Evigrade

Oxycodone

AEMPS

Semi-synthetic opioid analgesic (μ-agonist)

ATC code: N02AA05

Updated · Methodology

Indications

B

Acute pain

Third line

Severe acute pain uncontrolled by non-opioid analgesics or weak opioids: postoperative pain, severe trauma, acute breakthrough cancer pain, renal colic refractory to NSAIDs. Per SED 2024 and SEMERGEN 2023 – third-line after paracetamol, NSAIDs, and weak opioids. Dose: 5–10 mg every 4–6 hours (immediate release) or 10–20 mg every 12 hours (controlled release). Short course ≤7 days outside oncology. Taper at discontinuation to avoid withdrawal.

ICD-10: R52.0 · ICD-11: MG31

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

D

Chronic pain

Not recommended

Long-term therapy of chronic non-cancer pain – osteoarthritis, back pain, fibromyalgia. In the 2000-2010s oxycodone was aggressively marketed as a safe long-term opioid, driving the US opioid epidemic with >600,000 deaths. Per CDC 2022 Clinical Practice Guideline and SED-SEMERGEN 2023, long-term opioids are not used as first or second-line for chronic non-cancer pain: 3-month efficacy matches placebo, addiction rate 8–12%, overdose risk rises beyond 50 morphine milligram equivalents. If oxycodone was prescribed for back pain over months, consider getting a second opinion and treatment-plan review.

ICD-10: R52 · ICD-11: MG30.Z

How to read tiers A–F
  • AStrong evidence – first or second line in international guidelines
  • BRecommended in selected cases
  • CStudy data contradict each other
  • DBenefit not proven, no documented harm
  • FDocumented harm, or risk without benefit

Mechanism of action

Oxycodone is a semi-synthetic μ-opioid receptor agonist with potency similar to morphine (1 mg oral oxycodone ≈ 1.5 mg oral morphine). Also binds κ-receptors, producing more anxiolytic and sedative effects than pure μ-agonists. Metabolized via CYP3A4 and CYP2D6; CYP2D6 generates the active metabolite oxymorphone.

Safety

Boxed warning

FDA Black Box: risk of addiction, abuse, and misuse; life-threatening respiratory depression; neonatal opioid withdrawal syndrome with use in pregnancy; fatal interactions with benzodiazepines and alcohol.

Contraindications

  • Hypersensitivity
  • Respiratory depression, severe COPD, asthma exacerbation
  • Paralytic ileus
  • Acute abdomen of undetermined cause
  • Acute alcohol or psychotropic intoxication
  • MAOI use <2 weeks
  • Breastfeeding with long-term use

Serious adverse effects

  • Respiratory depression and death (especially with benzodiazepines, alcohol, in CYP2D6 ultra-rapid metabolizers)
  • Opioid dependence and use disorder (8–12% with long-term therapy)
  • Acute adrenal insufficiency
  • Seizures in predisposed patients
  • Serotonin syndrome with serotonergic drugs

Common adverse effects

  • Constipation
  • Nausea, vomiting
  • Drowsiness, sedation
  • Dry mouth
  • Dizziness
  • Pruritus
  • Sweating
  • Urinary retention in older adults

Pregnancy: can you take Oxycodone?

Long-term use causes neonatal opioid withdrawal. Short courses for labor pain or post-cesarean are acceptable. For women on chronic oxycodone in pregnancy, plan a taper with an obstetrician and addiction specialist.

Breastfeeding: can you take Oxycodone?

Single doses are compatible (RID about 3.5%, Hale L3). Long-term use and high doses are not recommended – infant sedation risk, especially in CYP2D6 ultra-rapid metabolizer mothers (FDA Safety Communication 2017). Monitor infant for sedation, poor feeding, respiratory depression.

RID, infant dose via milk
9%

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

Practical notes

Drug interactions

With benzodiazepines, gabapentinoids, antipsychotics, alcohol – sharp risk of respiratory depression and death ( Black Box 2016). Strong CYP3A4 inhibitors (clarithromycin, itraconazole) raise levels. With SSRIs and MAOIs – serotonin syndrome risk.

Timing and administration

No driving, no alcohol. Taper after 5–7 days – even short courses can produce transient withdrawal. Constipation is nearly universal – start a laxative from day 1.

