Patient leaflets and SmPCs, drug interaction checker, official dosages and NHS pharmacy opening hours — all in one place.
Patient leaflets and SmPCs, drug interaction checker, official dosages and NHS pharmacy opening hours — all in one place.
The electronic medicines compendium (emc) no longer publishes a Summary of Product Characteristics for this product, which usually means it is no longer marketed in the UK. The patient leaflet below is kept for reference, but the product may not be available.
If you were prescribed this medicine, other products containing Oxycodone hydrochloride may still be available. Do not stop your treatment — ask your pharmacist or GP what to use instead.
FOR
Oxylan is a strong painkiller (analgesic) from the group of opioids. Oxylan is indicated in adults and adolescents (from 12 years and older) for the treatment of severe pain, which can be adequately managed only with opioid analgesics. 2.
E OXYLAN
Do not take Oxylan
PIL – Oxylan 5 / 10 / 20 / 40 / 80 mg prolonged-release tablets
PIL – Oxylan 5 / 10 / 20 / 40 / 80 mg prolonged-release tablets
pain along with opioids. Your doctor should monitor you closely and make necessary adjustments to your dose while you are taking Oxylan to prevent addiction and abuse. This medicine contains oxycodone which is an opioid medicine. Repeated use of opioid painkillers can result in the drug being less effective (you become accustomed to it, known as tolerance). Repeated use of Oxylan may lead to dependence, abuse and addiction, which may result in lifethreatening overdose. The risk of these side effects can increase with a higher dose and longer duration of use. Dependence or addiction can make you feel that you are no longer in control of how much medicine you need to take or how often you need to take it. You might feel that you need to carry on taking your medicine, even when it doesn't help to relieve your pain. The risk of becoming dependent or addicted varies from person to person. You may have a greater risk of becoming dependent or addicted on Oxylan if:
PIL – Oxylan 5 / 10 / 20 / 40 / 80 mg prolonged-release tablets
If you need to have an operation, please tell your doctor that you are taking Oxylan. Contact your doctor if you experience severe upper abdominal pain possibly radiating to the back, nausea, vomiting or fever as this could be symptoms associated with inflammation of the pancreas (pancreatitis) and the biliary tract system. Similar to other opioids, oxycodone can affect the body's normal production of hormones (such as cortisol and sex hormones). This happens especially after you have received large doses for long periods of time. Children The safety and effectiveness of Oxylan have not been adequately studied in children under 12 years of age. Therefore, Oxylan is not recommended for children under 12 years of age. Anti-Doping Warning The use of Oxylan may produce positive results in doping controls. Use of Oxylan as a doping agent may be a health hazard. Other medicines and Oxylan Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. Concomitant use of Oxylan and sedative medicines such as benzodiazepines or related drugs increases the risk of drowsiness, difficulties in breathing (respiratory depression), coma and may be life-threatening. Because of this, concomitant use should only be considered when other treatment options are not possible. However if your doctor does prescribe Oxylan together with sedative medicines the dose and duration of concomitant treatment should be limited by your doctor. Please tell your doctor about all sedative medicines you are taking, and follow your doctor's dose recommendation closely. It could be helpful to inform friends or relatives to be aware of the signs and symptoms stated above. Contact your doctor when experiencing such symptoms. The side effects of Oxylan may become more common or more severe if Oxylan is used at the same time as medicines that can affect brain function or are used to treat allergies, motion sickness or vomiting. Side effects can be, e.g. flattening and slowing of breathing (respiratory depression), constipation, dry mouth or urination problems occur. The risk of side effects increases if you use antidepressants (such as citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, venlafaxine). These medicines can interact with oxycodone. You may experience the following symptoms, among others: involuntary, rhythmic muscle contractions, including the muscles that control the movement of the eye, restlessness, excessive sweating, tremors, exaggerated reflexes, increased muscle tension and body temperature above 38 ° C. Contact your doctor if you experience these symptoms.
