From the Guidelines
Oxycodone should be avoided in patients with abnormal Liver Function Tests (LFTs) due to its potential for increased side effects and risk of hepatic encephalopathy, as recommended by the most recent guidelines 1. When considering pain management options for patients with liver dysfunction, it is essential to prioritize alternatives with less hepatic metabolism to minimize risks.
- The 2023 ASCO guideline recommends avoiding opioids primarily eliminated in urine, such as oxycodone, in patients with renal or hepatic impairment, and instead suggests rotating to methadone if not contraindicated 1.
- The guideline also emphasizes the importance of frequent clinical observation and opioid dose adjustment in patients with renal or hepatic impairment who receive opioids 1.
- Additionally, the 2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma suggest that oxycodone has a longer half-life, lower clearance, and greater potency for respiratory depression before liver transplantation compared to after transplantation, making it a less desirable option for patients with liver dysfunction 1.
- Alternative pain management options, such as hydromorphone or fentanyl, may be safer choices due to their more stable metabolism in patients with liver cirrhosis 1.
- Ultimately, consultation with a hepatologist or pain specialist is advisable before initiating any opioid therapy in patients with significantly elevated liver enzymes to ensure appropriate pain management while minimizing risks.
From the FDA Drug Label
Because oxycodone is extensively metabolized in the liver, its clearance may decrease in patients with hepatic impairment. Initiate therapy in these patients with a lower than usual dosage of oxycodone hydrochloride tablets and titrate carefully. Monitor closely for adverse events such as respiratory depression, sedation, and hypotension [see Clinical Pharmacology (12.3)] .
Oxycodone can be used in patients with abnormal Liver Function Tests (LFTs), but with caution.
- Hepatic Impairment: Initiate therapy with a lower than usual dosage and titrate carefully.
- Monitoring: Monitor closely for adverse events such as respiratory depression, sedation, and hypotension 2.
From the Research
Oxycodone Use in Patients with Abnormal Liver Function Tests (LFTs)
- The use of oxycodone in patients with abnormal LFTs requires careful consideration, as the liver plays a crucial role in the metabolism of this opioid analgesic 3, 4.
- Studies have shown that the pharmacokinetics of oxycodone are altered in patients with hepatic impairment, resulting in decreased clearance and increased bioavailability of the drug 4.
- As a result, patients with liver disease may be at increased risk of adverse effects, such as sedation, constipation, and encephalopathy, when taking oxycodone 3, 4.
- To minimize the risk of adverse effects, it is recommended to use lower doses of oxycodone and longer administration intervals in patients with liver disease 3, 4.
- Additionally, patients with severe liver disease should be closely monitored for signs of toxicity and encephalopathy when taking oxycodone 4.
- There is no direct evidence to suggest that oxycodone is contraindicated in patients with abnormal LFTs, but caution is advised when using this medication in patients with liver disease 3, 4.
- Other studies have investigated the relationship between elevated LFTs and disease outcomes, but these findings are not directly relevant to the use of oxycodone in patients with abnormal LFTs 5, 6.
- The effects of oxycodone on respiratory depression and the development of tolerance have also been studied, but these findings do not provide guidance on the use of oxycodone in patients with abnormal LFTs 7.