What to Know About Oxycodone

A Strong Pain-Relieving Medication

Medically reviewed by David Ozeri, MD

Prescribed to help manage moderate to severe pain, oxycodone is an opioid analgesic drug. It acts on the central nervous system (CNS) of the brain, essentially suppressing pain signaling and stimulating the body’s own pain managing system.

Oxycodone is sold under many names, including Xtampza ER, Oxaydo, Oxycontin, and Roxybond. An active ingredient in other formulations of opioids, in its pure form, oxycodone, is usually a tablet or capsule, though it may be prescribed in liquid form.

Though highly effective in reducing discomfort, this drug produces a range of side-effects, has very high abuse potential, and overdoses can be deadly. Illicit use of opioids like oxycodone has contributed to a drastic increase in opioid-related deaths and health problems, which is a public health crisis in the U.S.

If you or a loved one has been prescribed oxycodone, a knowledge of how this drug works, what its effects are, and how to take it safely is essential.

Uses

Like all opioids, oxycodone is primarily a pain medication. Currently, Food and Drug Administration (FDA) guidelines for use are:

• Chronic moderate to severe pain as in osteoarthritis, back pain, and some other conditions: Healthcare providers prescribe extended-release versions of oxycodone, such as Xtampza ER or Oxycontin, for cases where other approaches aren't expected to be successful.

• Acute moderate to severe pain that cannot be managed with other methods: Faster-acting forms and some derivatives of this drug may be indicated to help with comfort following surgery, some types of cancer, or following painful injury, such as bone fracture.

Before Taking

In light of the growing opioid epidemic in the U.S., healthcare providers have become more wary when prescribing oxycodone. They’ll make sure pain can’t be managed by other means, and work with patients to make sure they don’t develop drug dependency. As such, careful evaluation is an essential part of the process.

Before this drug is administered or prescribed, the Centers for Disease Control (CDC) recommends practitioners consider the following:

• Abuse potential: Healthcare providers perform a careful evaluation to determine whether the patient is likely to develop opioid use disorder (OUD), which is an addiction to the drug. This will mean assessing their previous history of substance and alcohol use.

• Minimal effective dose: Opioids like oxycodone are considered when 24-hour management of moderate to severe pain is needed. healthcare providers will work with you to determine a dosage that is as limited as possible and monitor you throughout the course of medication, with the goal of weaning you off this drug.

• Risk factors: Since oxycodone ER has such a pervasive effect on multiple body systems, practitioners also need to factor in likely risk-factors for adverse effects. This means assessing health status as well as any prescribed or over-the-counter medications, as well as supplements, you’re taking.

• Other means of pain management: For chronic pain, especially, healthcare providers will first explore alternatives to oxycodone for pain management. These include taking Tylenol (acetaminophen), non-steroidal anti-inflammatory drugs (NSAIDs) such as Advil (ibuprofen) and Aleve (naproxen), or other approaches, such as cognitive-behavioral therapy (CBT) and exercise therapy.

• Urine testing: Practitioners test urine to assess levels of other drugs in the body or detect any unreported use of opioids.

Precautions and Contraindications

Healthcare providers are always very careful about prescribing oxycodone, and there are several factors that outright contraindicate its use:

• Respiratory depression: Since one of the side-effects of opioid drugs is respiratory depression, in which breathing is slower and less effective. Those who already have this condition should not be given these drugs.

• Unmonitored bronchial asthma: Related to the above, opioids are not safe for patients with un-managed asthma, in which airways are obstructed by inflammation in the lungs.

• Gastrointestinal obstruction: Oxycodone can also affect the gastrointestinal system, so conditions that cause obstruction of the intestines, like paralytic ileus, are contraindicators. These may arise due to a range of conditions, including pancreatitis, appendicitis, gastroenteritis (stomach flu), and other conditions.

• Allergy: Some patients have a hypersensitivity to oxycodone, leading to anaphylactic shock, a medical emergency characterized by difficulty breathing, skin rash, and shock.

In addition, healthcare providers will also need to consider the following, which can impact efficacy and increase risks associated with treatment:

• Age: Oxycodone is primarily indicated for adults, though reduced dosages can be given to children 11 years and older, with modifications made for those over 65.

• Pregnancy: Taking oxycodone or other opioids for prolonged periods during pregnancy can lead to neonatal withdrawal syndrome, in which the newborn is born addicted, and experiences withdrawal. This can be fatal and requires careful management.

• Breastfeeding: Evidence suggests that opioids can be transmitted to babies during nursing, so those who breastfeed may be counseled about alternatives.

• Chronic obstructive pulmonary disease (COPD): Patients with COPD, a progressive inflammation of the lungs that leads to breathing difficulties, may not be good candidates for oxycodone due to an increased risk of respiratory depression. This is particularly the case for those over 65.

• Adrenal insufficiency: This rare condition is when your body doesn’t produce enough of the hormones cortisol and/or aldosterone. It can result from treatment and will therefore be considered carefully in those with this condition.