Drug–nutrient interactions

Grapefruit juice

Grapefruit juice inhibits CYP3A4 and slows oxycodone clearance. In the OxyContin SmPC, 200 ml three times a day for five days raised exposure about 1.7-fold on average (range 1.1–2.1). More oxycodone in the blood means more drowsiness, nausea and constipation and, at worst, slow shallow breathing. The SmPC allows for dose adjustment, though the simplest course is to skip grapefruit juice during treatment.

Source: AEMPS: Ficha técnica de OxyContin 10 mg comprimidos de liberación prolongada (oxicodona) (2025)

Drug–drug interactions

2 pairs found. Sorted from critical to minor.

MajorPregabalinGabapentinoids (antiepileptics)

Mechanism

Pregabalin and oxycodone depress the central nervous system (CNS) through different pathways, and their effects add up. Oxycodone, like all opioids, blunts the respiratory centre. Pregabalin on its own causes somnolence, dizziness and, rarely, severe respiratory depression, and the risk rises with other CNS depressants (pregabalin SmPC, , section 4.4). There is no pharmacokinetic interaction. Pregabalin is barely metabolised and leaves the body unchanged in urine, and in a study with oxycodone the levels of both drugs stayed the same (pregabalin SmPC, EMA, section 4.5; label of pregabalin, section 7). Pregabalin does, however, add to the cognitive and motor impairment that oxycodone causes (pregabalin SmPC, EMA, section 4.5). Both drugs slow the gut: constipation, paralytic ileus and intestinal obstruction have been reported with the combination (pregabalin SmPC, EMA, section 4.4).

Symptoms

Somnolence, slowed thinking, dizziness, poor coordination and falls, especially in older patients. In severe cases, slow shallow breathing, deep sedation, coma and death: such cases were reported after marketing in patients taking pregabalin with opioids and other CNS depressants (pregabalin SmPC, , section 4.5; oxycodone SmPC, AEMPS, section 4.5). In an observational study, patients taking pregabalin with an opioid had a 1.68-fold higher risk of opioid-related death than those on an opioid alone. The rise was already present at pregabalin doses of 300 mg per day or less (pregabalin SmPC, EMA, section 4.4). The risk is highest at the start of treatment and after a dose increase, and in patients with impaired breathing, renal failure or older age (pregabalin SmPC, EMA, section 4.4; label of oxycodone, section 5.2). Constipation up to intestinal obstruction is a separate concern.

Management

The combination is allowed, but under strict limits. The oxycodone SmPC names pregabalin among CNS depressants. It requires limiting the dose and duration of concomitant use and reserving such pairs for patients with no alternative treatment options (oxycodone SmPC, AEMPS, sections 4.4 and 4.5; label of oxycodone, sections 5.3 and 7). Use the lowest effective dose and the shortest possible course (oxycodone SmPC, AEMPS, section 4.4). When starting oxycodone in a patient already on pregabalin, begin with one-third to one-half of the usual starting dose of oxycodone and consider a lower pregabalin dose (FDA label of oxycodone, section 2.6). When adding pregabalin to an opioid, start it at a low dose (FDA label of pregabalin, section 5.5) and adjust it to renal function, because renal impairment, lung disease and older age raise the risk of respiratory depression (pregabalin SmPC, , sections 4.2 and 4.4). Warn the patient and carers about the signs of respiratory depression and sedation and watch for them, especially in the first days and after every dose increase (oxycodone SmPC, AEMPS, section 4.4; pregabalin SmPC, EMA, section 4.4). The FDA advises considering an opioid overdose reversal agent, naloxone or nalmefene, for this combination (FDA label of oxycodone, section 5.3). If respiratory depression appears, reduce or withdraw the CNS depressants, including pregabalin (FDA label of pregabalin, section 5.5). Consider measures against constipation, especially in women and older patients (pregabalin SmPC, EMA, section 4.4).

