Percocet (Oxycodone and acetaminophen) is an analgesic medicine used orally to treat moderate to severe pain.
Percocet (Oxycodone and acetaminophen) Uses:
-
Pain management
-
Extended-release:
- Management of acute pain severe enough to require opioid treatment and for which alternative treatment options are not enough.
-
Immediate release:
- Endocet, Primlev:
- For moderate to moderately severe pain severe enough to require an opioid analgesic and for which alternative treatments are not adequate.
- Percocet:
- For pain severe enough to require opioid treatment and for which alternative treatment options are non-adequate.
- Endocet, Primlev:
-
Limitations of use:
- Reserved for cases where alternative pain management options (eg, nonopioid analgesics) are not effective, not tolerated, or would be otherwise inadequate.
-
Percocet Dose in Adults
- Note:
- The initial dose is according to the oxycodone content; however, the maximum per day dose is based on the acetaminophen content.
Percocet Dose in Pain management:
-
Extended-release:
- Oral: Usual dose: 2 tablets every 12 hours; the second initial dose may be administered as early as 8 hours after the first initial dose if needed; subsequent doses are to be administered 2 tablets every 12 hours.
- Do not exceed acetaminophen 4 g/day.
- NOTE: Oxycodone/acetaminophen ER is not interchangeable with other oxycodone/acetaminophen products because of different pharmacokinetic profiles that affect the frequency of drug administration.
-
Immediate-release:
- Oral: Doses should be titrated to appropriate analgesic effects.
- Initial dose, based on oxycodone content: 5 mg (moderate pain) or 10 to 20 mg (severe pain) or 2.5 to 10 mg (drug manufacturer's labeling).
- Doses typically are given every 4 to 6 hours as required.
- Do not exceed acetaminophen 4 g/day.
-
Discontinuation of therapy:
- The dose should be gradually tapered down when discontinuing chronic opioid therapy.
- An optimal universal tapering schedule has not been established.
- Proposed schedules range from slow (eg, 10% dose reductions per week) to rapid (eg, 25% to 50% reduction every few days).
- Tapering schedules should be individualized to minimize opioid withdrawal while considering patient-specific goals and concerns as well as the pharmacokinetics of the opioid being tapered.
- An even slower taper may be adequate in patients who have been receiving opioids for a long duration (eg, years), particularly in the final stage of tapering, whereas more rapid tapers may be adequate in patients experiencing severe adverse events.
- Monitor carefully for signs/symptoms of withdrawal.
- In case the patient develops withdrawal symptoms, slow the tapering schedule;
- variations may include prolongation of the interval between dose reductions, minimizing daily dose reduction, pausing the taper and restarting when the patient is ready, and/or coadministration of an alpha-2 agonist (eg, clonidine) to mask withdrawal symptoms
- Keep offering nonopioid analgesics as required for pain management during tapering of dose;
- consider nonopioid adjunctive treatments for withdrawal symptoms (eg, GI complaints, muscle spasm) as desired.
Percocet Dose in Childrens
- Note:
- Doses based on total oxycodone content;
- titrate dose to appropriate analgesic effects;
- maximum daily acetaminophen dose: 75 mg/kg/day not to exceed 4000 mg/day;
- do not exceed 5 doses in 24 hours
Percocet Dose in the treatment of moderate Pain:
-
Children and Adolescents:
- Oral: 0.1 to 0.2 mg/kg/dose;
- doses typically given every 4 to 6 hours as needed;
- manufacturer's labeling recommends every 6 hours;
- maximum initial oxycodone dose: 5 mg/dose.
Percocet Dose in Severe Pain:
-
Children and Adolescents:
- Initial dose: Oral: 0.2 mg/kg/dose;
- doses typically given every 4 to 6 hours as needed;
- manufacturer's labeling recommends every 6 hours;
- maximum initial oxycodone dose: 10 mg.
Pregnancy Risk Factor C
- [US Boxed Warning]: Long-term opioid use during pregnancy can lead to opioid withdrawal syndrome in the neonate. This may be fatal if it is not treated promptly. Management must follow protocols established by neonatologists.
- Counsel the pregnant woman about the possibility of opioid withdrawal syndrome in the neonate if an opioid is needed for a prolonged period during pregnancy.
