Oxycodone HCl 20mg – High-Dose Opioid for Severe Pain Management
(Extended-Release Formulation – For Opioid-Tolerant Patients Only)
⚠️ Critical Safety Alert
-
NOT FOR OPIOID-NAÏVE PATIENTS
-
Minimum Requirement: ≥40mg MEDD (morphine equivalent daily dose) for ≥1 week
-
ABSOLUTELY NEVER crush, chew, or dissolve
Therapeutic Profile
• Schedule II controlled substance (DEA)
• Duration: 12-hour controlled release
• Peak Effect: 4-5 hours post-dose
• Metabolism: Liver (CYP3A4/2D6 dependent)
FDA-Approved Indications
✔ Around-the-clock cancer pain
✔ Chronic severe pain (with documented tolerance)
✔ Palliative care when lower doses fail
Dosing Protocol
-
Conversion from Other Opioids:
20mg oxycodone ER q12h = 60mg oral morphine/day -
Renal Impairment:
Reduce dose by 50% if CrCl <30mL/min -
Hepatic Caution:
Start with 50% dose in cirrhosis
Abuse-Deterrent Features
-
Hardened Tablet Matrix (resists crushing)
-
Gel-Forming Technology if manipulated
-
Brand Examples: OxyContin OP, Xtampza ER
Black Box Warnings
🛑 HIGH ADDICTION POTENTIAL – Abuse may cause overdose/death
🛑 LIFE-THREATENING RESPIRATORY DEPRESSION (especially with CNS depressants)
🛑 ACCIDENTAL INGESTION – One tablet can kill a child
Prescribing Requirements
• Documented Opioid Tolerance
• Pain Management Agreement signed
• Naloxone Co-Prescription mandatory
• Monthly PDMP Checks
Product Identification
-
OxyContin OP 20mg:
• Round, pink tablets
• “OP” on one side, “20” on reverse -
Generic ER:
• Varies by manufacturer (all must have FDA-approved AD properties)
Clinical Protocol:
-
Confirm opioid tolerance
-
Calculate prior 72-hour MEDD
-
Start at 50-75% conversion dose
-
Reassess every 3-7 days