Pair details →Pregabalin →

MajorTramadolOther opioids

Mechanism

Tramadol and oxycodone are both opioid agonists, and their depressant effects on the central nervous system (CNS) and breathing add up. The SmPCs of both drugs list 'other opioids' among CNS depressants whose concomitant use raises the risk of sedation, respiratory depression, coma and death (tramadol SmPC, AEMPS, section 4.5; oxycodone SmPC, AEMPS, section 4.5). Tramadol has a second mechanism: it inhibits serotonin and noradrenaline reuptake. The label of oxycodone lists tramadol among serotonergic drugs whose combination with opioids has resulted in serotonin syndrome (FDA label of oxycodone, section 7). Tramadol also lowers the seizure threshold, and other opioids increase that risk (FDA label of tramadol, section 5.10). CYP3A4 and CYP2D6 metabolise both drugs, but the labels describe no effect of one on the other's blood levels.

Symptoms

Somnolence, slowed thinking, confusion, slow shallow breathing, pinpoint pupils, a drop in blood pressure; in severe cases deep sedation, coma and death (tramadol SmPC, AEMPS, sections 4.4 and 4.5; label of oxycodone, section 5.3). The risk is highest at the start of concomitant use and after a dose increase, and in elderly or debilitated patients and those with chronic lung disease (FDA label of oxycodone, sections 5.2 and 5.8). Signs of serotonin syndrome: agitation, hallucinations, tachycardia, labile blood pressure, fever, hyperreflexia, incoordination, muscle rigidity, nausea, vomiting, diarrhoea, usually within hours to a few days of concomitant use (FDA label of tramadol, section 5.9). Tramadol can cause seizures even at recommended doses, and other opioids raise that risk (FDA label of tramadol, section 5.10).

Management

Prescribe two opioids together only when other treatment options are inadequate, at the lowest effective dose and for the shortest time (tramadol SmPC, AEMPS, sections 4.4 and 4.5; oxycodone SmPC, AEMPS, sections 4.4 and 4.5; label of oxycodone, section 7). The prolonged-release oxycodone SmPC allows an immediate-release opioid as rescue medication; if the patient needs rescue medication more than twice a day, increase the prolonged-release oxycodone dose (oxycodone SmPC, AEMPS, section 4.2). When starting oxycodone in a patient already on tramadol, begin with one-third to one-half of the usual starting dose (FDA label of oxycodone, section 2.6). Keep tramadol at or below 400 mg per day, because above that limit the seizure risk rises (tramadol SmPC, AEMPS, sections 4.2 and 4.4). Watch the patient for respiratory depression and sedation, especially in the first days and after a dose increase, and warn the patient and carers about these signs (tramadol SmPC, AEMPS, section 4.4; oxycodone SmPC, AEMPS, section 4.4). The FDA advises discussing an opioid overdose reversal agent, naloxone or nalmefene, with the patient (FDA label of oxycodone, section 5.3). On suspicion of serotonin syndrome, stop tramadol immediately and stop oxycodone as well (FDA label of tramadol, section 7; FDA label of oxycodone, section 7).

Pair details →Tramadol →

Label mentions60 mentions

Verbatim lines from the interaction sections, in the language of the label

From this drug’s label

  • Majorantidepresivos tricíclicosclass named in the label
    «Medicamentos sedantes como las benzodiacepinas o medicamentos relacionados: Los anticolinérgicos (fenotiazina, antipsicóticos, antidepresivos tricíclicos, la mayoría de los antihistamínicos H 1 no…»

    AEMPS, section 4.5 · Open on CIMA

  • Majorantifúngicos azólicosclass named in the label
    «Los inhibidores de la CYP3A4, como los antibióticos macrólidos (p. ej., claritromicina, eritromicina y telitromicina), los antifúngicos azólicos (p. ej., ketoconazol, voriconazol, itraconazol y…»

    AEMPS, section 4.5 · Open on CIMA

  • Majorantipsicóticosclass named in the label
    «Medicamentos sedantes como las benzodiacepinas o medicamentos relacionados: El uso concomitante de opioides con medicamentos sedantes como las benzodiacepinas o medicamentos relacionados incrementa…»

    AEMPS, section 4.5 · Open on CIMA

  • Majorbenzodiazepinasclass named in the label
    «Medicamentos sedantes como las benzodiacepinas o medicamentos relacionados: El uso concomitante de opioides con medicamentos sedantes como las benzodiacepinas o medicamentos relacionados incrementa…»

