Oxycodone
Standing risks
| Risk | Recorded values | Confidence | Article section |
|---|---|---|---|
| Dangerous withdrawal, taper carefully |
| high | View in article: Dangerous withdrawal, taper carefully |
| High overdose risk, use caution |
| high | View in article: High overdose risk, use caution |
| Compulsive use risk, monitor frequency |
| high | View in article: Compulsive use risk, monitor frequency |
| High dependence, taper carefully |
| high | View in article: High dependence, taper carefully |
| Chronic toxicity, limit exposure |
| high | View in article: Chronic toxicity, limit exposure |
Lethal interactions
| Combination | Type | Severity | Mechanisms | Confidence |
|---|---|---|---|---|
| Ketamine | Substance | lethal | — | — |
| Tramadol | Substance | lethal | — | — |
| Benzodiazepines, Barbiturates | Drug class | lethal | 2 | high |
| GHB, Baclofen | Drug class | lethal | 2 | high |
| GHB, GBL | Drug class | lethal | 2 | high |
| Local anesthetics | Drug class | lethal | 4 | medium |
Dangerous interactions
39 dangerous interactions recorded for this substance.
See the full interactions tableContraindications
| Condition | Severity | Note |
|---|---|---|
| Respiratory | ||
| pre-existing respiratory depression | absolute | Patients with significant respiratory depression, acute or severe bronchial asthma in unmonitored settings, or hypercarbia must not receive oxycodone. The additive respiratory suppression can be rapidly fatal. |
| acute bronchospasm | absolute | Active bronchospasm or status asthmaticus in unmonitored settings is an absolute contraindication due to compounded ventilatory compromise. |
| Psychiatric | ||
| concurrent MAOI use | relative | Concurrent or recent MAOI use (within 14 days) significantly increases risk of serotonin syndrome and potentiated CNS depression. Case reports of serotonin syndrome with oxycodone + serotonergic agents exist despite oxycodone lacking direct SERT inhibition. |
| substance use disorder history | relative | History of substance use disorder significantly increases risk of oxycodone misuse and addiction. Misuse rates of 21-29% and addiction rates of 8-12% documented in chronic pain populations. Careful risk-benefit assessment required. |
| Hepatic | ||
| hepatic impairment | relative | Hepatic impairment requires dose reduction and careful monitoring. Reduced CYP3A4/CYP2D6 metabolism prolongs oxycodone elimination and increases risk of respiratory depression. |
| Renal | ||
| renal impairment | relative | Renal impairment requires dose adjustment and monitoring. Accumulation of oxycodone and metabolites increases risk of prolonged CNS and respiratory depression. |
| Metabolic | ||
| concurrent CYP3A4 inhibitor use | relative | Co-administration with strong CYP3A4 inhibitors substantially increases oxycodone exposure and risk of respiratory depression. Dose reduction and enhanced monitoring required. PBPK modeling confirms dramatic exposure increases. |
| Pregnancy & Breastfeeding | ||
| pregnancy | relative | Oxycodone use during pregnancy is associated with NOWS in newborns requiring pharmacological treatment. Perinatal exposure causes long-term neurodevelopmental changes in animal models. Use only when benefits clearly outweigh risks. |
| Age | ||
| elderly | relative | Elderly patients require reduced initial doses and careful titration. Increased sensitivity to respiratory depression, sedation, and falls risk. Immunosuppressive effects of chronic use are particularly concerning in this population. |
| Other | ||
| paralytic ileus or gastrointestinal obstruction | absolute | Known or suspected paralytic ileus or mechanical gastrointestinal obstruction is an absolute contraindication. Opioid-induced reduction in gut motility exacerbates obstruction. |
| known hypersensitivity to oxycodone | absolute | Known hypersensitivity to oxycodone or any component of the formulation is an absolute contraindication. |