Oxycontin dosage, forms, and strengths

Oxycontin is the brand name of oxycodone hydrochloride (generic), a schedule II narcotic analgesic. It contains an opioid used for those who have severe pain that requires around-the-clock pain management. This medication should only be used when over-the-counter analgesics (such as acetaminophen or ibuprofen), immediate-release oxycodone, other narcotic medications do not provide any pain relief, or there is a known allergy to these alternatives.  Oxycontin is not for as-needed use and must be used on a long-term basis daily. Xtampza ER, Roxicodone, Oxaydo, and RoxyBond are other brand names for oxycodone but in the immediate-release form of oxycodone only. 

Oxycontin is a long-acting opiate that has potentially serious adverse effects even when used properly. This includes the risk of addiction, misuse, or abuse that may lead to death. Due to these risks, healthcare professionals must perform a Risk Evaluation and Mitigation Strategy (REMS) required by the United States Food and Drug Administration (FDA).

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Oxycontin forms and strengths

Oxycontin is found in tablet form. It is an extended-release formulation only, which means it provides the opioid for an extended amount of time. Options available include:

• Tablets: 10 milligrams (mg), 15 mg, 20 mg, 30 mg, 40 mg, 60 mg, 80 mg

Oxycontin dosage for adults

Oxycontin is an extended-release analgesia used for the management of severe pain throughout the day in both adults and children. Prescribing of this medication only occurs when other analgesics such as acetaminophen, ibuprofen, or other opioid analgesics are not successful with achieving analgesia. Using the correct dosage given by your healthcare provider is vital for preventing some of the potential complications associated with the use of this medication.

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Oxycontin dosage for severe pain

Oxycontin is approved for long-term pain management in severe cases that require around-the-clock pain control. It is recommended that the lowest effective dose be given and then gradually increase the amount if required. This should be for the shortest amount of time needed for pain control.

Opioid-naive

• Initial dosage: 10 mg every 12 hours; amount may be increased by 25% to 50% with every 12-hour interval every one to two days until favorable pain management is achieved

• Standard dosage: Usually a dosage less than 40 mg every 12 hours is used

• Maximum dosage: Less than 80 mg daily

Opioid-tolerant

• Initial dosage: Based on the individual patient’s current oxycodone intake

• Standard dosage: Usually a dosage greater than 40 mg every 12 hours is used

• Maximum dosage: More than 80 mg daily

Patients who are considered opioid-tolerant are those taking at least 60 mg daily of oral morphine, 25 mcg of transdermal fentanyl an hour, 30 mg daily of oral oxycodone, 8 mg daily of oral hydromorphone, 25 mg daily of oral oxymorphone, 60 mg daily of oral hydrocodone, or any analgesic equivalent for a week.

Oxycontin dosage for children

Oxycontin is approved for long-term pain management in severe cases that require continuous pain control in pediatric patients 11 years of age and older who are already using opioids. Pediatric patients must be taking at least a 20 mg daily dose of oxycodone for five consecutive days or its equivalent for at least two days prior to starting Oxycontin. Here is a conversion chart and the steps used when calculating the daily dose of Oxycontin in pediatric patients:

* Parenteral administration occurs when any medication is entered into the body by any means other than through the digestive tract. Examples: Intravenous or intramuscular administration.

1. For pediatric patients taking a single opioid, use the current total daily dosage of the opioid and then multiply the total daily dosage by the approximate conversion factor found in the table above to calculate the approximate daily dosage for Oxycontin.

   1. For pediatric patients taking more than one opioid, calculate the approximate dose for each opioid. Add the totals, then use the conversion table above to obtain the approximate daily dosage for Oxycontin.

   2. For pediatric patients taking a mixed opioid/non-opioid analgesic product, use only the opioid component of these products in the conversion.

2. If rounding is necessary, always round the dosage down to the nearest Oxycontin tablet strength available. If the calculated total daily dosage is less than 20 mg, do not initiate Oxycontin.

3. If switching from transdermal fentanyl patch, make sure that the patch has been removed for at least 18 hours prior to starting Oxycontin. There is little knowledge known with this conversion so close monitoring is highly encouraged.

Oxycontin dosage restrictions

Oxycontin is contraindicated in anyone who has trouble breathing, asthma, bowel obstruction, in a coma, circulatory shock, or those who have a known allergy to oxycodone.  

Patients who take monoamine oxidase inhibitors (MAOIs) can not start Oxycontin for at least 14 days after discontinuing the medication (examples of MAOIs include serotonin). 

Caution is also recommended when prescribing this medication in the following individuals with these conditions:

• Renal impairment

• Pulmonary disease

• Hepatic impairment

• Sleep apnea

• History of alcohol or drug abuse

• Current alcohol use

• Head injury

• Seizure disorder

• Heart disease

• Hypothyroidism 

• Mental illness

• Older adults

• Acute pancreatitis or pancreas disease

• Low blood levels

Dosing alternative for renal impairment:

• Creatinine clearance (CrCl) less than 60: Titrate slowly

• Hemodialysis patients: No modifications 

• Peritoneal dialysis patients: No modifications

• No supplements  

Dosing alternative for hepatic  impairment:

• Initial dose should be decreased by 50% to 66%

• Titrate slowly 

Dosing alternative for seniors:

• Titrate slowly in those 65 years of age and older

How to take Oxycontin

Because of the potential harm associated with taking Oxycontin, it is important that this medication is taken as directed and monitored closely by healthcare professionals. Here are some helpful tips on how to take this oxycodone form appropriately:  

• Take your medicine as directed. Your dose may need to be changed several times to find what works best for you. An overdose can be dangerous. Follow directions carefully so you do not get too much medicine at one time.