    AEMPS, section 4.5 · Open on CIMA

  • «Los inhibidores de la CYP3A4, como los antibióticos macrólidos (p. ej., claritromicina, eritromicina y telitromicina), los antifúngicos azólicos (p. ej., ketoconazol, voriconazol, itraconazol y…»

    AEMPS, section 4.5 · Open on CIMA

  • «Los inhibidores de la CYP3A4, como los antibióticos macrólidos (p. ej., claritromicina, eritromicina y telitromicina), los antifúngicos azólicos (p. ej., ketoconazol, voriconazol, itraconazol y…»

    AEMPS, section 4.5 · Open on CIMA

  • Majorinductores del CYP3A4class named in the label
    «Los inductores de la CYP3A4 como la rifampicina, la carbamacepina, la fenitoína y el hipérico (hierba de San Juan) pueden inducir el metabolismo de la oxicodona y provocar un aumento del aclaramiento…»

    AEMPS, section 4.5 · Open on CIMA

  • Majorinhibidores del CYP3A4class named in the label
    «Los inhibidores de la CYP3A4, como los antibióticos macrólidos (p. ej., claritromicina, eritromicina y telitromicina), los antifúngicos azólicos (p. ej., ketoconazol, voriconazol, itraconazol y…»

    AEMPS, section 4.5 · Open on CIMA

  • «Los inhibidores de la CYP3A4, como los antibióticos macrólidos (p. ej., claritromicina, eritromicina y telitromicina), los antifúngicos azólicos (p. ej., ketoconazol, voriconazol, itraconazol y…»

    AEMPS, section 4.5 · Open on CIMA

  • «Los inhibidores de la CYP3A4, como los antibióticos macrólidos (p. ej., claritromicina, eritromicina y telitromicina), los antifúngicos azólicos (p. ej., ketoconazol, voriconazol, itraconazol y…»

    AEMPS, section 4.5 · Open on CIMA

  • MajorMAO inhibitorsclass named in the label
    «DRUG INTERACTIONS: Intervention: The use of oxycodone HCl is not recommended for patients taking MAOIs or within 14 days of stopping such treatment. If urgent use of an opioid is necessary, use test…»

    FDA, section 7 · Open on DailyMed

  • «Los medicamentos que inducen depresión respiratoria como las benzodiacepinas, el fenobarbital y otros opioides (analgésicos, antitusivos o tratamientos de sustitución) pueden aumentar el riesgo de…»

    AEMPS, section 4.5 · Open on CIMA

  • «Los inductores de la CYP3A4 como la rifampicina, la carbamacepina, la fenitoína y el hipérico (hierba de San Juan) pueden inducir el metabolismo de la oxicodona y provocar un aumento del aclaramiento…»

    AEMPS, section 4.5 · Open on CIMA

  • «Los inhibidores de la CYP3A4, como los antibióticos macrólidos (p. ej., claritromicina, eritromicina y telitromicina), los antifúngicos azólicos (p. ej., ketoconazol, voriconazol, itraconazol y…»

    AEMPS, section 4.5 · Open on CIMA

  • «Medicamentos sedantes como las benzodiacepinas o medicamentos relacionados: El uso concomitante de opioides con medicamentos sedantes como las benzodiacepinas o medicamentos relacionados incrementa…»

    AEMPS, section 4.5 · Open on CIMA

  • «DRUG INTERACTIONS: Examples: Benzodiazepines and other sedatives/hypnotics, anxiolytics, tranquilizers, muscle relaxants, general anesthetics, antipsychotics, gabapentinoids (gabapentin or…»

    FDA, section 7 · Open on DailyMed

  • «Los inductores de la CYP3A4 como la rifampicina, la carbamacepina, la fenitoína y el hipérico (hierba de San Juan) pueden inducir el metabolismo de la oxicodona y provocar un aumento del aclaramiento…»

    AEMPS, section 4.5 · Open on CIMA

  • «Los inhibidores de la CYP3A4, como los antibióticos macrólidos (p. ej., claritromicina, eritromicina y telitromicina), los antifúngicos azólicos (p. ej., ketoconazol, voriconazol, itraconazol y…»