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Please tell your doctor or pharmacist if you are taking any of the medicines from the following list: sleeping pills or sedatives (e.g. hypnotics or sedatives, including benzodiazepines) medicines for depression (e.g. paroxetine or amitriptyline), including those belonging to a group of MAOIs (such as tranylcypromine, phenelzine, isocarboxazid, moclobemide or linezolid), medicines for allergies, motion sickness or vomiting (antihistamines, antiemetics), medicines for psychological or mental disorders (such as psychotropic drugs, phenothiazines or neuroleptics), Medicines used to treat epilepsy, pain and anxiety such as e.g. gabapentin and pregabalin, Page 4 (11)
PIL – Oxylan 5 / 10 / 20 / 40 / 80 mg prolonged-release tablets
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muscle relaxants used to treat muscle spasms (such as tizanidine) medicines used to treat Parkinson's disease, other strong pain relievers (opioids), cimetidine (a medicine for stomach ulcers, indigestion or heartburn), medicines for fungal infections (such as ketoconazole, voriconazole, itraconazole or posaconazole), medicines for bacterial infections (such as clarithromycin, erythromycin or telithromycin), medicines from the group of protease inhibitors to treat HIV infection (e.g. boceprevir, ritonavir, indinavir, nelfinavir or saquinavir), rifampicin for tuberculosis, carbamazepine (a medicine for epilepsy or seizures and for certain types of pain), phenytoin (a medicine for epilepsy or seizures), the medicinal plant St. John's wort (also known as Hypericum perforatum), quinidine (a medicine for irregular heartbeat), certain medicines to prevent blood clotting or to thin the blood (such as phenprocoumon).
Oxylan with food and drink and alcohol Drinking alcohol whilst taking Oxylan may make you feel more sleepy or increase the risk of serious side effects such as shallow breathing with a risk of stopping breathing, and loss of consciousness. It is recommended not to drink alcohol while you're taking Oxylan. The tablets should be avoided in patients with a history of or present alcohol and drug abuse. Grapefruit juice may increase the levels of Oxylan in your blood. Check with your doctor if you drink grapefruit juice regularly. Pregnancy and breast-feeding If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine. Pregnancy You should not take Oxylan during pregnancy. There are no adequate data from the use of oxycodone in pregnant women. Oxycodone crosses the placenta into the blood circulation of the baby. Prolonged use of oxycodone during pregnancy can cause withdrawal symptoms in newborns. Infants born to mothers who have received oxycodone during the last 3-4 weeks before labour may experience severe difficulty (respiratory depression). Oxylan should only be used during pregnancy if the benefit outweighs the possible risks to the baby. Breast-feeding Oxycodone passes into breast milk and causes sedation and shallow and slow breathing (respiratory depression) in the breast-fed child. Oxylan should therefore not be used during breastfeeding. Driving and using machines Oxylan may impair the ability to drive and use machines. This is to be expected especially at the beginning of therapy with Oxylan, after increasing the dose or after switching preparation, as well as when Oxylan interacts with alcohol or drugs that can impair brain function. In the case of stable therapy, a general driving ban is not necessary. Your attending physician must assess your individual situation. Oxylan contains lecithin (soya) If you are allergic to peanut or soya, do not use this medicinal product. Oxylan contains sodium Page 5 (11)
PIL – Oxylan 5 / 10 / 20 / 40 / 80 mg prolonged-release tablets
This medicine contains less than 1 mmol sodium (23 mg) per prolonged-release tablet, that is to say essentially 'sodium-free'. 3.
OXYLAN
Always take this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure. Before starting treatment and regularly during treatment, your doctor will discuss with you what you may expect from using Oxylan, when and how long you need to take it, when to contact your doctor, and when you need to stop it (see also if you stop taking Oxylan). DOSAGE For doses not realisable/practicable with this strength, other strengths of this medicinal product are available. Your doctor will adjust your dosage according to pain intensity and to your individual susceptibility. Do not change the dosage without consulting your doctor. You should be given the lowest effective dose sufficient to relieve your pain. If you have previously been treated with opioids, your doctor may start your therapy with a higher dose. It may be necessary to increase the dose gradually if the pain relief is insufficient or if the pain becomes worse. Please talk to your doctor, if you think that the effect of Oxylan is too weak or too strong. If not prescribed otherwise by your doctor, the recommended dose is
PIL – Oxylan 5 / 10 / 20 / 40 / 80 mg prolonged-release tablets
Overdosing can cause: constriction of the pupils, flattening and slowing of breathing (respiratory depression), drowsiness up to absent-mindedness (narcosis-like state), decreased tension in the skeletal muscles, slowing your pulse, drop in blood pressure a brain disorder known as toxic leukoencephalopathy.
