Is Oxycodone an NSAID?
No, oxycodone is definitively not an NSAID—it is a semisynthetic opioid agonist that works through mu-opioid receptors in the central nervous system, whereas NSAIDs work by inhibiting cyclooxygenase (COX) enzymes to reduce inflammation. 1
Drug Classification
- Oxycodone is classified as an opioid analgesic, specifically a full mu-opioid receptor agonist that provides analgesia through central nervous system mechanisms 2, 1
- NSAIDs (nonsteroidal anti-inflammatory drugs) are a completely separate drug class that includes medications like ibuprofen, naproxen, and COX-2 selective inhibitors (coxibs), which work by inhibiting prostaglandin synthesis 3
Mechanism of Action Differences
- Oxycodone produces analgesia by binding to opioid receptors in the brain and spinal cord, altering pain perception and emotional response to pain 1
- NSAIDs reduce pain by blocking COX enzymes at peripheral sites of inflammation and centrally, reducing prostaglandin production that sensitizes pain receptors 3
- Paracetamol (acetaminophen) has central analgesic activity without NSAID-like or opioid-like effects, representing a third distinct mechanism 1
Clinical Context for Hip Replacement Surgery
- For postoperative pain after hip replacement, oxycodone and NSAIDs serve complementary roles in multimodal analgesia rather than being interchangeable 4, 5
- Guidelines recommend NSAIDs (such as naproxen 500 mg every 12 hours) combined with paracetamol as the foundation, with oxycodone reserved for breakthrough pain 4
- Oxycodone is typically prescribed as 5 mg tablets taken as needed (maximum every 4 hours) for moderate-to-severe pain that is not controlled by non-opioid analgesics alone 4
Multimodal Analgesia Strategy
- The American Society of Anesthesiologists recommends that opioids alone are insufficient—non-opioid analgesics must form the foundation of postoperative pain management 2
- Scheduled paracetamol provides opioid-sparing effects and should continue throughout recovery 2
- NSAIDs significantly reduce opioid consumption and should be used unless specific contraindications exist (renal impairment, bleeding risk, gastrointestinal concerns) 3, 2
Important Safety Distinction
- NSAIDs carry gastrointestinal bleeding risk, renal toxicity, and cardiovascular concerns, particularly in elderly patients or those with pre-existing conditions 3
- Opioids like oxycodone carry risks of respiratory depression, sedation, constipation, nausea, and potential for dependence, requiring different monitoring and precautions 4, 5
- These distinct side effect profiles underscore that oxycodone and NSAIDs are fundamentally different drug classes requiring separate risk-benefit assessments 3, 1