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4. Discontinue all other around-the-clock opioid drugs when OxyContin therapy is initiated. 5. No fixed conversion ratio is likely to be satisfactory in all patients, especially patients receiving large opioid doses. The recommended doses shown in Table 4 are only a starting point, and close observation and frequent titration are indicated until patients are stable on the new therapy. TABLE 4. Multiplication Factors for Converting the Daily Dose of Prior Opioids to the Daily Dose of Oral Oxycodone*
(Mg/ Day Prior Opioid x Factor = Mg/ Day Oral Oxycodone) Oral Prior Opioid Parenteral Prior Opioid Oxycodone 1 -- Codeine 0.15 -- Hydrocodone 0.9 -- Hydromorphone 4 20 Levorphanol 7.5 15 Meperidine 0.1 0.4 Methadone 1.5 3 Morphine 0.5 3 * To be used only for conversion to oral oxycodone. For patients receiving high-dose parenteral opioids, a more conservative conversion is warranted. For example, for high-dose parenteral morphine, use 1. 5 instead of 3 as a multiplication factor.
In all cases, supplemental analgesia should be made available in the form of a suitable short-acting analgesic. Text Continues Below
OxyContin ® can be safely used concomitantly with usual doses of non-opioid analgesics and analgesic adjuvants, provided care is taken to select a proper initial dose (see PRECAUTIONS). Conversion from Transdermal Fentanyl to OxyContin Eighteen hours following the removal of the transdermal fentanyl patch, OxyContin treatment can be initiated. Although there has been no systematic assessment of such conversion, a conservative oxycodone dose, approximately 10 mg q12h of OxyContin, should be initially substituted for each 25 µg/ hr fentanyl transdermal patch. The patient should be followed closely for early titration, as there is very limited clinical experience with this conversion. Managing Expected Opioid Adverse Experiences Most patients receiving opioids, especially those who are opioid-naive, will experience side effects. Frequently the side effects from OxyContin are transient, but may require evaluation and management. Adverse events such as constipation should be anticipated and treated aggressively and prophylactically with a stimulant laxative and/ or stool softener. Patients do not usually become tolerant to the constipating effects of opioids. Other opioid-related side effects such as sedation and nausea are usually self-limited and often do not persist beyond the first few days. If nausea persists and is unacceptable to patient, treatment with antiemetics or other modalities may relieve these symptoms and should be considered. Patients receiving OxyContin ® may pass an intact matrix "ghost" in the stool or via colostomy. These ghosts contain little or no residual oxycodone and are of no clinical consequence. Individualization of Dosage Once therapy is initiated, pain relief and other opioid effects should be frequently assessed. Patients should be titrated to adequate effect (generally mild or no pain with the regular use of no more than two doses of supplemental analgesia per 24 hours). Page: << Prev | 1 | 2 | 3 | 4 | 5 | Next >>
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