What is the maximum daily dose of oxycodone (opioid analgesic)?

Maximum Daily Dose of Oxycodone

There is no absolute upper limit to the maximum daily dose of oxycodone as long as side effects can be controlled, but caution is strongly advised when exceeding 50 MME/day (approximately 33mg of oxycodone daily). 1, 2

Oxycodone Potency and Dosing Considerations

• Oxycodone is approximately 1.5-2 times as potent as oral morphine, with a conversion factor of 1.5 when calculating morphine milligram equivalents (MME) 2, 1
• For example, 20mg of oxycodone equals 30 MME daily 2
• For opioid-naïve patients, start with the lowest effective dose, typically 5-10mg per day 2
• Careful titration based on pain control and side effects is essential 2, 1

Dose Escalation Guidelines

• Before increasing total opioid dosage to ≥50 MME/day (approximately 33mg of oxycodone), carefully reassess individual benefits and risks 1, 2
• Additional dosage increases beyond 50 MME/day are progressively more likely to yield diminishing returns in benefits relative to risks 1, 2
• If increasing beyond 50 MME/day, use caution and increase by the smallest practical amount 1
• Risks of opioid use increase continuously with dosage, with no single threshold below which risks are eliminated 2

Clinical Practice Patterns

• In clinical practice, the median total oxycodone-equivalent daily dosage has been reported as 80 mg for chronic pain patients 3
• Studies have documented safe use of oxycodone at doses up to 60 mg every 4 hours (360 mg/day) in cancer pain patients 4
• The mean oxycodone doses in cancer pain studies have ranged from 114-127 mg/day, with ranges of 20-400 mg/day for controlled-release and 40-640 mg/day for immediate-release formulations 5

Breakthrough Pain Management

• For breakthrough pain, prescribe a "breakthrough dose" typically equivalent to 10% of the total daily dose 2, 1
• Patients with uncontrolled pain can take a rescue dose every hour for up to 4 hours before consulting a physician 1
• If more than 4 breakthrough doses per day are necessary, the baseline opioid treatment should be adjusted 2, 1

Special Considerations and Monitoring

• More frequent monitoring of respiratory rate, sedation level, and other vital signs is recommended for patients on higher doses 2
• Use caution with dosage increases in patients with renal or hepatic insufficiency 2
• Consider evaluation by a pain specialist at relatively high dosages 2
• Elderly patients may require lower doses due to pharmacokinetic similarities between oxycodone and morphine 4
• When converting between opioids, the new opioid should be dosed at a substantially lower dose than the calculated MME dose to avoid overdose due to incomplete cross-tolerance 1, 2

Common Side Effects

• Side effects include nausea, constipation, drowsiness, vomiting, pruritus, and dizziness 6
• Oxycodone may cause somewhat less nausea, hallucinations, and pruritus than morphine 6
• The intensity of side effects tends to decrease over time 6
• Concurrent use with other central nervous system depressants increases risk of respiratory depression and requires dose adjustment 2