Risk of Orthostatic Hypotension with Oxycodone
Oxycodone carries a significant risk of causing orthostatic hypotension and syncope through peripheral vasodilation, and this risk is explicitly warned about in the FDA labeling. 1
Mechanism and Clinical Significance
Oxycodone produces orthostatic hypotension through peripheral vasodilation, which may also result in syncope in ambulatory patients. 1 The FDA labeling specifically warns that oxycodone may cause severe hypotension including orthostatic hypotension and syncope. 1
The mechanism involves:
- Direct peripheral vasodilation from opioid effects 1
- Possible histamine release contributing to vasodilation 1
- Manifestations may include pruritus, flushing, red eyes, sweating, and orthostatic hypotension 1
High-Risk Populations
The risk is substantially increased in patients with:
- Reduced blood volume or hypovolemia 1
- Concurrent use of CNS depressants (phenothiazines, general anesthetics, benzodiazepines) 1
- Circulatory shock (oxycodone should be avoided entirely in these patients) 1
- Elderly, cachectic, or debilitated patients due to altered pharmacokinetics 1
Clinical Monitoring and Management
Monitor patients for signs of hypotension after initiating or titrating oxycodone dosage. 1 The FDA specifically recommends monitoring these patients closely, particularly when starting therapy or increasing doses. 1
Patient education is critical: Instruct patients to recognize symptoms of low blood pressure and how to reduce risk of serious consequences, such as sitting or lying down and carefully rising from sitting or lying positions. 1
Medication Review Context
While opioids like oxycodone are not typically listed among the most common medication classes causing orthostatic hypotension (which include diuretics, vasodilators, β-blockers, ACE inhibitors, antipsychotics, and tricyclic antidepressants) 2, 3, 4, the FDA labeling makes clear that oxycodone specifically carries this risk and requires appropriate monitoring and patient counseling. 1
If symptomatic orthostatic hypotension develops, consider dose reduction or discontinuation if clinically feasible, as medication modification is a first-line approach to managing drug-induced orthostatic hypotension. 5