Roxinal (Oxycodone) in Hospice Care: Pain Management Protocol

Roxinal in Palliative and Hospice Settings

Roxinal is a brand name for oxycodone hydrochloride, an immediate-release opioid agonist. In hospice, it is a cornerstone for managing moderate-to-severe pain and dyspnea.

Clinical Use

• Indications: Cancer pain, end-stage organ failure pain, dyspnea (air hunger), breakthrough pain.
• Dosing: Individualized; start low (2.5–5 mg q4h PRN), titrate to effect. No ceiling dose for pure agonists in palliative care.
• Routes: PO (tablet, concentrate), PR, SL, IV/SC (if available).
• Around-the-clock (ATC) + Breakthrough: Scheduled long-acting opioid (e.g., oxycontin) + Roxinal PRN for incident pain.

Side Effect Management (Proactive)

• Constipation: Universal prophylaxis—stimulant + softener (senna + docusate) started with opioid.
• Nausea: Usually transient; antiemetic PRN (ondansetron, metoclopramide).
• Sedation/Respiratory Depression: Monitor closely after initiation/dose increase; naloxone available.
• Delirium/Myoclonus: Consider opioid rotation if persistent.

Regulatory & Safety

• Schedule II controlled substance; strict documentation, counting, waste.
• Hospice nurses administer per physician order; family caregivers may be trained for home dosing.
• PDMP checks; treatment agreements.

Ethical Principle

Double effect: Intent is symptom relief; risk of hastening death is accepted but not intended. Dose titrated to comfort, not to cause sedation.

Roxinal enables many to die comfortably at home. Individualize, reassess frequently, communicate openly.