- For more information, refer to the individual monographs.
Use of oxycodone or acetaminophen while breastfeeding
- Breast milk contains oxycodone, acetaminophen, and other substances.
- The manufacturer does not recommend breastfeeding due to the risk of serious adverse reactions in breastfeeding infants. Refer to the individual monographs.
Percocet Dose in Kidney Disease:
-
Extended-release:
- Initial dose: One tablet every 12 hours; adjust the dose as needed.
-
Immediate release:
- There are no dosage adjustments provided in the drug manufacturer’s labeling.
- Use with caution and initiate at the low end of the dosing range;
- titrate carefully and monitor closely.
Percocet Dose in Liver Disease:
-
Extended-release:
- Initial dose: One tablet every 12 hours; adjust the dose as needed.
-
Immediate release:
- There are no dosage adjustments provided in the drug manufacturer’s labeling. Use with caution and initiate at the low end of the dosing range; titrate carefully and monitor closely.
Common Side Effects of Percocet (Oxycodone and acetaminophen):
-
Central nervous system:
- Dizziness
-
Gastrointestinal:
- Nausea
Less Common Side Effects of Percocet (Oxycodone and acetaminophen):
-
Cardiovascular:
- Peripheral Edema
-
Central Nervous System:
- Headache
- Drowsiness
- Fatigue
- Insomnia
-
Dermatologic:
- Skin Rash
- Erythema
- Excoriation
- Pruritus
- Skin Blister
-
Endocrine & Metabolic:
- Hot Flash
-
Gastrointestinal:
- Vomiting
- Constipation
- Diarrhea
- Dyspepsia
- Xerostomia
-
Genitourinary:
- Dysuria
-
Hepatic:
- Increased Liver Enzymes
-
Respiratory:
- Cough
Percocet Side effects (Frequency unknown):
-
Cardiovascular:
- Circulatory Depression
- Hypotension
- Shock
-
Central Nervous System:
- Dysphoria
-
Dermatologic:
- Erythematous Dermatitis
-
Hematologic & Oncologic:
- Hemolytic Anemia
- Neutropenia
- Pancytopenia
- Thrombocytopenia
-
Respiratory:
- Apnea
- Respiratory Depression
Contraindications to Percocet (Oxycodone and acetaminophen):
- Hypersensitivity to oxycodone, Acetaminophen or any other component of the formulation (eg, anaphylaxis);
- Significant respiratory depression
- Acute or severe bronchial asthma (in a setting without monitoring or in the absence de resuscitative devices);
- Paralytic ileus, GI obstruction (known or suspected).
Additional contraindications specific to product types: Endocet, Primlev: Hypercarbia
- There is not much evidence of cross-reactivity between opioids and allergens. Cross-sensitivity cannot be ruled out because of similarities in chemical structures and/or pharmacologic effects.
Canadian labeling:Additional contraindications not listed in the US labeling:
- Severe hepatic impairment or active liver disease
- Suspected surgical abdomen (eg acute appendicitis, pancreatitis)
- Mild pain can be managed with pain medication;
- Chronic obstructive Airway; cor Pulmonale
- acute alcoholism, delirium tremens, or convulsive disorders;
- severe CNS depression,
- Increased cerebrospinal and intracranial pressure
- or head injury
- Concurrent use within 14 days of MAOI therapy or with it;
- Pregnant women and during labor and birth;
- Breastfeeding
Warnings and precautions
-
CNS depression:
- CNS depression can lead to mental and physical impairments.
- Patients must be aware of the dangers involved in driving, operating machinery, or other activities that require mental alertness.
-
Constipation
- Patients with unstable angina or post-MI may experience constipation from Oxycodone.
- To reduce constipation, consider preventive measures such as stool softener or increased fiber.
-
Hepatotoxicity: [US Boxed Warning]
- Acetaminophen has been linked to cases of acute liver failure. This can sometimes lead to death or liver transplantation.
- Most cases of hepatic injury are linked with the use of acetaminophen at doses of more than 4 g per day and usually involve more than 1 acetaminophen-containing product.
- Risk is increased with the use of alcohol, preexisting liver disorder, and intake of more than one source of acetaminophen-containing medications.
- Some patients have suffered liver damage from chronic daily doses of alcohol in their adult lives.