In more severe cases, unconsciousness (coma), water retention in the lungs and circulatory failure
PIL – Oxylan 5 / 10 / 20 / 40 / 80 mg prolonged-release tablets
You can then continue with your usual intake plan. In general, you shouldn't take Oxylan more than every 8 hours. Please ask your doctor or pharmacist if you are not sure Do not take a double dose to make up for a forgotten tablet. If you stop taking Oxylan Do not stop treatment without first speaking with your doctor.. If you stop taking Oxylan, this may trigger withdrawal symptoms (e.g. yawning, dilated pupils, tearing, runny nose, tremors, sweating, anxiety, restlessness, seizures, insomnia or muscle pain). Therefore, it may be advisable for your doctor to reduce the dose gradually If you do not require treatment with Oxylan anymore, your doctor will advise you on how to reduce the dose gradually to prevent the occurrence of withdrawal symptoms. If you have any further questions on the use of this product, ask your doctor or pharmacist. 4.
Like all medicines, this medicine can cause side effects, although not everybody gets them. Contact a doctor immediately if any of the following symptoms occur: ♦ Sudden breathing difficulties, swelling of the eyelids, face or lips, skin rash and itching, especially all over the body- these are signs of severe allergic reactions. ♦ Very slow or weak breathing (respiratory depression). This is the most serious risk in connection with medicines such as Oxylan (opioids), and may even be fatal after high doses of this medicine. ♦ Drop in blood pressure – this can cause dizziness and fainting (syncope). ♦ Constriction of the pupils, spasm of the bronchial muscles (leading to shortness of breath), suppression of the cough reflex. OTHER SIDE EFFECTS Very common (affects more than 1 user in 10)
PIL – Oxylan 5 / 10 / 20 / 40 / 80 mg prolonged-release tablets
PIL – Oxylan 5 / 10 / 20 / 40 / 80 mg prolonged-release tablets
OXYLAN
Keep out of the sight and reach of children. Store this medicine in a locked safe and secure storage space, where other people cannot access it. It can cause serious harm and be fatal to people when it has not been prescribed for them. Do not use this medicine after the expiry date which is stated on the blister and the carton after EXP. The expiry date refers to the last day of that month. Do not store above 25°C. Do not throw away medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment. 6.
What Oxylan contains
PIL – Oxylan 5 / 10 / 20 / 40 / 80 mg prolonged-release tablets
Page 11 (11)
Oxylan 10mg prolonged-release tablets comes as tablet containing 10mg. Always follow the dose your doctor or pharmacist has given you, and read the leaflet that comes with the medicine.
The active substance in Oxylan 10mg prolonged-release tablets is oxycodone hydrochloride.
Medicines with the same active substance, strength and form include: Ixyldone 10 mg prolonged-release tablets, Longtec 10 mg Prolonged Release Tablets, Onexila XL 10mg prolonged-release tablets. In total there are 6 equivalent products. They are interchangeable only if your prescriber or pharmacist says so.
This leaflet reproduces the patient information leaflet approved for Oxylan 10mg prolonged-release tablets, as published on the electronic medicines compendium (emc). The version printed inside your medicine’s packaging is the one that applies to you.
Whether a medicine is available over the counter or on prescription only depends on its licence. Check the leaflet, or ask your pharmacist — they can tell you straight away.
The text above reproduces the patient information leaflet approved for this medicine, restructured for easier reading.
Oxylan is indicated in adults and adolescents (from 12 years and older) for the treatment of severe pain, which can be adequately managed only with opioid analgesics.
Posology
The dosage depends on the pain intensity and the patient's individual susceptibility to the treatment.
For doses not realisable/practicable with this strength, other strengths of this medicinal product are available.
