ABHB Prescribing Guideline Use of Oxycodone - NHS Wales

1 This Guidance should be used in conjunction with the Summary of Product Characteristics (SmPC) for the particular formulation of Oxycodone being used. Adapted from Fife Palliative Care guidelines for the use of Oxycodone in Cancer Pain Status: APPROVED Date produced: 27 May 2011 (Revised Jan. 2012) Approved by: abhb MTC Page 1 of 2 Review Date: Jan 2015 abhb Prescribing Guideline Use of Oxycodone INDICATION FOR Oxycodone In Gwent Oxycodone is restricted to initiation by Oncology, Haematology and Palliative Care only. Morphine sulphate is the first choice strong opioid for patients at the third stage of the WHO ladder. Oxycodone is no more effective as an analgesic than Morphine.

2 Oral Oxycodone should only be considered if: Morphine cannot be tolerated due to side effects vomiting, drowsiness, confusion, hallucinations, signs of opioid toxicity Subcutaneous Oxycodone should only be considered if: Subcutaneous Morphine / Diamorphine cannot be tolerated due to side effects drowsiness, confusion, hallucinations, signs of opioid toxicity Patients have been taking Oxycodone orally and are no longer able to swallow / use the oral route ** Oxycodone SHOULD ONLY BE USED FOR PALLIATIVE CARE** Local guidance on the Use of Strong Opiates in Chronic Non malignant Pain is at: GwentGuidance%5 BFinal% USEFUL FACTS There have been issues around patients receiving the incorrect form of Oxycodone so it should always be prescribed by brand name: OxyNorm or Oxycontin The potency of Oxycodone is twice that of morphine sulphate MST 60mg bd = Oxycontin 30mg bd The potency of subcutaneous Oxycodone is twice that of oral Oxycodone Orally it has a more predictable bioavailability (60 87%) than morphine sulphate (15 65%) Oxycodone may be more likely to cause constipation than morphine Oxycodone undergoes hepatic metabolism to active metabolites that are excreted renally it should be used with caution in patients with hepatic and renal impairment Targinact ( Oxycodone and naloxone) is non formulary and should NOT be used Beware the confusing use of OxyNorm for oral immediate release and injectable forms OxyNorm (Oral immediate release form) 5mg, 10mg and 20mg capsules and 5mg/5ml liquid and 10mg / ml concentrate liquid.

3 Onset of action is 20 30 minutes with peak effect at 1 hours Duration of action is 4 6 hourly. If titrating a dose, prescribe 4 hourly The breakthrough dose of OxyNorm should be one sixth (1/6) the total daily regular dose of Oxycontin oral Oxycontin 30mg 12 hourly requires a breakthrough dose of oral Oxynorm 10mg Oxycontin (Oral sustained release over 12 hours) 5mg, 10mg, 20mg, 40mg and 80mg tablets M/R forms should be swallowed whole, crushing or chewing may lead to rapid release and overdose of Oxycodone Peak effect of M/R form is 3 hours OxyNorm (Injection) 10mg / ml injection (1ml and 2ml ampoules) 50mg / ml injection (1ml ampoules) Conversion ratio oral : subcutaneous is 2:1 oral Oxycontin 30mg/ 12hrly = sc Oxynorm 30mg 24hrly This Guidance should be used in conjunction with the Summary of Product Characteristics (SmPC) for the particular formulation of Oxycodone being used.

4 Adapted from Fife Palliative Care guidelines for the use of Oxycodone in Cancer Pain Status: APPROVED Date produced: 27 May 2011 (Revised Jan. 2012) Approved by: abhb MTC Page 2 of 2 Review Date: Jan 2015 DOSING OF Oxycodone Because Oxycodone will be used after Morphine Sulphate, patients will need to be transferred to a roughly equivalent dose of Oxycodone . To calculate the dose of Oxycontin divide the dose of MST by 2. Convert from: To Breakthrough (prn) MST 60mg bd Oxycontin 30mg bd OxyNorm 10mg oral Morphine Sulphate inj 60mg/24 hrs s/cOxyNorm inj 30mg/24hrs s/c Oxynorm inj 5mg s/c Diamorphine inj 40mg/24hrs s/c OxyNorm inj 30mg/24hrs s/c Oxynorm inj 5mg s/c Oral Oxycontin 30mg bd OxyNorm inj 30mg/24 hrs s/cOxyNorm inj 5mg s/c At higher doses consideration should be given to the volume of OxyNorm injection required in a syringe driver Contact the Specialist Palliative Care Service for advice Patients should be monitored closely during opioid switching and titrated accordingly CONVERSION AND BREAKTHROUGH CHART The figures below are an approximation and the patient should always be reviewed for signs of toxicity and inadequate analgesia during a conversion.

5 When switching opioid consider whether the patient s pain is already controlled or is a higher dose likely to be needed. EQUIVALENT ORAL MORPHINE (MG IN 24 HRS) ORAL Oxycodone (MG IN 24 HRS) SUBCUTANEOUS Oxycodone (MG IN 24 HRS) BREAKTHROUGH ORAL Oxycodone (MG) 40 20 10 60 30 15 5 80 40 20 160 80 40 15 240 120 60 20 FURTHER ADVICE ON THE USE Oxycodone PREPARATIONS OR ON SWITCHING BETWEEN OPIOIDS CONTACT A MEMBER OF THE SPECIALIST PALLIATIVE CARE TEAM Within working hours Specialist Hospital Palliative Care Teams Royal Gwent Hospital Tel. 01633 234934 Caerphilly Miner s Hospital Tel. 029 20851811 Bleep 0853 Nevill Hall Hospital Tel. 01873 732777 Specialist Palliative Care Inpatient Units (including Hospices) St Anne s Hospice, Newport Tel. 01633 820317 Community Specialist Palliative Care Teams St David s Foundation Tel.

6 01633 271364 Hospice of the Valleys Tel. 01495 717277 Out of Hours specialist palliative care advice If a healthcare professional needs more advice or guidance outside normal working hours, please call 02920 426000 (Marie Curie Hospice, Penarth)