-
Hypersensitivity and anaphylactic reactions
- Acetaminophen has been shown to cause hypersensitivity and anaphylactic reactions.
- If you experience symptoms of hypersensitivity or allergic reactions, discontinue use immediately.
-
Hypotension
- Hypotension can be severe (including orthostatic hypotension, syncope), and patients with cardiovascular disease (including acute MI) should be cautious.
- After dose titration or initiation, monitor for hypotension symptoms.
- Patients with circulatory shock should not use this product.
-
Phenanthrene hypersensitivity:
- Oxycodone should be used with extreme caution in patients with hypersensitivity/ Allergy reactions to other phenanthrene-derivative opioid agonists drugs i.e codeine, hydrocodone, hydromorphone, levorphanol, oxymorphone.
-
Respiratory depression [US Boxed Warning]
- It is possible to develop severe, life-threatening or fatal respiratory depression.
- You should monitor your respiratory health closely, especially when you start therapy or increase the dose.
- Swallow oxycodone/acetaminophen ER whole; crushing, chewing, or dissolving oxycodone/acetaminophen ER can lead to rapid release and absorption of a potentially fatal dose of oxycodone.
- The sedating effects that opioid-induced respiratory depression can cause carbon dioxide retention may be exaggerated by opioid-induced carbon dioxide retention.
-
Reactions to skin:
- Rarely have severe and potentially fatal skin reactions been caused by acetaminophen.
- The first sign of a skin rash should prompt you to stop treatment.
-
Conditions abdominales:
- This may make it difficult to diagnose or follow the clinical course of acute abdominal disorders.
-
Adrenocortical Insufficiency
- Patients with adrenal insufficiency (including Addison disease) should exercise caution.
- Opioid long-term use can cause secondary hypogonadism. This could lead to infertility and sexual dysfunction.
-
Insufficiency of the biliary tract:
- Patients with biliary dysfunction (including acute pancreatitis) should be cautious. Opioids may cause constriction to the sphincter.
-
CNS depression and coma
- Patients with CNS depression and coma should not be given this medication. They are more susceptible to the intracranial effects CO retention.
-
Delirium tremens:
- Patients with delirium-tremens should be taken with caution
-
G6PD deficiency:
- Acetaminophen should be used with caution in cases of G6PD deficiency.
-
Head trauma
- Extreme caution should be taken in the event of head injury, intracranial lesion, or elevated intracranial Pressure. An exacerbated elevation may also occur.
-
Hepatic impairment
- Patients with hepatic impairment should be cautious.
- Take care when you have alcoholic liver disease
- Consuming more than 3 alcoholic drinks per day may increase your risk of liver damage.
-
Mental health conditions
- Patients with mental health conditions should be cautious when using opioids for chronic pain (eg depression, anxiety disorders or post-traumatic stress disorder). This is because of the increased risk of opioid overdose and opioid dependence.
- It is advised to monitor your health more often.
-
Obesity:
- Patients who are severely obese should be taken with caution
-
Prostatic hyperplasia/urinary restriction:
- Patients with prostatic hyperplasia or urinary stricture should be cautious.
-
Psychosis:
- Patients with toxic psychosis should be treated with caution.
-
Renal impairment
- Patients with impaired renal function should be cautious.
-
Respiratory disease
- It is important to exercise caution when using this medication. Also, be aware of respiratory depression in COPD and cor pulmonale.
- Even with therapeutic doses, critical respiratory depression can occur.
- You might consider other non-opioid analgesics for such patients.
-
Seizures:
- Patients with seizure disorders should be cautious.
- may cause or exacerbate seizures.
-
Sleep-disordered breathing
- Patients with sleep-disordered breathing risk factors, such as HF or obesity, should exercise caution when using this medication for chronic pain.
- Opioids should be avoided in patients with moderate to severe sleep-disordered breathing.
-
Thyroid dysfunction:
- Patients with thyroid dysfunction should be cautious.
