What is the recommended dose of oxycodone (opioid analgesic) for pediatric patients?

Pediatric Oxycodone Dosing

For pediatric patients requiring oxycodone, the recommended oral dose is 0.05–0.15 mg/kg every 4–6 hours, with the pediatric dose (adjusted for body weight) not exceeding the corresponding adult dose. 1

Oral Dosing Guidelines

• Starting dose: 0.05–0.15 mg/kg orally every 4–6 hours for moderate to severe pain in opioid-naive pediatric patients 1
• The duration of effect is approximately 4–6 hours 1
• Critical safety parameter: The calculated pediatric dose should never exceed the standard adult dose (typically 5–10 mg for adults), regardless of the child's weight 1

Intravenous Dosing (When Applicable)

• IV route: Not available/not recommended as a standard formulation for oxycodone 1
• If parenteral opioid analgesia is required, alternative agents like morphine (0.1–0.2 mg/kg IV) or fentanyl (1–2 mcg/kg IV) are preferred 1

Clinical Context and Evidence

The American Thoracic Society provides these dosing recommendations specifically for opioid-naive patients with moderate to severe pain 1. These guidelines emphasize that:

• Titration is essential: The correct dose is the one that relieves pain without intolerable adverse effects, with no absolute upper limit beyond safety considerations 1
• Neonatal exclusion: These dosing recommendations do not apply to neonates, who have distinct pharmacokinetics requiring specialized dosing protocols 1

Practical Application in Emergency Settings

Research supports oxycodone's safety and efficacy in pediatric acute pain:

• A randomized controlled trial demonstrated that buccal oxycodone at 0.1 mg/kg provided significant pain relief in children aged 4–15 years with acute abdominal pain without obscuring surgical diagnosis or adversely affecting clinical examination 2
• This dose was well-tolerated and did not interfere with diagnostic accuracy, which actually improved from 72% to 88% after administration 2

Important Safety Considerations

• Respiratory monitoring: All pediatric patients receiving opioids require continuous assessment for respiratory depression, particularly when combined with other sedative agents 1
• Reversal agent availability: Naloxone should be immediately available at 0.1 mg/kg IV/IM for children <5 years or <20 kg 1
• Duration of therapy: For patients receiving opioids less than 7 days, abrupt discontinuation is generally safe; those receiving opioids for 7–14 days may require brief weaning; exposure beyond 14 days typically necessitates a formal weaning protocol 1

Common Pitfalls to Avoid

• Do not use extended-release formulations (controlled-release oxycodone) for acute pain in children—these are reserved for chronic pain management in opioid-tolerant patients only 1
• Avoid intramuscular administration: The IV route allows for titration and is preferred over IM, which is painful and does not permit dose adjustment 1
• Weight-based dosing errors: Always verify that the calculated pediatric dose does not exceed adult dosing limits 1
• Combination products: When using oxycodone-acetaminophen combinations, ensure the acetaminophen component does not exceed maximum daily limits (varies by age and weight) 1