see also:

• opiates and opioids
• pain, analgesia and analgesics

• has a higher bioavailability (up to 90%) when taken orally and is thus 1-2x as potent as oral morphine
• although metabolised by CYP2D6 to oxymorphone, this has limited role in analgesia
• perhaps a better choice for mod-severe pain than panadeine forte as codeine has variable metabolism, but continued use will lead to opiate and opioid dependence.

• see opiates and opioids

• eg. Oxynorm, Endone
• usual dose: 1 tablet swallowed whole, 4-6hrly
• tablets usually available in 5mg, 10mg, and 20mg (available on PBS as packs of 20, restricted benefit)
  • NB. Endone only available as 5mg tabs.
• also available as oral liquid 5mg/5ml

• onset with 1hr and lasts ~12 hours
• as of 31st March 2014, 5mg modified release oxycodone tablets are no longer be available on the PBS

• as of April 2014, these have been reformulated to make it difficult to use iv by substance abusers
  • to avoid difficulty swallowing with reformulated OxyContin® tablets:
    • SHOULD NOT be pre-soaked, licked or otherwise wetted before taking
    • SHOULD be taken one tablet at a time with enough water to ensure complete swallowing immediately after placing in the mouth
  • contraindicated in patients with suspected mechanical GI obstruction (e.g. bowel obstruction, strictures) or in patients with diseases/conditions that affect bowel transit (e.g. ileus of any type)
  • use caution in patients who have any underlying GI disorders that may predispose them to intestinal obstruction or in patients with difficulty in swallowing or who have been diagnosed with narrowing of the oesophagus
• usual dose: 1 tablet swallowed whole, twice daily
• available strengths: 10mg, 15mg, 20mg, 30mg, 40mg, 80mg Modified Release Tablets (PBS in packs of 28)
• remember the quantity supplied on the prescription (for any Schedule 8 medication) needs to be written in words and figures, i.e. 28 TWENTY-EIGHT

• the addition of naloxone reduces opiate-induced constipation but still poses a high risk of opiate dependence and longer term use will require gradual withdrawal
• can concurrently use immediate release preparations for breakthrough pain
• only available on PBS in Australia on restricted benefit for chronic severe disabling pain not responsive to non-opiate analgesics
  • as of 2014, PBS authorities for increased maximum quantities and/or repeats will be granted only for:
    • (i) chronic severe disabling pain associated with proven malignant neoplasia; or
    • (ii) chronic severe disabling pain not responding to non-narcotic analgesics where the total duration of narcotic analgesic treatment is less than 12 months; or
    • (iii) first application for treatment beyond 12 months of chronic severe disabling pain not responding to non-narcotic analgesics where the patient's pain management has been reviewed through consultation by the patient with another medical practitioner, and the clinical need for continuing narcotic analgesic treatment has been confirmed. The date of the consultation must be no more than 3 months prior to the application for a PBS authority. The full name of the medical practitioner consulted and the date of consultation are to be provided at the time of application; or
    • (iv) subsequent application for treatment of chronic severe disabling pain not responding to non-narcotic analgesics where a PBS authority prescription for treatment beyond 12 months has previously been issued for this patient.
• preparations available:
  • 5mg/2.5mg
  • 10mg/5mg
  • 20mg/10mg
  • 40mg/20mg
• dose every 12hrs

• eg. Proladone 30mg (packs of 12 on PBS with restricted benefit)
• 1 supp every 6-8hrs prn.

• eg. Oxynorm injection