ABHB Prescribing Guideline
Use of Oxycodone
INDICATION FOR OXYCODONE
• In Gwent oxycodone is restricted to initiation by Oncology, Haematology and Palliative Care only.
• Morphine sulphate is the first choice strong opioid for patients at the third stage of the WHO ladder.
• Oxycodone is no more effective as an analgesic than Morphine.
Oral Oxycodone should only be considered if:
• Morphine cannot be tolerated due to side effects e.g. vomiting, drowsiness, confusion,
hallucinations, signs of opioid toxicity
Subcutaneous Oxycodone should only be considered if:
• Subcutaneous Morphine / Diamorphine cannot be tolerated due to side effects e.g drowsiness,
confusion, hallucinations, signs of opioid toxicity
• Patients have been taking oxycodone orally and are no longer able to swallow / use the oral route
***OXYCODONE SHOULD ONLY BE USED FOR PALLIATIVE CARE***
Local guidance on the Use of Strong Opiates in Chronic Non‐malignant Pain is at:
http://www.wales.nhs.uk/sites3/Documents/814/OpioidInNonMalignantPain‐
GwentGuidance%5BFinal%5DJan2010.pdf
USEFUL FACTS
•
•
•
•
•
•
•
•
There have been issues around patients receiving the incorrect form of Oxycodone so it should always
be prescribed by brand name: OxyNorm® or Oxycontin®
The potency of Oxycodone is twice that of morphine sulphate e.g. MST 60mg bd = Oxycontin 30mg bd
The potency of subcutaneous Oxycodone is twice that of oral Oxycodone
Orally it has a more predictable bioavailability (60‐87%) than morphine sulphate (15‐65%)
Oxycodone may be more likely to cause constipation than morphine
Oxycodone undergoes hepatic metabolism to active metabolites that are excreted renally – it should
be used with caution in patients with hepatic and renal impairment
Targinact® (oxycodone and naloxone) is non‐formulary and should NOT be used
Beware the confusing use of OxyNorm® for oral immediate release and injectable forms
OxyNorm® (Oral immediate release form)
• 5mg, 10mg and 20mg capsules and 5mg/5ml liquid and 10mg / ml concentrate liquid.
• Onset of action is 20‐30 minutes with peak effect at 1 – 1.5 hours
• Duration of action is 4‐6 hourly. If titrating a dose, prescribe 4 hourly
• The breakthrough dose of OxyNorm® should be one sixth (1/6) the total daily regular dose of
Oxycontin® e.g. oral Oxycontin 30mg 12 hourly requires a breakthrough dose of oral Oxynorm 10mg
Oxycontin® (Oral sustained release over 12 hours)
• 5mg, 10mg, 20mg, 40mg and 80mg tablets
• M/R forms should be swallowed whole, crushing or chewing may lead to rapid release and overdose of
Oxycodone
• Peak effect of M/R form is 3 hours
OxyNorm® (Injection)
• 10mg / ml injection (1ml and 2ml ampoules)
• 50mg / ml injection (1ml ampoules)
• Conversion ratio oral : subcutaneous is 2:1 e.g. oral Oxycontin 30mg/ 12hrly = sc Oxynorm 30mg
24hrly
This Guidance should be used in conjunction with the Summary of Product Characteristics (SmPC) for the particular
formulation of oxycodone being used. Adapted from Fife Palliative Care Guidelines for the use of Oxycodone in Cancer Pain
Status: APPROVED
Date produced: 27 May 2011 (Revised Jan. 2012)
Approved by: ABHB MTC
Page 1 of 2
Review Date: Jan 2015
DOSING OF OXYCODONE
Because Oxycodone will be used after Morphine Sulphate, patients will need to be transferred to a roughly
equivalent dose of Oxycodone. To calculate the dose of Oxycontin® divide the dose of MST by 2.
•
•
Convert from:
To
Breakthrough (prn)
MST 60mg bd
Oxycontin 30mg bd
OxyNorm 10mg oral
Morphine Sulphate inj 60mg/24 hrs s/c OxyNorm inj 30mg/24hrs s/c Oxynorm inj 5mg s/c
Diamorphine inj 40mg/24hrs s/c
OxyNorm inj 30mg/24hrs s/c Oxynorm inj 5mg s/c
Oral Oxycontin 30mg bd
OxyNorm inj 30mg/24 hrs s/c OxyNorm inj 5mg s/c
At higher doses consideration should be given to the volume of OxyNorm injection required in a syringe
driver – Contact the Specialist Palliative Care Service for advice
Patients should be monitored closely during opioid switching and titrated accordingly
CONVERSION AND BREAKTHROUGH CHART
The figures below are an approximation and the patient should always be reviewed for signs of toxicity and
inadequate analgesia during a conversion. When switching opioid consider whether the patient’s pain is
already controlled or is a higher dose likely to be needed.
EQUIVALENT ORAL
MORPHINE
(MG IN 24 HRS)
40
ORAL
OXYCODONE
(MG IN 24 HRS)
20
SUBCUTANEOUS
OXYCODONE
(MG IN 24 HRS)
10
BREAKTHROUGH ORAL
OXYCODONE
(MG)
2.5
60
30
15
5
80
40
20
7.5
160
80
40
15
240
120
60
20
FURTHER ADVICE ON THE USE OXYCODONE PREPARATIONS OR ON SWITCHING BETWEEN OPIOIDS
CONTACT A MEMBER OF THE SPECIALIST PALLIATIVE CARE TEAM
Within working hours
Specialist Hospital Palliative Care Teams
Royal Gwent Hospital
Tel. 01633 234934
Specialist Palliative Care Inpatient Units (including Hospices)
St Anne’s Hospice, Newport
Tel. 01633 820317
Caerphilly Miner’s Hospital
Tel. 029 20851811
Bleep 0853
Nevill Hall Hospital
Tel. 01873 732777
Community Specialist Palliative Care Teams
St David’s Foundation
Tel. 01633 271364
Hospice of the Valleys
Tel. 01495 717277
Out of Hours specialist palliative care advice
If a healthcare professional needs more advice or guidance outside normal working hours, please call 02920 426000
(Marie Curie Hospice, Penarth)
This Guidance should be used in conjunction with the Summary of Product Characteristics (SmPC) for the particular
formulation of oxycodone being used. Adapted from Fife Palliative Care Guidelines for the use of Oxycodone in Cancer Pain
Status: APPROVED
Date produced: 27 May 2011 (Revised Jan. 2012)
Approved by: ABHB MTC
Page 2 of 2
Review Date: Jan 2015