    AEMPS, section 4.5 · Open on CIMA

  • «Los inhibidores de la CYP3A4, como los antibióticos macrólidos (p. ej., claritromicina, eritromicina y telitromicina), los antifúngicos azólicos (p. ej., ketoconazol, voriconazol, itraconazol y…»

    AEMPS, section 4.5 · Open on CIMA

  • ModerateCYP3A4 inducersclass named in the label
    «DRUG INTERACTIONS: Intervention: If concomitant use is necessary, consider increasing the oxycodone HCl dosage until stable drug effects are achieved. Evaluate patients for signs of opioid…»

    FDA, section 7 · Open on DailyMed

  • ModerateCYP3A4 inhibitorsclass named in the label
    «DRUG INTERACTIONS: Intervention: If concomitant use is necessary, consider dosage reduction of oxycodone HCl until stable drug effects are achieved. Evaluate patients at frequent intervals for…»

    FDA, section 7 · Open on DailyMed

  • ModerateIMAOclass named in the label
    «La oxicodona se debe utilizar con precaución en los pacientes a los que se les administra IMAO o que hayan recibido IMAO durante las dos últimas semanas .»

    AEMPS, section 4.5 · Open on CIMA

  • ModerateISRSclass named in the label
    «La administración concomitante de oxicodona con fármacos serotoninérgicos , tales como un inhibidor selectivo de la recaptación de serotonina (ISRS) o un inhibidor de la recaptación de serotonina y…»

    AEMPS, section 4.5 · Open on CIMA

  • Moderatemacrólidosclass named in the label
    «Los inhibidores de la CYP3A4, como los antibióticos macrólidos (p. ej., claritromicina, eritromicina y telitromicina), los antifúngicos azólicos (p. ej., ketoconazol, voriconazol, itraconazol y…»

    AEMPS, section 4.5 · Open on CIMA

  • Moderatemedicamentos serotoninérgicosclass named in the label
    «La administración concomitante de oxicodona con fármacos serotoninérgicos , tales como un inhibidor selectivo de la recaptación de serotonina (ISRS) o un inhibidor de la recaptación de serotonina y…»

    AEMPS, section 4.5 · Open on CIMA

  • Moderatemuscle relaxantsclass named in the label
    «DRUG INTERACTIONS: Intervention: Because respiratory depression may be greater than otherwise expected, decrease the dosage of oxycodone HCl and/or the muscle relaxant as necessary. Due to the risk…»

    FDA, section 7 · Open on DailyMed

  • ModerateParoxetine
    «Los fármacos que inhiben la actividad de la CYP2D6 como la paroxetina y la quinidina pueden disminuir el aclaramiento de la oxicodona, lo que podría conducir a un aumento de las concentraciones…»

    AEMPS, section 4.5 · Open on CIMA

  • Moderateserotonergic drugsclass named in the label
    «DRUG INTERACTIONS: Serotonergic Drugs: Concomitant use may result in serotonin syndrome. Discontinue oxycodone HCl tablets if serotonin syndrome is suspected. ( 7 )»

    FDA, section 7 · Open on DailyMed

  • ModerateTramadol
    «DRUG INTERACTIONS: Examples: Selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), triptans, 5-HT3 receptor…»

    FDA, section 7 · Open on DailyMed

  • antipsychoticsclass named in the label
    «DRUG INTERACTIONS: Examples: Benzodiazepines and other sedatives/hypnotics, anxiolytics, tranquilizers, muscle relaxants, general anesthetics, antipsychotics, gabapentinoids (gabapentin or…»

    FDA, section 7 · Open on DailyMed

  • azole antifungalsclass named in the label
    «DRUG INTERACTIONS: Examples: Macrolide antibiotics (e.g., erythromycin), azole-antifungal agents (e.g., ketoconazole), protease inhibitors (e.g., ritonavir).»

