What is the typical starting dose of oxycodone (OxyContin) HCL (hydrochloride) IR (immediate release) for managing moderate to severe pain?

Oxycodone HCL IR Dosing for Moderate to Severe Pain

The typical starting dose of oxycodone HCL IR for managing moderate to severe pain is 5 to 15 mg every 4 to 6 hours as needed for pain. 1

Initial Dosing Guidelines

• For opioid-naïve patients, initiate treatment with oxycodone hydrochloride IR tablets in a dosing range of 5 to 15 mg every 4 to 6 hours as needed for pain 1
• Titrate the dose based upon the individual patient's response to their initial dose of oxycodone hydrochloride tablets 1
• For severe chronic pain, oxycodone should be administered on a regularly scheduled basis, every 4 to 6 hours, at the lowest dosage level that will achieve adequate analgesia 1

Dosing Considerations

• Use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals 1
• When determining the initial dose, consider:
  • The severity of the patient's pain 1
  • Prior analgesic treatment experience 1
  • Risk factors for addiction, abuse, and misuse 1
  • The general condition and medical status of the patient 1

Monitoring and Titration

• Monitor patients closely for respiratory depression, especially within the first 24 to 72 hours of initiating therapy and following dosage increases 1
• For breakthrough pain, provide a "breakthrough dose" typically equivalent to 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

Comparative Efficacy

• Oxycodone is approximately 1.5-2 times as potent as oral morphine 2, 3
• The clinical efficacy of oxycodone is similar to that of morphine, with a ratio of 1/1.5-2 for the treatment of cancer pain 3
• Oxycodone IR has an onset of action within approximately 46 minutes and duration of effect of about 4-6 hours 4

Special Populations and Considerations

• No dose reduction is needed in the elderly or in cases of moderate hepatic or renal failure 3
• For patients with chronic pain, consider transitioning to around-the-clock dosing to prevent the reoccurrence of pain rather than treating the pain after it has occurred 1
• When converting from other opioids to oxycodone, use a conservative approach as there is inter-patient variability in the potency of opioid drugs 1

Common Side Effects

• The most common side effects include nausea, constipation, and drowsiness 3
• Vomiting, pruritus, and dizziness are less common 3
• Oxycodone causes somewhat less nausea, hallucinations, and pruritus than morphine 3
• The intensity of these side effects tends to decrease over time 3

Important Cautions

• Always initiate the dosing regimen for each patient individually, taking into account the patient's specific characteristics and response 1
• It is safer to underestimate a patient's 24-hour oxycodone hydrochloride tablets dosage than to overestimate and manage an adverse reaction due to overdose 1
• For patients transitioning from fixed-ratio opioid/non-opioid combinations, the starting dose of oxycodone should be based upon the most recent dose of opioid 1