acetaminophen/oxycodone (Percocet, Endocet, Tylox, Roxicet)
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Introduction
oxycodone + acetaminophen: DEA-controlled substance: class 2. FDA Advisory panel recommends removing Percocet from the US market. June 2009[5]
Indications
- treatment of moderate to severe acute pain-related syndrome
- not for chronic pain
* combinations of acetaminophen & opiate no longer recommended due to risk of acetaminophen toxicity[6]
Contraindications
Caution: G6PD deficiency
Dosage
- 1-2 tab PO every 4-6 hours PRN
- maximum: 12 tabs/day (4 g acetaminophen), 6 in alcoholics
Tablets
| oxycodone | acetaminophen 325 mg |
|---|---|
| 2.5 mg | 325 mg |
| 5 mg | 325 mg |
| 7.5 mg | 325 mg |
| 10 mg | 325 mg |
| 7.5 mg | 500 mg |
| 10 mg | 650 mg |
Dosage adjustment in renal failure
[2] creatinine dosage clearance 10-50 (mL/min) every 6 hours < 10 (mL/min) every 8 hours (metabolites may accumulate)
Pharmacokinetics
elimination: liver
Adverse effects
- common (> 10%)
- less common (1-10%)
- ureteral spasms, pain at site of injection, nervousness, headache, restlessness, anorexia, malaise, epigastric cramps, dry mouth, constipation, biliary spasm, decreased urination, confusion, dyspnea*
- uncommon (< 1%)
- paralytic ileus, depression, histamine release, hallucinations, paradoxical CNS stimulation, rash, urticaria, increased intracranial pressure, physical & psychologic dependence, hypersensitivity reactions, blood dyscrasias (neutropenia, leukopenia, pancytopenia) hepatic necrosis with overdose, nephrotoxicity with chronic use
* respiratory depression is dose & tolerance-related
- drug adverse effects of opiates
- drug adverse effects of psychotropic agents
- drug adverse effects of sedatives
Drug interactions
- agents that increase acetaminophen hepatotoxicity
- carbamazepine, hydantoin, barbiturates, chronic alcohol use, rifampin
- acetaminophen can elevate INR in patients taking warfarin
- naloxone is a direct opiate antagonist
- drug interaction(s) of acetaminophen in combination with GLP1-agonist
- drug interaction(s) of acetaminophen in combination with phenylephrine
- drug interaction(s) of benzodiazepine with opiates
- drug interaction(s) of Z-drugs with opiates
- drug interaction(s) of alcoholic beverage with opiates
- drug interaction(s) of pregabalin with opiates
- drug interaction(s) of gabapentin with opiates
- drug interaction(s) of alcoholic beverage with acetaminophen
- drug interaction(s) of ethanol with acetaminophen
Laboratory
More general terms
Components
- acetaminophen (Tylenol, Paracematol, Panadol, Tempra, Datril, APAP, non-Aspirin)
- oxycodone (Roxicodone, OxyContin, OxyIR, OxyFast, Oxecta, Xtampza ER)
References
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998 Department of Veterans Affairs, VA National Formulary
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ Prescriber's Letter 9(1):2 2002
- ↑ 5.0 5.1 FDA Advisory panel Acetaminophen Overdose and Liver Injury Background and Options for Reducing Injury June 2009 http://www.fda.gov/ohrms/dockets/ac/09/briefing/2009-4429b1-01-FDA.pdf
- ↑ 6.0 6.1 Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013