• Low blood pressure (hypotension): If your blood pressure is too low—due to reduced blood volume or as a result of taking some medications—taking oxycodone can increase the risk of developing shock, reducing heart productivity to dangerous levels.

• Intracranial pressure: Some brain tumor or head injury patients experience increased intracranial pressure, in which increases in cerebrospinal fluid (the fluid that surrounds the brain) put pressure on the brain, itself. Taking oxycodone can further exacerbate this issue.

• Seizure disorders: Patients who experience seizures, or brain attack, may be at increased risk of developing these if prescribed.

• Use of certain drugs: Though they may not outright contraindicate its use, benzodiadepines and drugs that act on CYP3A4 receptors in the brain may also cause severe reactions when taken alongside oxycodone (see below).

Make sure to let your healthcare provider know about all medications, supplements, and vitamins you’re currently taking. Though some drugs have minor interaction risks, others may outright contraindicate use or prompt careful consideration as to whether Xtampza ER is an appropriate treatment.

Other Opioids

As mentioned, oxycodone is what is considered an opioid or narcotic. There are other drugs of this class, including:

• Codeine

• Fentanyl

• Heroin

• Hydrocodone

• Methadone

• Morphine

• Tramadol

In addition, oxycodone is also an ingredient in other commonly prescribed opioids, including:

• Percocet

• Oxycet

Dosage

As noted above, oxycodone comes in both a liquid form, and as tablets or pills. Here’s a quick breakdown of how dosage works in these forms.

Extended-release tablets/capsule: Oxycontin, a tablet, and Xtampza ER, a capsule, are the extended-release versions of oxycodone. Whereas the former is round in shape, the latter is narrower and filled with yellow to light brown capsules.

Tablets and capsules will vary in strength; for instance, typical Xtampza ER tablets come in doses of 9, 13.5, 18, 27, 36 milligrams (mg). Film-coated Oxycontin tablets (controlled-release) come in doses of 10, 15, 20, 30, 40, 60, and 80 mg.

Specific instructions depend on your healthcare provider, but, according to the manufacturer, one tablet every 12 hours (twice daily) is recommended.

Solution: Liquid forms of oxycodone are taken orally. The solution comes in two concentrations: 1 milligram (mg)/milliliter (mL) and a much stronger 20 mg/mL solution, typically reserved for patients more tolerant of opioids.

Specific dosages vary based on the case and level of tolerance, but dosing tends to call for 5 to 15 mg every four to six hours as necessary for pain. You’ll get specific guidance on how to correctly administer this solution.

Modifications

Naturally, some health conditions and other factors may necessitate modifications to dosage of both extended-release and liquid forms of oxycodone. Roughly speaking, these are as follows:

• Children 11 and older: The safety of some kinds of oxycodone, like Xtampza ER, has not been established; however, those 11 and up may receive smaller, modified doses of Oxycontin. Oxycodone, in any form, will only be attempted after a child has already developed tolerance to other opioids.

• Adults above 65: It tends to take longer for the bodies of people over 65 to process medications and drugs. They also are more likely to suffer from conditions that impact this process, so dosages typically begin at about one-half to one-third of what a healthy adult gets. If necessary, this can be slightly increased.

• Liver impairment: Though not an outright contraindicator, those with liver conditions may also have more trouble clearing oxycodone from the bloodstream. In these cases, standard dosages may be cut by as much as one half.
  CNS depressants: Patients taking sedatives like Ambien (zolpidem) or benzodiazepines like Valium (diazepam) should start with a reduced dosage.

Be sure to follow the prescription and your healthcare provider’s directions closely when it comes to taking any medications and never modify dosages on your own.

How to Take and Store

You’ll get specific instructions from your practitioner about taking oxycodone. However, the typical guidelines are as follows:

• Extended-release capsules, such as Xtampza ER, must be taken with food; try to be consistent with regards to the size of the meal taken with the drug. For those who have difficulty swallowing, the contents of these capsules can be sprinkled onto soft foods.

• Extended-release tablets, like Oxycontin, should also be taken with food. These tablets, however, should be taken whole, and not licked or made wet before administration. Never crush, break, or attempt to dissolve them.

• Liquid oxycodone should be stored at room temperature 15° - 30°C (59° - 86°F). You’ll be provided a measuring cup; always use that to measure the dosages, and don’t use teaspoons or tablespoons. Make sure to swallow what you’ve measured out right away, and don’t pour any back for future use.

And what do you do if you miss a dose? The recommendation is that you take the medication as soon as you remember, and try to return to your normal schedule of doses as soon as possible.

If so much time has elapsed that you’re almost to your next scheduled dose, you can go ahead and skip one. Don’t double-up on medications if you missed them.   

It’s also important not to stop taking this drug suddenly as this can lead to withdrawal, which can lead to a range of symptoms, including irritability, nausea, restlessness, runny nose, anxiety, cramps, and many others.

Once it’s been determined that there’s no need to continue treatment, healthcare providers will need to taper your intake. This typically means reductions of 25% to 50% of dosage every two to four days, alongside careful monitoring.

