To LAWMED or any other professional who cares to answer:
I have a question regarding tolerance to Oxycontin. First off my surgery was July 10th of last year. On 4/27 I filled a prescription of 90 10 mg flexeril, PRN, for back spasms. On 6/19 I filled a prescription for 40 5-500 vicodin, PRN. I was an Air Traffic Controller so any meds like these disaualify me from working for 24 hours after the last pill is taken.
Thank you very much
Rick
Initiation of Therapy
It is critical to initiate the dosing regimen for each patient individually, taking into account
the patient's prior opioid and non-opioid analgesic treatment. Attention should be given to:
(1) the general condition and medical status of the patient;
(2) the patient's opioid exposure and opioid tolerance (if any);
(3) the daily dose, potency, and kind of the analgesic(s) the patient has been taking;
( 4) the reliability of the conversion estimate used to calculate the dose of oxycodone;
(5) special safety issues associated with conversion to OxyContin® doses at or exceeding
160 mg q12h (see Special Instructions for OxyContin 80 mg and 160 mg Tablets);
and
(6) the balance between pain control and adverse experiences.
Care should be taken to use low initial doses of OxyContin in patients who are not already
opioid-tolerant, especially those who are receiving concurrent treatment with muscle
relaxants, sedatives, or other CNS active medications (see PRECAUTIONS: Drug-Drug
Interactions).
Experience indicates a reasonable starting dose of OxyContin for patients who are taking
non-opioid analgesics and require continuous around-the-clock therapy for an extended
period of time is 10 mg q12h. If a non-opioid analgesic is being provided, it may be
continued. OxyContin should be individually titrated to a dose that provides adequate
analgesia and minimizes side effects.
For initiation of OxyContin therapy for patients previously taking opioids, the conversion
ratios from Foley, KM. [NEJM, 1985; 313:84-95], found below, are a reasonable starting
point, although not verified in well-controlled, multiple-dose trials.
1. Using standard conversion ratio estimates (see Table 4 below), multiply the mg/day of
the previous opioids by the appropriate multiplication factors to obtain the equivalent
total daily dose of oral oxycodone.
2. When converting from oxycodone, divide the 24-hour oxycodone dose in half to obtain
the twice a day (q12h) dose of OxyContin.
3. Round down to a dose which is appropriate for the tablet strengths available.
4. Discontinue all other around-the-clock opioid drugs when OxyContin therapy is initiated.
5. No fixed conversion ratio is likely to be satisfactory in all patients, especially patients
receiving large opioid doses. The recommended doses shown in Table 4 are only a
starting point, and close observation and frequent titration are indicated until patients are
stable on the new therapy.
TABLE 4.
Multiplication Factors for Converting the Daily Dose
of Prior Opioids to the Daily Dose of Oral Oxycodone*
(Mg/Day Prior Opioid x Factor = Mg/Day Oral
Oxycodone)
Oral Prior Opioid Parenteral Prior Opioid
Oxycodone 1 --
Codeine 0.15 --
Hydrocodone 0.9 --
Hydromorphone 4 20
Levorphanol 7.5 15
Meperidine 0.1 0.4
Methadone 1.5 3
Morphine 0.5 3
* To be used only for conversion to oral oxycodone. For patients receiving high-dose
parenteral opioids, a more conservative conversion is warranted. For example, for highdose
parenteral morphine, use 1.5 instead of 3 as a multiplication factor.
In all cases, supplemental analgesia should be made available in the form of a suitable shortacting
analgesic.
OxyContin® can be safely used concomitantly with usual doses of non-opioid analgesics and
analgesic adjuvants, provided care is taken to select a proper initial dose (see
PRECAUTIONS).
