Why oxycodone instead of morphine




















The potency ratio is approximately 1. As with other opioids, oxycodone is associated with adverse effects such as drowsiness, dizziness, hypotension and respiratory depression. Tolerance to nausea and vomiting usually occurs within the first week of treatment, but constipation can persist for the entire course.

Prescribe a combination stimulant plus softener laxative, e. In cases where constipation is unable to be effectively managed, consider switching to fentanyl patches if chronic pain and stable opioid requirements as fentanyl is associated with less constipation than either oxycodone or morphine.

For example, if the regular dose is OxyContin 30 mg, twice daily 60 mg in 24 hours , then prescribe OxyNorm 10 mg with instructions to take a maximum of one extra dose, two to four hourly depending on clinical condition , for pain which is not controlled by the regular regimen.

If three or more extra doses are needed within 24 hours, this would be an indication that a review of pain control is required. Regularly check pain levels with the patient. When the pain diminishes, step-down the dose of oxycodone, replace with alternative milder analgesia weaker opioid, such as codeine or paracetamol, if required, and then cease analgesia. As with all opioids, when oxycodone is used with other sedating medicines, drugs or alcohol, there is additive depression of the central nervous system, including respiratory depression.

Careful consideration should be given to concurrent prescription of benzodiazepines with strong opioids such as oxycodone. Concomitant use with other medicines and substances which inhibit these enzymes will theoretically result in an enhanced effect of oxycodone and potentially fatal respiratory depression. CYP3A4 and CYP2D6 inhibitors, such as fluoxetine, erythromycin, azole antifungals and grapefruit juice, should be used with caution or avoided in patients taking oxycodone.

Follow us on facebook. Decision support for health professionals ». South Island general practice support ». Practice acquisition and careers in health ». Click here to register ». Forgot your login? Login to my bpac. Remember me. Pain management Smoking, alcohol, and drug misuse. Oxycodone use still increasing Oxycodone is a strong opioid used for the treatment of moderate to severe pain in people for whom morphine is not tolerated or not suitable.

In this article Key concepts Oxycodone is a strong opioid for severe pain Prescribing oxycodone References In this article. Key concepts Oxycodone use is rapidly increasing in New Zealand Oxycodone is a strong opioid, used to treat moderate to severe pain. It is no more effective than morphine but is considerably more expensive. Morphine is the first-line treatment for moderate to severe pain and oxycodone should only be used if morphine is not tolerated or not suitable - other options may include fentanyl or methadone, depending on individual patient circumstances Strong opioids should be used at the lowest effective dose for the shortest possible time, and stepped down when pain resolves Use of strong opioids for long-term, non-malignant pain should only be considered if other treatment or analgesia options are not suitable or have not controlled pain adequately Patients who are prescribed opioids for long periods, especially if the dose is escalating and the pain is worsening, should be regularly assessed for a different diagnosis or worsening of the condition or consider referral to a specialist pain clinic Strong opioids have a significant potential for misuse and they should be prescribed with caution in people with a history of addictive or risk-taking behaviour.

Oxycodone is a strong opioid for severe pain From its name, oxycodone is often perceived as being similar to codeine, an opioid for mild to moderate pain, but in fact oxycodone is an opioid for severe pain, like morphine. Figure 2: WHO analgesic ladder. Use oxycodone only when morphine is not tolerated If a patient requires a medicine at step three on the analgesic ladder, morphine is the first-line treatment. Increased fracture risk in elderly people All opioids affect the central nervous system.

No consensus on role in chronic pain management The role of oxycodone, along with other strong opioids, in the treatment of chronic, non-malignant pain is controversial.

Potential for misuse and addiction Oxycodone has become one of the most problematic misused opioids in the United States. Prescribing oxycodone If the clinical decision to use oxycodone is made, the following prescribing points may be helpful. Opioid-naive patient The usual oral starting dose in opioid-naive patients for severe pain is: 5 mg oxycodone, every four to six hours, increased as necessary according to response OxyNorm is the current funded immediate release brand Oxycodone may then be given orally as a modified release preparation OxyContin is the current funded controlled release brand , every 12 hours once the 24 hour opioid requirement has been established 11 N.

Changing from morphine Changing from morphine to another strong opioid such as oxycodone, due to intolerable adverse effects, should be a more common scenario than beginning with oxycodone as the strong opioid for pain relief. Constipation Prescribe a combination stimulant plus softener laxative, e. Nausea Prescribe an antiemetic, e. Slow dose titration can also help to reduce the incidence of nausea and vomiting. Stepping down dose Regularly check pain levels with the patient.

Interactions with other medicines As with all opioids, when oxycodone is used with other sedating medicines, drugs or alcohol, there is additive depression of the central nervous system, including respiratory depression. Opioids and the management of chronic severe pain in the elderly: consensus statement of an international expert panel with focus on the six clinically most often used World Health Organisation step III opioids Buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone.

Pain Pract ;8 4 Therapeutic use, abuse, and nonmedical use of opioids: a ten-year perspective. If there is pain between regular doses of long-acting opioids, other medications can be given as needed. Most patients find they function very well while taking pain medication. However, some experience side effects of nausea, vomiting or constipation. Sleepiness or sedation can also result, especially when morphine is first started or when the dose is increased.

Properly prescribed opioids do nor cause or hasten death but can make the patient more comfortable. Appropriate use of these pain relievers does not shorten life or prevent breathing. Skip to content. Facebook page opens in new window Instagram page opens in new window Linkedin page opens in new window.

Helping you understand Morphine and Oxycodone use. What is morphine? Mean pain scores decreased over time but remained similar between the groups: 30 min 6. The largest NRS mean difference was from baseline to 60 min: 4.

No clinically significant changes or any serious adverse events were observed in either group. Keywords: Analgesia; Emergency department; Morphine; Percocet.



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