It’s important that you keep your medications safe and out of reach of children. Finally, it’s absolutely essential that you dispose of any leftover medicine safely. These drugs can be habit-forming, and they should never be shared. Excess medication should be taken to a pharmacy, police station, or other safe disposal location.

Side Effects

Among the reasons that excessive opioid use can become problematic is the propensity for users to experience both major and minor side-effects. Though these may be challenging, they can be managed. Throughout the course of treatment, stay vigilant of how you’re feeling and keep your healthcare provider informed on your progress.

Common

Not usually warranting emergency care, the most common side-effects of oxycodone are:

• Constipation

• Headache

• Nausea

• Sleepiness

• Dizziness

• Abdominal pain

If these persist or become severe, let your healthcare provider know.

Severe

Rarer, more severe adverse reactions, occurring in between 1% and 5% of cases, require immediate medical attention. These include:

• Opioid dependency/addiction

• Circulatory issues (rapid or irregular heartbeat).

• Psychiatric issues like anxiety, confusion, and nervousness.

• Chills, sweating, and/or fever.

• Muscle twitching

• Enlarged lymph nodes

• Tinnitus (ringing in the ears)

• Decreased fertility

• Impotence

• Menstruation problems

• Neurological disorders (tremors, speech problems, vertigo, abnormal walk, and others)

• Anaphylactic shock (swelling in the face, throat, tongue, lips, and extremities)

Overdose of oxycodone can lead to coma and even death. In these cases, the primary danger is respiratory depression, which leads to insufficient oxygen circulating the body.

If your loved one is taking this kind of medication, it’s essential to know the signs, so you can get help as soon as possible. These include:

• Very small, “pinpoint” pupils

• Loss of consciousness

• Slow, shallow breathing

• Choking and gurgling sounds

• Unresponsive body

• Pale, blue, and/or cold skin

If you find a loved one in this condition, there are several steps to take:

• Call 911 immediately.

• Administer naloxone (a drug that counters the effect of opioids) if available.

• Try to keep the person awake and breathing.

• Lay the person on their side.

• Stay nearby until help arrives.

Warnings and Interactions

Oxycodone carries black box warnings, the most serious type of safety-related warning the Food and Drug Administration (FDA) gives a medication. These medications can cause life-threatening effects that can lead to hospitalization or death.

In addition, several other prescribed and over-the-counter medications, herbs, supplements, and other substances can also affect how opioids like this work. These include:

• Alcohol: When alcohol is mixed with opioid drugs, they become much stronger. This severely increases the chance for overdose and can be deadly.

• Benzodiazepines: When used alongside benzodiadepines, such as Valium (diazepam), Xanax (alprazolam), and Klonopin (clonazepam), oxycodone can lead to severe side-effects up to and including death. Certain muscle-relaxers, tranquilizers, and even other types of opioids can have this effect.

• CYP3A4 inhibitors: Drugs that act on CYP3AG receptors like erythromycin, ketoconazole, or ritonavir may also cause severe reactions when taken alongside oxycodone. In some cases, respiratory depression can result.

• Serotonergic drugs: Typically prescribed for depression, these include selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, triptans, 5-HT3 receptor antagonists, and others. Concomitant use has lead to serotonin syndrome, in which an excess of this brain chemical causes shivering or diarrhea in mild cases, or fever, seizures, and muscle-stiffness in severe ones.

• Monoamine oxidase inhibitors (MAOIs): Interactions between this class of anti-depressant drugs like phenelzine, tranylcypromine, and linezolid may also lead to serotonin syndrome or respiratory depression.

• Partial-agonist opioids: Use of this class of opioids alongside oxycodone may significantly reduce the efficacy of the drug, or even start to cause withdrawal symptoms.

• Muscle relaxers: Those that take muscle-relaxers like baclofen, carisoprodol, metaxalone, and others may also have an increased risk of respiratory arrest.

• Diuretics: Drugs that promote urination, such as thiazides like metolazone, hydrochlorothiazide, and others may interact poorly with oxycodone, limiting their effect.

• Anticholinergic drugs: Users of this class of drug, which acts on the brain chemical acetylcholine, may experience severe constipation and even develop paralytic ileus when taking oxycodone.

This is only a partial list; make sure to have a clear sense of what you can and can’t take alongside oxycodone, and let your healthcare provider know if you’re making any changes.

When an opioid overdose is suspected, Narcan (naloxone hydrochloride) should be administered as soon as possible. The FDA approved Narcan Nasal Spray in March 2023 as an over-the-counter (OTC) emergency treatment for opioid overdose.

A Word From Verywell

There is always a fine-line with opioid drugs like oxycodone; for as well as it works in managing pain, this medication is not without its disadvantages and outright dangers. There certainly is an extent to which prescription opioids have contributed to the overall opioid epidemic, and there’s no doubt that any responsible use involves being mindful of potential dependency.

However, in the face of this crisis, healthcare providers and medical professionals have become better-versed at educating patients about these drugs. They’ve revised their prescription approaches to minimize risk and have developed better protocols for managing issues that arise. So long as its used safely and as directed, there’s no doubt that oxycodone has an important place in medicine.