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Oxycodone in palliative care

Oxycodone is a medicine like morphine that works as a strong pain reliever (painkiller). The name sounds similar to codeine, but it isn't the same.

Doctors prescribe oxycodone when someone has strong pain. This might be after a serious accident or after an operation. It's also used for cancer pain or other serious conditions that simpler pain relievers don't work for.

In palliative care, the time to start using oxycodone is when your pain is bad enough. It doesn't mean that you're dying.

Oxycodone only helps some types of pain and you may need to take other pain relief medicines as well. Your doctor will discuss this with you.

You may need to steadily increase the dose of oxycodone, particularly when starting it, to work out the right dose. Your doctor will do this slowly and steadily over a few days, sometimes taking up to two weeks to get the right dose. As your illness progresses, you may need to increase the dose. But this usually happens because the pain is getting worse. It doesn't mean that the oxycodone is losing its effect.

When used correctly at the right dose, there's no evidence that oxycodone either shortens or prolongs life.

Taking oxycodone

There are two common ways of taking oxycodone.

Controlled-release (slow-acting) tablets

Controlled-release tablets usually last for 12 hours. They come in different strengths from 5 mg through to 80 mg. Your doctor may need to prescribe a combination of tablet strengths to get the right dose for you. You need to swallow the tablets whole – don't chew or crush any of them.

Because they last for 12 hours, you need to take them every 12 hours. For example, at 8 am and 8 pm or at 9 am and 9 pm. These tablets don't help with sudden sharp pain or bouts of pain that happen between the morning and night-time doses.

Immediate-release (fast-acting) capsules or liquid

This also comes in different strengths. It starts to work within half to one hour of taking it and lasts for four to six hours.

Fast-acting capsules or liquid are suitable for sudden pain that happens despite regular pain relief. This pain is known as breakthrough pain or incident pain.

You can also occasionally use it before you start taking long-acting medications or doing an activity you know will cause you pain.

Possible side effects

Constipation

Although oxycodone is a good pain reliever, almost everybody who takes it gets constipated. You should make sure your doctor routinely prescribes a good laxative, which you need to take regularly. You can also help to ease this by eating more fruit, vegetables, brown bread, bran-based breakfast cereals and drinking plenty of liquids.

Nausea and vomiting

About a third of people starting oxycodone can feel sick or even throw up in the first week to 10 days. Fortunately, this usually goes away. If this is a problem for you, your doctor can prescribe an anti-sickness tablet. Bear in mind that other things might be causing your nausea and vomiting – it may not be the oxycodone. Talk to your doctor or nurse if you're having problems.

Drowsiness

Sometimes people feel more sleepy or drowsy than usual for a few days after starting oxycodone or increasing the dose. This usually wears off quickly. If it affects you in this way, you must not drive or operate dangerous machinery.

Less common side effects when taking oxycodone include unsteadiness, confusion and hallucinations, sweating, blurred vision and a dry mouth.

Oxycodone addiction

Addiction happens when people who have no pain abuse opioid medicines. When oxycodone is used to relieve pain, it's very unlikely to cause addiction.

It's sometimes possible to reduce your oxycodone dose if another treatment can relieve your pain. If you need to reduce or stop your oxycodone, make sure you talk to your doctor about it. It's best to reduce the dose gradually to decrease the risk of having withdrawal symptoms.

If you need to take higher and higher doses, it may be because your body is getting used to the oxycodone or because your disease is getting worse. It doesn't mean you're becoming addicted.

Driving

Taking oxycodone doesn't automatically mean you can't drive. You need to talk to your doctor about this. But if you have difficulty staying alert or concentrating, or if you're physically weak or ill, it isn't wise to drive. If your doctor says driving is OK, follow these general guidelines:

Remember – the risk lies with you. If you're involved in an accident, you'll be questioned closely if you seem to be under the influence of drugs.

Alcohol

The combination of oxycodone and alcohol will probably make you feel sleepy or drunk much sooner than usual. So, it's sensible to drink less than you're used to until you know what sort of effect it has on you.

Recording your oxycodone use

Keep a diary of the doses and times of any medications you take for breakthrough pain and any changes to your controlled-release oxycodone. Have this available for your community nurse or GP each time you see them. Also record how often you pass a bowel motion (poo).

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Written by Christchurch Hospital Palliative Care Service. Adapted by HealthInfo clinical advisers. Last reviewed November 2020.

Page reference: 59259

Review key: HIPAL-17434