Oxycodone and acetaminophen (paracetamol): Drug Interaction
|
Alizapride |
May enhance the CNS depressant effect of CNS Depressants. |
|
Amphetamines |
May enhance the analgesic effect of Opioid Agonists. |
|
Anticholinergic Agents |
May enhance the adverse/toxic effect of Opioid Agonists. Specifically, the risk for constipation and urinary retention may be increased with this combination. |
|
Aprepitant |
May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). |
|
Bosentan |
May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). |
|
Brimonidine (Topical) |
May enhance the CNS depressant effect of CNS Depressants. |
|
Bromopride |
May enhance the CNS depressant effect of CNS Depressants. |
|
Busulfan |
Acetaminophen may increase the serum concentration of Busulfan. |
|
Cannabidiol |
May enhance the CNS depressant effect of CNS Depressants. |
|
Cannabis |
May enhance the CNS depressant effect of CNS Depressants. |
|
Chlorphenesin Carbamate |
May enhance the adverse/toxic effect of CNS Depressants. |
|
Clofazimine |
May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). |
|
CYP3A4 Inducers (Moderate) |
May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). |
|
CYP3A4 Inhibitors (Moderate) |
May enhance the adverse/toxic effect of OxyCODONE. CYP3A4 Inhibitors (Moderate) may increase the serum concentration of OxyCODONE. Serum concentrations of the active metabolite Oxymorphone may also be increased. |
|
Dapsone (Topical) |
May enhance the adverse/toxic effect of Methemoglobinemia Associated Agents. |
|
Deferasirox |
May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). |
|
Desmopressin |
Opioid Agonists may enhance the adverse/toxic effect of Desmopressin. |
|
Dimethindene (Topical) |
May enhance the CNS depressant effect of CNS Depressants. |
|
Diuretics |
Opioid Agonists may enhance the adverse/toxic effect of Diuretics. Opioid Agonists may diminish the therapeutic effect of Diuretics. |
|
Dronabinol |
May enhance the CNS depressant effect of CNS Depressants. |
|
Duvelisib |
May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). |
|
Erdafitinib |
May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). |
|
Erdafitinib |
May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). |
|
Flucloxacillin |
May enhance the adverse/toxic effect of Acetaminophen. Specifically, the risk for high anion gap metabolic acidosis may be increased. |
|
Fosaprepitant |
May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). |
|
Fosnetupitant |
May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). |
|
Gastrointestinal Agents (Prokinetic) |
Opioid Agonists may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic). |
|
Imatinib |
Acetaminophen may enhance the hepatotoxic effect of Imatinib. |
|
Isoniazid |
May enhance the adverse/toxic effect of Acetaminophen. |
|
Ivosidenib |
May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). |
|
Kava Kava |
May enhance the adverse/toxic effect of CNS Depressants. |
|
Larotrectinib |
May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). |
|
Local Anesthetics |
Methemoglobinemia Associated Agents may enhance the adverse/toxic effect of Local Anesthetics. Specifically, the risk for methemoglobinemia may be increased. |
|
Lofexidine |
May enhance the CNS depressant effect of CNS Depressants. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs. |
|
Magnesium Sulfate |
May enhance the CNS depressant effect of CNS Depressants. |
|
MetyraPONE |
May increase the serum concentration of Acetaminophen. More importantly, by inhibiting the conjugative metabolism of acetaminophen, metyrapone may shift the metabolism towards the oxidative route that produces a hepatotoxic metabolite. |
|
MetyroSINE |
CNS Depressants may enhance the sedative effect of MetyroSINE. |
|
Minocycline |
May enhance the CNS depressant effect of CNS Depressants. |
|
Mipomersen |
Acetaminophen may enhance the hepatotoxic effect of Mipomersen. |
|
Nabilone |
May enhance the CNS depressant effect of CNS Depressants. |
|
Netupitant |
May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). |
|
Nitric Oxide |
May enhance the adverse/toxic effect of Methemoglobinemia Associated Agents. Combinations of these agents may increase the likelihood of significant methemoglobinemia. Management: Monitor patients for signs of methemoglobinemia (e.g., hypoxia, cyanosis) when nitric oxide is used in combination with other agents associated with development of methemoglobinemia. Avoid lidocaine/prilocaine. |
|
Palbociclib |
May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). |
|
Pegvisomant |
