How should a patient's 135 mg daily dose of oxycodone (oxycondone) be split up?

Oxycodone 135 mg Daily Dosing Schedule

For a patient on 135 mg daily oxycodone, divide the dose into three administrations of 45 mg every 8 hours, as this dosing interval is most commonly required in clinical practice and provides more stable analgesia than twice-daily dosing. 1

Primary Dosing Recommendation

• Administer 45 mg every 8 hours (three times daily) for the 135 mg total daily dose 1
• This every-8-hour schedule is used in 93% of patients requiring more frequent than twice-daily dosing in chronic pain management 1
• The three-times-daily regimen provides more consistent pain control and reduces the need for supplemental breakthrough medication 1, 2

Evidence Supporting Every-8-Hour Dosing

• In a survey of 128 chronic pain patients on stable sustained-release oxycodone, 67% required dosing more frequently than every 12 hours, with the vast majority (93%) prescribed three-times-daily administration 1
• Patients maintained on every-12-hour dosing were twice as likely to require regularly scheduled short-acting opioids for breakthrough pain compared to those on more frequent dosing 1
• The average interval between oxycodone administrations in clinical practice was 7.8 hours, significantly shorter than the manufacturer's recommended 12-hour interval 2
• Only 1.9% of patients reported adequate pain relief lasting 12 or more hours with twice-daily dosing 2

Alternative Dosing Considerations

If attempting twice-daily dosing: Administer 67.5 mg every 12 hours, but anticipate the need for substantial breakthrough medication 1

• Patients on twice-daily dosing typically require 47% to use regularly scheduled supplemental short-acting opioids 1
• The median dose for patients successfully managed on twice-daily dosing is 80 mg, suggesting 135 mg daily may be too high for adequate 12-hour coverage 1

Four-times-daily dosing (33.75 mg every 6 hours) is rarely necessary and typically reserved for patients requiring very high total daily doses (median 120 mg in those needing this frequency) 1

Breakthrough Pain Management

• Provide immediate-release oxycodone at 10-20% of the total daily dose (13.5-27 mg, rounded to 15-30 mg) every 2 hours as needed for breakthrough pain 3
• If more than 3-4 rescue doses are required per day, increase the scheduled dose by 25-50% 3

Critical Safety Considerations

• At 135 mg daily oxycodone (equivalent to approximately 200 morphine milligram equivalents), this patient is well above the 50 MME vigilance threshold and requires close monitoring 4
• Ensure single-entity oxycodone formulation is used at this dose to avoid excessive acetaminophen exposure 3
• Initiate prophylactic stimulant laxatives immediately, as constipation is universal with opioid therapy and does not resolve with tolerance 3
• Monitor for sedation, respiratory depression, and cognitive impairment, particularly during the first 48-72 hours after any dose adjustment 5

Common Pitfalls to Avoid

• Do not use PRN-only dosing for continuous pain at this dose level; scheduled around-the-clock administration is essential 3
• Do not delay dose adjustments if the patient is self-escalating with breakthrough medication; formalize the effective dose immediately 3
• Do not assume 12-hour duration based on controlled-release formulation labeling; clinical reality demonstrates shorter duration in most patients 1, 2