The following general dosage recommendations apply:
Adults and adolescents 12 years and older
Dose titration and adjustment
In general, the initial dose for opioid-naïve patients is 10 mg oxycodone hydrochloride given at intervals of 12 hours. Some patients may benefit from a starting dose of 5 mg to minimize the incidence of adverse reactions.
Patients already receiving opioids may start treatment with higher dosages taking into account their experience with former opioid therapies.
Switching from morphine to oxycodone
The inter-patient variability requires that each patient be carefully adjusted to the dose that is appropriate for them. At the beginning of the change, a dose that is lower than the dose equivalent may be recommended. Patients who received oral morphine prior to oxycodone therapy should receive their daily dose based on the following ratio: 10 mg oral oxycodone is equivalent to 20 mg oral morphine
Because of individual differences in sensitivity for different opioids, it is recommended that patients should start conservatively with Oxycodone hydrochloride prolonged-release tablets after conversion from other opioids, with 50-75% of the calculated oxycodone dose.
Some patients who take Oxycodone hydrochloride prolonged-release tablets following a fixed schedule need rapid-release analgesics as rescue medication in order to control breakthrough pain. Oxycodone hydrochloride prolonged-release tablets are not indicated for the treatment of acute pain and/or breakthrough pain. The single dose of the rescue medication should amount to 1/6 of the equianalgesic daily dose of Oxycodone hydrochloride prolonged-release tablets. Use of the rescue medication more than twice daily indicates that the dose of Oxycodone hydrochloride prolonged-release tablets needs to be increased. The dose should not be adjusted more often than once every 1-2 days until a stable twice daily administration has been achieved.
Following a dose increase from 10 mg to 20 mg, taken every 12 hours, dose adjustments should be made in steps of approximately one third of the daily dose. The aim is a patient-specific dosage which, with twice daily administration, allows for adequate analgesia with tolerable undesirable effects and as little rescue medication as possible as long as pain therapy is needed.
Even distribution (the same dose in the morning and in the evening) following a fixed schedule (every 12 hours) is appropriate for the majority of the patients. For some patients it may be advantageous to distribute the doses unevenly. In general, the lowest effective analgesic dose should be chosen. For the treatment of non-malignant pain a daily dose of 40 mg is generally sufficient; but higher dosages may be necessary. Patients with cancer-related pain may require dosages of 80 to 120 mg, which in individual cases can be increased to up to 400 mg. If even higher doses are required, the dose should be decided individually balancing efficacy against tolerance and the risk of undesirable effects.
Elderly patients
Elderly patients without clinical manifestation of impaired liver and/or kidney function usually do not require dose adjustments.
Patients with renal or hepatic impairment
The dose initiation should follow a conservative approach in these patients. The recommended adult starting dose should be reduced by 50% (for example a total daily dose of 10 mg orally in opioid naïve patients), and each patient should be titrated to adequate pain control according to his/her clinical situation. It is therefore possible that the lowest single dose recommended in this SmPC, i.e. 10 mg, is not suitable as a starting dose. In these cases Oxylan 5 mg prolonged-release tablets can be used.
Other risk patients
In patients with low body weight or slow metabolism of drugs who are also opioid-naive, the recommended starting dose should be reduced to half the normally recommended starting dose for adults. It is therefore possible that the lowest single dose recommended in this SmPC, i.e. 10 mg, is not suitable as a starting dose. In these cases Oxylan 5 mg prolonged-release tablets can be used.
Paediatric population
Opioids must only be used for appropriate indications and prescribed by a specialist experienced in managing severe pain in children, with careful assessments of the benefits and risks.
Children below the age of 12 years
The safety and efficacy of oxycodone in children below 12 years of age has not yet been established. No data are available.
METHOD OF ADMINISTRATION
Oral use.
Oxylan prolonged-release tablets should be taken twice daily based on a fixed schedule at the dosage determined.
The prolonged-release tablets may be taken with or independent of meals with a sufficient amount of liquid. Oxylan prolonged-release tablets must be swallowed whole, and they must not be chewed, divided or crushed.