Opioid Agonists may diminish the therapeutic effect of Pegvisomant. |
|
Phenylephrine (Systemic) |
Acetaminophen may increase the serum concentration of Phenylephrine (Systemic). |
|
Piribedil |
CNS Depressants may enhance the CNS depressant effect of Piribedil. |
|
Pramipexole |
CNS Depressants may enhance the sedative effect of Pramipexole. |
|
Prilocaine |
Methemoglobinemia Associated Agents may enhance the adverse/toxic effect of Prilocaine. Combinations of these agents may increase the likelihood of significant methemoglobinemia. Management: Monitor patients for signs of methemoglobinemia (e.g., hypoxia, cyanosis) when prilocaine is used in combination with other agents associated with development of methemoglobinemia. Avoid lidocaine/prilocaine in infants receiving such agents. |
|
Ramosetron |
Opioid Agonists may enhance the constipating effect of Ramosetron. |
|
RifAMPin |
May decrease the serum concentration of OxyCODONE. |
|
ROPINIRole |
CNS Depressants may enhance the sedative effect of ROPINIRole. |
|
Rotigotine |
CNS Depressants may enhance the sedative effect of Rotigotine. |
|
Rufinamide |
May enhance the adverse/toxic effect of CNS Depressants. Specifically, sleepiness and dizziness may be enhanced. |
|
Sarilumab |
May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). |
|
Selective Serotonin Reuptake Inhibitors |
CNS Depressants may enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors. Specifically, the risk of psychomotor impairment may be enhanced. |
|
Serotonin Modulators |
Opioid Agonists may enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Exceptions: Nicergoline. |
|
Siltuximab |
May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). |
|
Simeprevir |
May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). |
|
Sodium Nitrite |
Methemoglobinemia Associated Agents may enhance the adverse/toxic effect of Sodium Nitrite. Combinations of these agents may increase the likelihood of significant methemoglobinemia. |
|
St John's Wort |
May decrease the serum concentration of OxyCODONE. |
|
Succinylcholine |
May enhance the bradycardic effect of Opioid Agonists. |
|
Tetrahydrocannabinol |
May enhance the CNS depressant effect of CNS Depressants. |
|
Tetrahydrocannabinol and Cannabidiol |
May enhance the CNS depressant effect of CNS Depressants. |
|
Tocilizumab |
May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). |
|
Vitamin K Antagonists (eg, warfarin) |
Acetaminophen may enhance the anticoagulant effect of Vitamin K Antagonists. This appears most likely with daily acetaminophen doses exceeding 1.3 or 2 g/day for multiple consecutive days. |
|
Risk Factor D (Consider therapy modification) |
|
|
Alvimopan |
Opioid Agonists may enhance the adverse/toxic effect of Alvimopan. This is most notable for patients receiving long-term (i.e., more than 7 days) opiates prior to alvimopan initiation. Management: Alvimopan is contraindicated in patients receiving therapeutic doses of opioids for more than 7 consecutive days immediately prior to alvimopan initiation. |
|
Blonanserin |
CNS Depressants may enhance the CNS depressant effect of Blonanserin. |
|
Chlormethiazole |
May enhance the CNS depressant effect of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used. |
|
CNS Depressants |
May enhance the CNS depressant effect of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. |
|
CYP3A4 Inducers (Strong) |
May increase the metabolism of CYP3A4 Substrates (High risk with Inducers). Management: Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated. Consult appropriate manufacturer labeling. |
|
CYP3A4 Inhibitors (Strong) |
May enhance the adverse/toxic effect of OxyCODONE. CYP3A4 Inhibitors (Strong) may increase the serum concentration of OxyCODONE. Serum concentrations of the active metabolite oxymorphone may also be increased. |
|
Dabrafenib |
May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Seek alternatives to the CYP3A4 substrate when possible. If concomitant therapy cannot be avoided, monitor clinical effects of the substrate closely (particularly therapeutic effects). |
|
Dasatinib |
Acetaminophen may enhance the hepatotoxic effect of Dasatinib. Dasatinib may increase the serum concentration of Acetaminophen. |
|
Droperidol |
May enhance the CNS depressant effect of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Exceptions to this monograph are discussed in further detail in separate drug interaction monographs. |
|
Enzalutamide |
May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Concurrent use of enzalutamide with CYP3A4 substrates that have a narrow therapeutic index should be avoided. Use of enzalutamide and any other CYP3A4 substrate should be performed with caution and close monitoring. |