• Extended-release tablet: Swallow the extended-release tablet whole. Do not crush, break, or chew it. Do not take a tablet that is chipped or broken. Do not soak, lick, or wet the tablet before you place it in your mouth. Take one tablet at a time with enough water to swallow it completely.

• Extended-release capsule: It is best to take this medicine with food or milk. Swallow the extended-release capsule whole. Do not crush, break, or chew it. If you have trouble swallowing the capsule, you may open it and sprinkle the contents on soft foods (such as applesauce, pudding, ice cream, or jam) or into a cup. Eat the mixture or swallow the contents immediately. Drink a glass of water after you take the medicine to make sure you get a full dose.

• This medicine should come with a Medication Guide. Ask your pharmacist for a copy if you do not have one.

• Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Store the medicine in a safe and secure place. Drop off any unused narcotic medicine at a drug take-back location right away. If you do not have a drug take-back location near you, flush any unused narcotic medicine down the toilet. Check your local drug store and clinics for take-back locations. You can also check the DEA website for locations.

RELATED: How to dispose of medication

Oxycontin dosage FAQs

What happens if I miss a dose of Oxycontin?

It is important that you take Oxycontin exactly as instructed by your healthcare provider.  Do not take more than what is prescribed. Take your medication every 12 hours at the exact time every day. If a dose is missed, take the next dose at its scheduled time. Never take two doses of this medication.

How do I stop taking Oxycontin?

To discontinue the use of Oxycontin, this must be under the strict guidance of your healthcare provider. Discontinuing the analgesic prematurely may cause opioid withdrawal symptoms. It is recommended that tapering the amount of Oxycontin be done gradually. Usually, reduction of this opioid therapy by 10% to 25% is done every two to four weeks to reduce the potential of opioid withdrawal symptoms or other complications. 

Can you overdose on Oxycontin?

If too much Oxycontin is taken, this may cause a fatal overdose, which is a common concern with the use of opioids in general. Oxycontin may cause shallow breathing when initially starting the medication or if the amount may be increased by your healthcare provider to achieve pain control. If this occurs, seek emergency medical attention immediately. 

Close monitoring is encouraged for the first 72 hours under these circumstances. Your healthcare provider may also prescribe naloxone to use if an overdose occurs. It can reverse the effects of oxycodone preventing overdose. Even if this medication is given, it is recommended that you seek emergency medical attention. 

Never share your Oxycontin, as someone’s reaction to the medication may differ from you and this may cause an opioid overdose. Store this medication safely and away from children.  Here are some other adverse effects to be aware of: 

Serious side effects

• Hypersensitivity reaction or anaphylaxis

• Respiratory depression or arrest

• Apnea or central sleep apnea

• Shock

• Intracranial pressure increase

• Circulatory depression

• Severe hypotension (low blood pressure)

• Seizures

• Paralytic ileus

• Biliary spasm

• Adrenal insufficiency

• Opioid-induced androgen deficiency (long-term use)

• Dependency or abuse

• Withdrawal symptoms with abrupt discontinuation (prolonged or long-term use)

Common side effects

• Constipation

• Nausea

• Drowsiness

• Dizziness

• Itching

• Vomiting

• Headache

• Insomnia

• Dry mouth

• Lack of energy

• Sweating

• Anorexia

• Nervousness

• Fever

• Rigors

• Confusion

• Diarrhea

• Abdominal pain

• Indigestion

• Rash

• Anxiety

• Unhappiness or intense happiness

What interacts with Oxycontin?

There are many drug interactions to be aware of when considering Oxycontin for long-term analgesia. Discuss all medications being taken with your healthcare professional before taking this opioid analgesic. Here are some drugs that may cause side effects with Oxycontin and alternatives should be found:    

• Macrolide antibiotics (i.e. erythromycin)

• Azole-antifungal agents (i.e. ketoconazole) 

• Protease inhibitors

• Rifampin

• Carbamazepine

• Phenytoin

• Benzodiazepines

• Central nervous system (CNS) depressants 

• Anxiolytics  

• Tranquilizers 

• Muscle relaxants 

• General anesthetics 

• Antipsychotics 

• Other opioids (buprenorphine and butorphanol)

• Ritonavir

What happens when you mix Oxycontin and alcohol?

Oxycontin should not be combined with alcohol as it can cause several different side effects. Like all opiates, the mixture of alcohol may cause fatal consequences such as death due to opioid overdose. It may increase drowsiness or sedation, which is also enhanced by alcohol. This medication should never be taken while driving or operating heavy machinery. 

Is it safe to take Oxycontin during pregnancy?

Oxycontin is not safe for pregnant women. Its prolonged use while pregnant may be life-threatening or cause withdrawal symptoms in the infant. It can also pass through breast milk and potentially harm the child. Alternative treatment options are recommended for those attempting to get pregnant, those pregnant, and those breastfeeding. 

Related resources for Oxycontin dosages:

• Oxycontin, FDA

• Adult dosing, Epocrates

• Oxycontin, oxycontin.com

• Pediatric dosing, Epocrates

• Adverse reactions, Epocrates

• Pregnancy/lactation, Epocrates