Page 81 WHO - Guidelines on the pharmacological treatment of persisting pain in children with medical illness

A1.7 Oxycodone

ATC Code: N02AA05
Tablet: 5 mg, 10 mg, 15 mg, 20 mg, 30 mg (as hydrochloride).
Tablet (modified release): 5 mg, 10 mg, 15 mg, 20 mg, 30 mg, 40 mg, 60 mg, 80 mg, 160 mg
(as hydrochloride).
Capsule: 5 mg, 10 mg, 20 mg (as hydrochloride).
Oral liquid: 1 mg/ml (as hydrochloride).
Concentrated oral liquid: 10 mg/ml, 20 mg/ml (as hydrochloride).

Indications: moderate to severe persisting pain.

Contraindications: hypersensitivity to opioid agonists or to any component of the formulation;
acute respiratory depression; acute asthma; paralytic ileus; concomitant use of, or use within 14 days
after ending monoamine oxidase inhibitors; raised intracranial pressure and/or head injury, if ventilation
not controlled; coma; use within 24 hours before or after surgery.

Precautions: impaired respiratory function; avoid rapid injection which may precipitate chest
wall rigidity and difficulty with ventilation; bradycardia; asthma; hypotension; shock; obstructive or
inflammatory bowel disorders; biliary tract disease; convulsive disorders; hypothyroidism; adrenocortical
insufficiency; avoid abrupt withdrawal after prolonged treatment; diabetes mellitus; impaired
consciousness; acute pancreatitis; myasthenia gravis; hepatic impairment; renal impairment; toxic
psychosis.

Skilled tasks: warn the patient or caregiver about the risk of undertaking tasks requiring attention or
coordination, for example, riding a bike.

Dosage:

Starting dose for opioid-naive patients:
Oral (immediate-release formulation):
• infant 1–12 months – 50–125 mcg/kg every 4 hours;
• child 1–12 years – 125–200 mcg/kg every 4 hours, max 5 mg.

Oral (prolonged-release formulation):
• child over 8 years – 5 mg every 12 hours.

Continuation: After a starting dose according to the dosages above, the dosage should be adjusted
to the level that is effective (with no maximum), but the maximum dosage increase is 50% per
24 hours in outpatient settings. Experienced prescribers can increase up to 100% with careful
monitoring of the patient.

Dose for breakthrough pain
Oral (using immediate-release preparation):
• infant or child: Additional oxycodone may be administered as frequently as required with a
maximum of 5–10% of the regular daily baseline oxycodone dose. If repeated breakthrough
doses are required, adjust the regular baseline oxycodone dose guided by the amount of
oxycodone required for breakthrough pain with a maximum increase of 50% per 24 hours.

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