|
Flunitrazepam |
CNS Depressants may enhance the CNS depressant effect of Flunitrazepam. |
|
HYDROcodone |
CNS Depressants may enhance the CNS depressant effect of HYDROcodone. Management: Avoid concomitant use of hydrocodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. |
|
Lorlatinib |
May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Avoid concurrent use of lorlatinib with any CYP3A4 substrates for which a minimal decrease in serum concentrations of the CYP3A4 substrate could lead to therapeutic failure and serious clinical consequences. |
|
Methotrimeprazine |
CNS Depressants may enhance the CNS depressant effect of Methotrimeprazine. Methotrimeprazine may enhance the CNS depressant effect of CNS Depressants. Management: Reduce adult dose of CNS depressant agents by 50% with initiation of concomitant methotrimeprazine therapy. Further CNS depressant dosage adjustments should be initiated only after clinically effective methotrimeprazine dose is established. |
|
MiFEPRIStone |
May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Management: Minimize doses of CYP3A4 substrates, and monitor for increased concentrations/toxicity, during and 2 weeks following treatment with mifepristone. Avoid cyclosporine, dihydroergotamine, ergotamine, fentanyl, pimozide, quinidine, sirolimus, and tacrolimus. |
|
Mitotane |
May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Doses of CYP3A4 substrates may need to be adjusted substantially when used in patients being treated with mitotane. |
|
Monoamine Oxidase Inhibitors |
OxyCODONE may enhance the serotonergic effect of Monoamine Oxidase Inhibitors. This could result in serotonin syndrome. Management: Seek alternatives when possible. Avoid use of oxycodone/naltrexone during and within 14 days after monoamine oxidase inhibitor treatment. Non-US labeling for some oxycodone products states that such use is contraindicated. |
|
Nalmefene |
May diminish the therapeutic effect of Opioid Agonists. Management: Avoid the concomitant use of nalmefene and opioid agonists. Discontinue nalmefene 1 week prior to any anticipated use of opioid agonistss. If combined, larger doses of opioid agonists will likely be required. |
|
Naltrexone |
May diminish the therapeutic effect of Opioid Agonists. Management: Seek therapeutic alternatives to opioids. See full drug interaction monograph for detailed recommendations. |
|
Perampanel |
May enhance the CNS depressant effect of CNS Depressants. Management: Patients taking perampanel with any other drug that has CNS depressant activities should avoid complex and high-risk activities, particularly those such as driving that require alertness and coordination, until they have experience using the combination. |
|
PHENobarbital |
May enhance the CNS depressant effect of OxyCODONE. PHENobarbital may decrease the serum concentration of OxyCODONE. Management: Avoid use of oxycodone and phenobarbital when possible. Monitor for respiratory depression/sedation. Because phenobarbital is also a strong CYP3A4 inducer, monitor for decreased oxycodone efficacy and withdrawal if combined. |
|
Primidone |
May enhance the CNS depressant effect of OxyCODONE. Primidone may decrease the serum concentration of OxyCODONE. Management: Avoid use of oxycodone and primidone when possible. Monitor for respiratory depression/sedation. Because primidone is also a strong CYP3A4 inducer, monitor for decreased oxycodone efficacy and withdrawal if combined. |
|
Probenecid |
May increase the serum concentration of Acetaminophen. Probenecid may also limit the formation of at least one major non-toxic metabolite, possibly increasing the potential for formation of the toxic NAPQI metabolite. |
|
Sincalide |
Drugs that Affect Gallbladder Function may diminish the therapeutic effect of Sincalide. Management: Consider discontinuing drugs that may affect gallbladder motility prior to the use of sincalide to stimulate gallbladder contraction. |
|
Sodium Oxybate |
May enhance the CNS depressant effect of CNS Depressants. Management: Consider alternatives to combined use. When combined use is needed, consider minimizing doses of one or more drugs. Use of sodium oxybate with alcohol or sedative hypnotics is contraindicated. |
|
SORAfenib |
Acetaminophen may enhance the hepatotoxic effect of SORAfenib. SORAfenib may increase the serum concentration of Acetaminophen. |
|
Stiripentol |
