What is the recommended dosing for oxycodone (opioid analgesic) for managing moderate to severe pain?

Oxycodone Dosing for Moderate to Severe Pain Management

For moderate to severe pain, initiate oxycodone at 5-15 mg every 4-6 hours as needed, titrating based on individual patient response while monitoring for side effects. 1

Initial Dosing

Opioid-Naïve Patients

• Start with 5-15 mg oral oxycodone every 4-6 hours as needed for pain 1
• For chronic pain, administer on a scheduled basis rather than as-needed to prevent pain recurrence 1
• Lower starting doses (5 mg) are appropriate for:
  • Elderly patients
  • Patients with renal impairment
  • Opioid-naïve patients

Patients Converting from Other Opioids

• Consider previous opioid dose, potency, and characteristics when determining initial oxycodone dose 1
• Use a conservative approach when converting - it's safer to underestimate than overestimate the required dose 1
• Close observation during conversion is essential to adjust dosing based on patient response 1

Formulation Selection

Immediate-Release (IR) Formulation

• Appropriate for initial titration and breakthrough pain
• Dosing: 5-15 mg every 4-6 hours 1
• Provides faster onset of analgesia for acute pain episodes

Controlled-Release (CR) Formulation

• Can be used for initial titration as effectively as IR formulation 2
• Typically dosed every 12 hours, though 67% of chronic pain patients may require more frequent dosing (e.g., three times daily) 3
• Provides more consistent pain control with less frequent dosing
• Median dose for twice-daily dosing: 80 mg; for three-times daily: 60 mg 3

Titration and Maintenance

• Individually titrate to a dose that provides adequate analgesia with minimal adverse effects 1
• Provide breakthrough medication (immediate-release oxycodone) at approximately 10-15% of the total daily dose 4, 5
• If more than 4 breakthrough doses per day are needed, increase the baseline opioid dose 4, 5
• For cancer pain, doses can be titrated up to 400 mg/day if needed 2
• For non-cancer pain, maximum doses are typically lower, with studies using up to 80 mg/day 2

Combination Products

• Fixed-dose combinations with acetaminophen can be effective for moderate pain 6
• Low-dose oxycodone (5 mg) combined with acetaminophen (325 mg) effectively managed moderate pain in 97% of patients 6
• Oxycodone/ibuprofen (5 mg/400 mg) is approved for short-term management (≤7 days) of acute moderate-to-severe pain 7
• When using combination products, be mindful of maximum daily doses of the non-opioid component (e.g., acetaminophen ≤4000 mg/day) 5

Monitoring and Side Effect Management

• Monitor patients closely for respiratory depression, especially within the first 24-72 hours of therapy and following dose increases 1
• Routinely prescribe laxatives for prophylaxis and management of opioid-induced constipation 5
• Use metoclopramide or antidopaminergic drugs for opioid-related nausea/vomiting 5
• Regularly assess pain control, functional improvement, and side effects at each visit 5

Special Considerations

• Use lower doses and titrate more slowly in patients with renal impairment 5
• For severe chronic pain, controlled-release oxycodone every 12 hours is as effective as immediate-release oxycodone four times daily, with fewer reported adverse events 8
• Consider opioid rotation if inadequate analgesia or intolerable side effects occur despite dose optimization 5

Common Pitfalls to Avoid

1. Undertreatment of pain due to fear of adverse effects
2. Failure to provide breakthrough medication for patients on scheduled dosing
3. Not adjusting baseline doses when breakthrough doses are frequently needed
4. Neglecting prophylactic management of common side effects like constipation
5. Inadequate monitoring for respiratory depression, especially during initiation and dose increases

Remember that the goal of pain management is to improve function and quality of life while minimizing adverse effects, not just to reduce pain scores.