Oxycodone Intravenous for Adults

Who can administer

Administration RESTRICTED - see Appendix 1

Important information

• This monograph is for use in the setting of ACUTE pain ONLY
• Ensure correct programme is selected on PCA pump for Oxycodone (See "PCA" policy on QPulse, CLN-NM-047)

Dose equivalency

• There are significant differences of opinion as to the bioavailability of IV and oral oxycodone preparations
• Inter-patient variability requires that each patient is carefully titrated to the appropriate dose
• In general, in the context of acute pain management use the following equivalency
  • Oral oxycodone 2mg is equivalent to 1mg parenteral oxycodone
  • Note: inter-patient variability requires that each patient is carefully titrated to the appropriate dose
• Patients already on opioids
  • Conversion is problematic and should require input from a consultant with a special interest in pain or palliative care

Available preparations

Oxycodone 10mg in 1ml ampoules

• For IV use: available for theatres, recovery and surgical wards only
• Used to prepare PCA bags in the event of commercially produced stock being unavailable

Oxycodone 50mg in 100mL PCA bags (commercially prepared)

Oxycodone 50mg in 1ml ampoules (not routinely supplied)

Reconstitution

• Not required
• Already in solution
• Dilute further prior to administration

Infusion fluids

Sodium chloride 0.9% or Glucose 5%

Methods of intravenous administration

PCA

• Administer via programmed PCA device - ensure correct programme is selected on PCA pump for Oxycodone
• If commercially prepared PCA bags are not available, it may be required to prepare an infusion using ampoules.  Prepare an infusion containing 50mg per 100ml

Bolus Intravenous injection

• Dilute to 1mg per ml with infusion fluid or Water for Injections
• Administer slowly over one to two minutes

Intravenous infusion

• Dilute to 1mg per ml with infusion fluid or Water for Injections (unless PCA- see above for required strength for PCA)
• Administer at a starting rate of 2mg per hour

Dose in adults

Subcutaneous dosing (at ward level)

• Give 2.5 to 5mg given every 4 to 6 hours PRN (maximum in older patients 2.5mg/dose) ^{(ref 1)}
• Used in Continuous subcutaneous infusions- as per Palliative care

Intravenous bolus (Anaesthetist, Recovery theatre nurses, Specialist pain nurses ONLY)^{(ref 1)}

• Give 0.5 to 1mg, repeated in 5 minutes if required (not to be given outside theatre/recovery unless on direct instruction of anaesthetist)

PCA

• Give according to hospital policy-see QPulse document CLN-NM-047

Continuous Subcutaneous Infusion (CSCI)

• Use as per Palliative care

Renal dosing

• Dose initiation should follow a conservative approach. Doses should be reduced by 50% and each patient should be titrated to adequate pain control according to their clinical situation

Monitoring

• Monitor blood pressure, heart rate, respiratory rate, oxygen saturation, pain and sedation scores
• As per GUH Early Warning Score chart
• Treatment of overdose: use naloxone

Further information

• Toxicity may be enhanced by inhibitors of CYP3A4 , ultra-rapid metabolisers of CYP2D6 and in renal impairment

Storage

• Store below 25⁰C
• Controlled drug cupboard

References

SPC Oxynorm 10mg/ml February 2022

1: Email communication with Dr Olivia Finnerty February 9th, 2023

Therapeutic classification

Opioid analgeisa