What is the recommended dosage of oxycodone (opioid analgesic) for pain management?

Recommended Dosage of Oxycodone for Pain Management

The recommended starting dosage of oxycodone for opioid-naïve patients with moderate to severe pain is 5-15 mg every 4-6 hours as needed, with careful titration based on individual response. 1

Initial Dosing Strategy

• For patients who have not previously taken opioids, start with the lowest effective dose (5-10 mg) every 4-6 hours as needed for acute pain 1
• For moderate pain, low-dose oxycodone (5 mg) combined with acetaminophen can be effective 2
• The initial dose should be individualized based on:
  • Severity of pain
  • Patient response
  • Prior analgesic experience
  • Risk factors for addiction, abuse, and misuse 1

Dosage Titration

• Titrate the dose based on individual patient response to their initial dose 1
• For chronic pain, administer on an around-the-clock basis every 4-6 hours at the lowest effective dosage to prevent pain recurrence 1
• If more than four breakthrough doses per day are necessary, increase the baseline opioid regimen 2
• The breakthrough dose for transient pain exacerbations should be approximately 10-15% of the total daily dose 2

Formulation Selection

• Immediate-release formulations are appropriate for initial titration and breakthrough pain 3
• Controlled-release formulations (typically dosed every 12 hours) are suitable for patients with stable opioid requirements 2
• Studies show that dose titration can be accomplished as readily with controlled-release oxycodone as with immediate-release formulations 3

Dosage Equivalence and Conversion

• Oxycodone is approximately 1.5 times more potent than oral morphine (conversion factor of 1.5) 4, 2
• When converting from other opioids, use a conservative approach due to inter-patient variability 1
• For patients already on opioid therapy, factor in the potency of the prior opioid relative to oxycodone when selecting the total daily dose 1

Special Considerations

• For geriatric patients or those with moderate hepatic or renal impairment, consider lower starting doses and slower titration 4
• Avoid exceeding 50 MME/day when possible, as higher doses increase risk without proportional benefit in pain relief 4
• For patients with chronic non-cancer pain seen in emergency departments, avoid routine prescribing of outpatient opioids 4
• If prescribing opioids on discharge from emergency departments, use the lowest practical dose for a limited duration (e.g., 1 week) 4

Risk Mitigation

• Monitor patients closely for respiratory depression, especially within the first 24-72 hours of initiating therapy and following dosage increases 1
• Assess potential risks and benefits before initiating long-term opioid therapy 2
• Consider the patient's risk for opioid misuse, abuse, or diversion when determining prescription duration and quantity 4

Adverse Effects Management

• Routinely prescribe laxatives for both prophylaxis and management of opioid-induced constipation 2
• For opioid-related nausea/vomiting, consider metoclopramide or antidopaminergic medications 2
• Common side effects include nausea, constipation, drowsiness, vomiting, pruritus, and dizziness 5

Clinical Evidence Supporting Lower Doses

• Research shows that a low-dose combination of oxycodone with acetaminophen can effectively manage moderate pain while potentially reducing adverse reactions and drug dependence 6
• In a study of chronic pain patients, the median total oxycodone-equivalent daily dosage was 80 mg, with many patients requiring dosing more frequently than twice daily 7