Page 82 WHO - Guidelines on the pharmacological treatment of persisting pain in children with medical illness

Dosage discontinuation: for short-term therapy (7–14 days), the original dose can be decreased by
10–20% of the original dose every 8 hours increasing gradually the time interval. In the case of a long-
term therapy protocol, the dose should be reduced not more than 10–20% per week (79, 80). A1 A1

Renal impairment: mild (GRF 20–50 ml/min or approximate serum creatinine 150–300 micromol/l)
to severe (GFR <10ml/min or serum creatinine >700micromol/l) – dose reduction may be required; start
with lowest dose and titrate according to response.

Hepatic impairment: moderate and severe; reduce dose by 50% or avoid use.
A2
Adverse effects:
• common – nausea, vomiting, constipation, diarrhoea, dry mouth, sedation, biliary spasm, abdominal
pain, anorexia, dyspepsia, pruritus, somnolence, dizziness;
• less common – muscle rigidity, hypotension, respiratory depression, bronchospasm, dyspnoea,
impaired cough reflex, asthenia, anxiety, chills, muscle fasciculation, postural hypotension,
hallucinations, vertigo, euphoria, dysphoria, dizziness, confusion;
• uncommon – bradycardia, tachycardia, palpitation, oedema, mood changes, dependence,
drowsiness, sleep disturbances, headache, miosis, visual disturbances, sweating, flushing, rash, A3
urticaria, restlessness, difficulty with micturition, urinary retention, ureteric spasm, gastritis,
flatulence, dysphagia, taste disturbance, belching, hiccups, vasodilation, supraventricular
tachycardia, syncope, amnesia, hypoesthesia, pyrexia, amenorrhoea, hypotonia, paraesthesia,
disorientation, malaise, agitation, speech disorder, tremor, dry skin;
• rare – raised intracranial pressure, circulatory depression, cardiac arrest, respiratory arrest, shock,
paralytic ileus, seizures.
A4
Interactions with other medicines:
• central nervous system depressants – additive or potentiating effects with oxycodone;
• monoamine oxidase inhibitors* – severe and unpredictable potentiation of opioids;
• naloxone* – precipitates opioid withdrawal symptoms;
• naltrexone* – precipitates opioid withdrawal symptoms;
• opioid antagonists/partial agonists* – may precipitate opioid withdrawal symptoms.
* Indicates severe. A5

Notes:
• Oxycodone is subject to international control under the Single Convention on Narcotic Drugs, 1961.
• Prolonged-release oxycodone preparations must not be crushed or chewed; the child must be able to
swallow the whole tablet.
• To administer with food to reduce gastrointestinal upset.
• Oxycodone is partially metabolized to an active metabolite, oxymorphone, via CYP2D6 pathway; slow or A6
ultra-fast metabolizers may experience reduced or enhanced analgesia and dose-related side-effects.
• High strength modified-release tablets should only be used in patients who are opioid tolerant.
Administration of these strengths to non-opioid tolerant patients may cause fatal respiratory
depression.
• Naloxone is used as an antidote in case of opioid overdose.

Equianalgesic doses:
A7
When converting from oral morphine to oral oxycodone, use an initial dose conversion ratio of
1.5:1 (e.g. replace 15 mg morphine with 10 mg oxycodone). Then titrate to optimize the analgesia.

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