose
- Frequency: Every 4-6 hours as needed
- Duration of effect: 4-6 hours
Important Considerations
- Pediatric dosage (adjusted for body weight) should not exceed the corresponding adult dose 1
- These dosing recommendations do not apply to neonates, who have distinct pharmacokinetics 1
- Opioid-naïve patients should start at the lower end of the dosing range
- Weight-normalized oral clearance is approximately 42% higher in children compared to adults, which may necessitate more frequent dosing in some cases 2
Special Populations and Precautions
Age-Related Considerations
- Neonates: Oxycodone is not recommended due to distinct pharmacokinetics 1
- Children <12 years: Use with caution; monitor closely for respiratory depression
- Adolescents: Body weight-based dosing remains appropriate, but total dose should not exceed adult recommendations
Contraindications
- Breastfeeding mothers: Avoid oxycodone as infants may receive >10% of therapeutic dose through breast milk, which poses a risk of causing infant sedation 1
- Children with obesity, obstructive sleep apnea, or severe lung disease: Use with extreme caution due to increased risk of respiratory depression 3
- Post-tonsillectomy/adenoidectomy: Not recommended for patients under 18 years 3
Monitoring and Safety
- Monitor for signs of respiratory depression, sedation, and decreased alertness
- Multiple case reports have documented sedation, respiratory depression, and feeding difficulties in infants exposed to oxycodone, especially at doses >30 mg/day 1
- Oxycodone should not be prescribed as monotherapy for acute pain; use a multimodal approach including non-opioid analgesics 3
Duration of Treatment
- For acute pain management, provide an initial supply of 5 or fewer days, unless related to trauma or surgery with expected longer duration of pain 3
- For patients requiring oxycodone for more than 7-14 days, develop a weaning protocol to prevent withdrawal symptoms 1
- Long-term use increases risk of dependence and should be avoided when possible
Practical Administration Tips
- Use immediate-release formulations for pediatric patients
- Titrate carefully based on clinical response
- Reassessment of the drug's effects and titration are the mainstays of successful pain management 1
- Consider body surface area-based dosing rather than weight-based dosing for more optimal achievement of similar systemic exposure to adults 2
Oxycodone should be used judiciously in pediatric patients, with careful consideration of risks and benefits. The goal is to provide adequate pain relief while minimizing adverse effects and the potential for dependence.