    FDA, section 7 · Open on DailyMed

  • benzodiazepinesclass named in the label
    «DRUG INTERACTIONS: Benzodiazepines and Other Central Nervous System (CNS) Depressants»

    FDA, section 7 · Open on DailyMed

From other drugs’ labels

  • ModerateAbiraterone
    «Posibilidad de que afecte a la exposición de otros medicamentos: Se recomienda precaución cuando se administre conjuntamente con medicamentos activados o metabolizados por el CYP2D6, en especial…»

    AEMPS, section 4.5 · Open on CIMA

  • ModerateDarunavir
    «ANALGÉSICOS NARCÓTICOS / TRATAMIENTO DE LA DEPENDENCIA A LOS OPIÁCEOS: Fentanilo Oxicodona Tramadol»

    AEMPS, section 4.5 · Open on CIMA

  • ModerateDarunavir
    «Established and Other Potentially Significant Drug Interactions: Narcotic analgesics metabolized by CYP3A: e.g. fentanyl, oxycodone ­  fentanyl ­  oxycodone Careful monitoring of therapeutic…»

    FDA, section 7 · Open on DailyMed

  • ModeratePregabalin
    «Estudios in vivo y análisis farmacocinético de la población: En consecuencia, en los estudios in vivo , no se observaron interacciones farmacocinéticas relevantes desde el punto de vista clínico…»

    AEMPS, section 4.5 · Open on CIMA

  • ModeratePregabalin
    «DRUG INTERACTIONS: Multiple oral doses of pregabalin were co-administered with oxycodone, lorazepam, or ethanol. Although no pharmacokinetic interactions were seen, additive effects on cognitive and…»

    FDA, section 7 · Open on DailyMed

  • ModerateVoriconazole
    «Opioides: Se debe considerar una reducci ó n de la dosis de oxicodona y de otros opi á ceos de acci ó n prolongada que se metabolizan por el CYP3A4 (p. ej., hidrocodona). Puede ser necesario…»

    AEMPS, section 4.5 · Open on CIMA

  • ModerateVoriconazole
    «DRUG INTERACTIONS: Oxycodone (CYP3A4 Inhibition) Significantly Increased Increased visual effects (heterophoria and miosis) of oxycodone were observed when coadministered with voriconazole. Reduction…»

    FDA, section 7 · Open on DailyMed

  • «Drugs Having Clinically Important Interactions with Alprazolam: Examples Morphine, buprenorphine, hydromorphone, oxymorphone, oxycodone, fentanyl, methadone, alfentanil, butorpenol, codeine…»

    FDA, section 7 · Open on DailyMed

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Frequently asked

What is Oxycodone used for?

Oxycodone is evaluated for the following indications with varying evidence strength: Acute pain (evidence tier B), Chronic pain (evidence tier D). See the full indication matrix with dosing and citations above on this page.

What are the side effects of Oxycodone?

Common side effects of Oxycodone (≥ 1 in 100): Constipation, Nausea, vomiting, Drowsiness, sedation, Dry mouth, Dizziness, Pruritus. See the Safety section for uncommon and serious reactions.

Is Oxycodone safe during pregnancy?

Long-term use causes neonatal opioid withdrawal. Short courses for labor pain or post-cesarean are acceptable. For women on chronic oxycodone in pregnancy, plan a taper with an obstetrician and addiction specialist.

Is Oxycodone compatible with breastfeeding?

Single doses are compatible (RID about 3.5%, Hale L3). Long-term use and high doses are not recommended – infant sedation risk, especially in CYP2D6 ultra-rapid metabolizer mothers (FDA Safety Communication 2017). Monitor infant for sedation, poor feeding, respiratory depression.

Can you drink alcohol while taking Oxycodone?

With benzodiazepines, gabapentinoids, antipsychotics, alcohol – sharp risk of respiratory depression and death (FDA Black Box 2016). No driving, no alcohol.

Who should not take Oxycodone?

Oxycodone is contraindicated in: Hypersensitivity; Respiratory depression, severe COPD, asthma exacerbation; Paralytic ileus; Acute abdomen of undetermined cause; Acute alcohol or psychotropic intoxication. Full list in the Safety section.

Does Oxycodone carry an FDA boxed warning?

FDA Black Box: risk of addiction, abuse, and misuse; life-threatening respiratory depression; neonatal opioid withdrawal syndrome with use in pregnancy; fatal interactions with benzodiazepines and alcohol.

Official sources

Direct links to regulator labels. Open in a new tab.

Other drugs in this group

Oxycodone + Naloxone, Paracetamol, Palmitoylethanolamide, Rizatriptan, Tramadol + Paracetamol, Dihydroergotamine, Frovatriptan, Sumatriptan