OxyContin (Oxycodone ER): Uses, Dosing, Risks, and Safe Prescribing

OxyContin = extended-release oxycodone (opioid agonist).

Indication

Management of severe, persistent pain requiring daily, around-the-clock, long-term opioid treatment where alternatives are inadequate. Not for PRN/as-needed or acute pain.

Dosing Principles

• Individualize; start low (e.g., 10 mg q12h opioid-naive).
• Titrate q3–7 days based on pain/function.
• Max dose not defined; limited by side effects.
• Convert from other opioids using equianalgesic tables + 25–50% reduction.

Critical Safety

• Boxed Warning: Addiction, abuse, misuse; life-threatening respiratory depression; accidental ingestion (pediatric); neonatal withdrawal; CYP3A4 interactions; concomitant benzodiazepines.
• REMS Program: Required education for prescribers.
• Monitoring: Pain/function, aberrant behaviors (UDS, PDMP), side effects (constipation, nausea, sedation).
• Discontinuation: Taper slowly to avoid withdrawal.

Prescribe per CDC Guideline, state laws, and institutional policy. Consider non-opioid/non-pharmacologic first.