Can Oxycodone Cause Decreased Appetite?
Yes, oxycodone can cause decreased appetite, which is a recognized adverse effect listed in the FDA drug label, occurring in approximately 13% of patients treated with oxycodone. 1
Evidence from FDA Drug Labeling
The FDA-approved prescribing information for oxycodone explicitly lists decreased appetite as an adverse reaction under "Metabolism and nutrition disorders" in clinical trials. 1 This represents direct regulatory evidence that appetite suppression is an established side effect of oxycodone therapy.
Clinical Trial Data on Appetite Effects
In systematic reviews of opioid adverse events in cancer pain patients, anorexia (loss of appetite) occurred at an incidence rate of 13% across studies of morphine, fentanyl, oxycodone, and codeine. 2
The frequency of appetite-related adverse effects with oxycodone is dose-dependent and represents a typical opioid-related adverse reaction that commonly occurs on initiation of therapy. 1
Mechanism and Related Symptoms
Oxycodone affects reward-related brain regions including the striatum, midbrain, thalamus, and orbitofrontal cortex, which are involved in appetite regulation. 3
Decreased appetite often occurs alongside other gastrointestinal adverse effects including nausea (21% incidence), vomiting (13% incidence), and constipation (25% incidence). 2
The combination of nausea and decreased appetite can be particularly problematic, as these symptoms frequently co-occur with opioid therapy. 1, 2
Important Clinical Considerations
Monitor for appetite suppression particularly during:
- Initial opioid therapy or dose escalation 1
- Combination with other medications that affect appetite 1
- In patients with cancer or chronic pain who may already have compromised nutritional status 2
Critical Pitfall to Avoid
Do not automatically assume improved appetite after opioid dose reduction. In one case report, a patient experienced worsening nausea and loss of appetite after tapering oxycodone following a celiac plexus block—these symptoms were actually manifestations of opioid withdrawal rather than side effects, and improved with administration of fast-release oxycodone. 4 This highlights that appetite changes can occur both as a direct opioid effect and paradoxically during withdrawal.
Management Approach
Prophylactic antiemetics may help manage nausea-related appetite suppression, with first-line agents including phenothiazines (prochlorperazine) and dopamine receptor antagonists (metoclopramide). 5
For persistent appetite issues, consider adding serotonin receptor antagonists (ondansetron) or combination therapy. 5
Nutritional counseling and monitoring of weight and nutritional parameters is warranted in patients on chronic opioid therapy with appetite suppression. 1