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acetaminophen/oxycodone (Percocet, Endocet, Tylox, Roxicet)

oxycodone + acetaminophen: DEA-controlled substance: class 2. FDA Advisory panel recommends removing Percocet from the US market. June 2009 [5] Indications: 1) treatment of moderate to severe acute pain-related syndrome 2) not for chronic pain * combinations of acetaminophen & opiate no longer recommended due to risk of acetaminophen toxicity [6] Contraindications: Caution: G6PD deficiency pregnancy-category C safety in lactation - Dosage: 1) 1-2 tab PO every 4-6 hours PRN 2) 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 Pharmacokinetics: elimination: liver. 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) Adverse effects: 1) common (> 10%) - weakness, tiredness, nausea/vomiting, hypotension, drowsiness, dizziness 2) 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* 3) 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 interactions: 1) agents that increase acetaminophen hepatotoxicity - carbamazepine, hydantoin, barbiturates, chronic alcohol use, rifampin 2) acetaminophen can elevate INR in patients taking warfarin 3) naloxone is a direct opiate antagonist Laboratory: - acetaminophen+oxycodone in serum/plasma

Interactions

drug interactions drug adverse effects of opiates

General

narcotic combination

Database Correlations

PUBCHEM cid=656790

References

  1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
  2. 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
  3. Kaiser Permanente Northern California Regional Drug Formulary, 1998
  4. Prescriber's Letter 9(1):2 2002
  5. 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. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013

Components

acetaminophen (Tylenol, Paracematol, Panadol, Tempra, Datril, APAP, non-Aspirin) oxycodone (Roxicodone, OxyContin, OxyIR, OxyFast, Oxecta, Xtampza ER)