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Oxycodone Intravenous for Adults

Who can administer

Administration RESTRICTED - see Appendix 1

Important information

  • The subcutaneous route is preferred 
  • 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 equivalence

  • 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 for opioid naive patients, use the following equivalency  
Dose of ORAL Oxycodone Equivalent dose of PARENTERAL oxycodone
20mg daily 10mg daily

Available preparations

Oxycodone 10mg in 1ml ampoules

  • available for theatres, recovery and surgical wards only
  • used to prepare PCA bags in the event of comercially produced stock being unavailable

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

Reconstitution

Not required

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) 

Intravenous bolus (Anaesthetist, Recovery theatre nurses, Specialist pain nurses ONLY) 

  • 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)

  • Not currently used by Palliative Care in this hospital on grounds of safety

Patients already on opioids

  • Conversion is problematic and should require input from a consultant with a special interest in pain or 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 

Further information

  • Toxicity may be enhanced by inhibitors of CYP3A4 , ultra-rapid metabolisers of CYP2D6 and in renal impairment
  • Ensure that multiple other sedatives do not predispose susceptible patients to oxycodone toxicity

Storage

Controlled drug press in Recovery Theatres (ampoules)

Controlled drug press on selected wards (PCA bags)(Store at room temperature)

 

References

SPC Oxynorm 10mg/ml July 2018

1: Meeting with Dr Olivia Finnerty April 30th, 2019

Therapeutic classification

Opioid