May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Management: Use of stiripentol with CYP3A4 substrates that are considered to have a narrow therapeutic index should be avoided due to the increased risk for adverse effects and toxicity. Any CYP3A4 substrate used with stiripentol requires closer monitoring. |
|
Suvorexant |
CNS Depressants may enhance the CNS depressant effect of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended. |
|
Tapentadol |
May enhance the CNS depressant effect of CNS Depressants. Management: Avoid concomitant use of tapentadol and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. |
|
Voriconazole |
May enhance the adverse/toxic effect of OxyCODONE. Voriconazole may increase the serum concentration of OxyCODONE. Management: A reduced oxycodone dose may be necessary with concurrent voriconazole. Increased frequency and duration of monitoring for oxycodone-related adverse effects is recommended. |
|
Zolpidem |
CNS Depressants may enhance the CNS depressant effect of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol. |
|
Risk Factor X (Avoid combination) |
|
|
Azelastine (Nasal) |
CNS Depressants may enhance the CNS depressant effect of Azelastine (Nasal). |
|
Bromperidol |
May enhance the CNS depressant effect of CNS Depressants. |
|
Conivaptan |
May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). |
|
Eluxadoline |
Opioid Agonists may enhance the constipating effect of Eluxadoline. |
|
Fusidic Acid (Systemic) |
May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). |
|
Idelalisib |
May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). |
|
Opioids (Mixed Agonist / Antagonist) |
May diminish the analgesic effect of Opioid Agonists. Management: Seek alternatives to mixed agonist/antagonist opioids in patients receiving pure opioid agonists, and monitor for symptoms of therapeutic failure/high dose requirements (or withdrawal in opioid-dependent patients) if patients receive these combinations. |
|
Orphenadrine |
CNS Depressants may enhance the CNS depressant effect of Orphenadrine. |
|
Oxomemazine |
May enhance the CNS depressant effect of CNS Depressants. |
|
Paraldehyde |
CNS Depressants may enhance the CNS depressant effect of Paraldehyde. |
|
Thalidomide |
CNS Depressants may enhance the CNS depressant effect of Thalidomide. |
Monitoring Parameters:
- Pain relief
- Status of the lungs and mental.
- Blood pressure
- Bowel function
- Signs and symptoms of abuse, misuse, or addiction
- Signs and symptoms of hypogonadism/hypoadrenalism
Alternate suggestions:
- Chronic pain management is long-term treatment that does not include end-of life or palliative care.
- It can also be used for active cancer treatment, sickle cells disease, and medication-assisted treatment of opioid abuse disorder.
- Assess the benefits and risks of opioid therapy within one to four weeks after initiation.
- Patients at high risk for overdose or those with opioid addiction should be re-evaluated 3 times per month.
- Before initiating any drug treatment, it is recommended that urine drug testing be done.
- Re-checking should occur at least once a year. This includes controlled prescription drugs and illicit drugs of abuse.
- Clinicians should review state prescription drug monitoring program data (PDMP) before initiation, and periodically during therapy (frequency ranging between every prescription to every three months).
How to administer Percocet (Oxycodone and acetaminophen)?
Extended-release:
- Administer without regard to food.
- Swallow the Extended-release tablets whole one tablet at a time; do not break, crush, cut, chew, dissolve, or split.
- Breaking, chewing, crushing, cutting, dissolving, or splitting ER tablets will result in the uncontrolled delivery of oxycodone and can lead to overdose or death.
Mechanism of action of Percocet (Oxycodone and acetaminophen):
-
Oxycodone:
- The central nervous system attaches to the opiate receptors, producing inhibition of ascending pain pathways, altering pain perception and response.
- It causes generalized CNS depression.
-
Acetaminophen:
- The activation of the CNS's descending serotonergic inhibitory pathway is believed to be responsible for the analgesic effect, although this has not been fully explained.
- There may also be interactions with other nociceptive system.
- Antipyresis is caused by inhibition of the hypothalamic temperature-regulating center.
International Brands of Oxycodone and acetaminophen:
- Endocet
- Percocet
- Primlev
- Xartemis XR
- Percocet-5
- Plexicodim
- Tylenol Oxy
Oxycodone and acetaminophen Brand Names in Pakistan:
No Brands Available in Pakistan. Napadoc contains paracetamol + codeine + Caffeine
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