What is a reasonable maximum dose of oxycodone (opioid analgesic) per day?

Maximum Daily Dose of Oxycodone

There is no absolute maximum daily dose of oxycodone, but doses should be carefully reassessed when reaching 50 MME/day (approximately 33mg of oxycodone) with caution exercised for any increases beyond this threshold. 1, 2

Oxycodone Potency and Conversion

• Oxycodone is approximately 1.5-2 times as potent as oral morphine 2
• When calculating morphine milligram equivalents (MME), use a conversion factor of 1.5 for oxycodone 1, 2
• For example, 20mg of oxycodone daily is equivalent to 30 MME daily 2

Dosing Guidelines and Thresholds

• For opioid-naïve patients, start with the lowest effective dose, typically 5-10mg per day 2, 3
• Initial dosing range should be 5 to 15 mg every 4 to 6 hours as needed for pain 3
• Before increasing total opioid dosage to ≥50 MME/day (approximately 33mg of oxycodone), carefully reassess evidence of individual benefits and risks 1, 2
• If increasing beyond 50 MME/day, use caution and increase by the smallest practical amount 1, 2
• Additional dosage increases beyond 50 MME/day are progressively more likely to yield diminishing returns in benefits relative to risks 1, 2

Clinical Considerations for Higher Doses

• Risks of opioid use, including overdose and death, increase continuously with dosage, with no single threshold below which risks are eliminated 2
• In clinical practice, patients with chronic pain have been managed on median doses of 80 mg per day of oxycodone 4
• For cancer pain, doses up to 60 mg every 4 hours (360 mg/day) have been used safely with appropriate monitoring 5
• Elderly patients typically require lower doses due to pharmacokinetic similarities between oxycodone and morphine 5

Administration Recommendations

• For chronic pain, administer on a regularly scheduled basis, every 4 to 6 hours, at the lowest dosage level that will achieve adequate analgesia 3
• In clinical practice, 67% of chronic pain patients required more frequent than twice-daily dosing of sustained-release oxycodone (usually every 8 hours) 4
• For breakthrough pain, prescribe 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

Safety Monitoring

• Monitor patients closely for respiratory depression, especially within the first 24 to 72 hours of initiating therapy and following dosage increases 3
• For patients on higher doses, more frequent monitoring of respiratory rate, sedation level, and other vital signs is recommended 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

Important Caveats

• Dosage recommendations are not intended as rigid standards of care but as guideposts to inform clinical decision-making 1, 2
• 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
• Concurrent use of oxycodone with other central nervous system depressants increases risk of respiratory depression and requires dose adjustment 2