Treatment goals and discontinuation
Before initiating treatment with Oxylan prolonged-release tablets, a treatment strategy including treatment duration and treatment goals, and a plan for end of the treatment, should be agreed together with the patient, in accordance with pain management guidelines. During treatment, there should be frequent contact between the physician and the patient to evaluate the need for continued treatment, consider discontinuation and to adjust dosages if needed. When a patient no longer requires therapy with oxycodone, it may be advisable to taper the dose gradually to prevent symptoms of withdrawal. In absence of adequate pain control, the possibility of hyperalgesia, tolerance and progression of underlying disease should be considered (see section 4.4).
Duration of administration
Oxylan prolonged-release tablets should not be taken longer than necessary.
hypersensitivity to oxycodone hydrochloride, soya, peanut, or to any of the excipients
Oxycodone must not be used in any situation where opioids are contraindicated:
• severe respiratory depression with hypoxia and/or hypercapnia
• severe chronic obstructive pulmonary disease
• cor pulmonale
• severe bronchial asthma
• paralytic ileus
• acute abdomen, delayed gastric emptying
Caution should be exercised in
• elderly or debilitated patients,
• severely impaired respiratory function,
• impaired hepatic function,
• impaired renal function,
• sleep apnoea,
• myxoedema, hypothyroidism,
• concomitant use of centrally depressant substances (see below and 4.5),
• Addison's disease (adrenal insufficiency),
• intoxication psychosis (e.g. alcohol),
• prostatic hypertrophy,
• alcoholism, known opioid dependence,
• psychological dependence [addiction], abuse profile and history of substance and/or alcohol abuse (see below)
• delirium tremens,
• head injury, increased intracranial pressure,
• impaired consciousness of unknown cause,
• hypotension,
• hypovolaemia,
• epileptic disorder or predisposition to convulsions,
• pancreatitis,
• diseases of the biliary tract, biliary or ureteric colic,
• obstructive or inflammatory intestinal diseases,
• constipation,
• disturbances of circulatory regulation,
• in patients taking MAO inhibitors (see below and section 4.5).
With the occurrence or suspicion of paralytic ileus, oxycodone should be immediately discontinued.
Respiratory depression
The major risk of opioid excess is respiratory depression.
Sleep-related breathing disorders
Opioids can cause sleep-related breathing disorders including central sleep apnoea (CSA) and sleep-related hypoxemia. Opioid use increases the risk of CSA in a dose-dependent fashion. In patients who present with CSA, consider decreasing the total opioid dosage.
Risk from concomitant use of sedative medicines such as benzodiazepines or related drugs
Concomitant use of Oxylan and sedative medicines such as benzodiazepines or related drugs may result in sedation, respiratory depression, coma and death. Because of these risks, concomitant prescribing with these sedative medicines should be reserved for patients for whom alternative treatment options are not possible. If a decision is made to prescribe Oxylan concomitantly with sedative medicines, the lowest effective dose should be used, and the duration of treatment should be as short as possible.
The patients should be followed closely for signs and symptoms of respiratory depression and sedation.
In this respect, it is strongly recommended to inform patients and their caregivers to be aware of these symptoms (see section 4.5).
MAOIs
Oxycodone should be administered with caution to patients taking MAOIs or who have received MAOIs within the last two weeks.
Tolerance, physical dependence, withdrawal symptoms and tapering off
The patient may develop tolerance to the drug with chronic use and require progressively higher doses to maintain pain control.
Oxylan prolonged-release tablets have a primary dependence potential.
Prolonged use of Oxylan prolonged-release tablets may lead to physical dependence and a withdrawal syndrome may occur upon abrupt cessation of therapy. When a patient no longer requires therapy with oxycodone, it may be advisable to taper the dose gradually to prevent withdrawal symptoms.
Withdrawal symptoms may include yawning, mydriasis, lacrimation, rhinorrhoea, tremor, hyperhidrosis, anxiety, agitation, convulsions, insomnia, and myalgia.
Hyperalgesia
Hyperalgesia that will not respond to a further dose increase of oxycodone may very rarely occur, particularly in high doses. An oxycodone dose reduction or change to an alternative opioid may be required.
Opioid Use Disorder (abuse and dependence)
Tolerance and physical and/or psychological dependence may develop upon repeated administration of opioids such as oxycodone.
Repeated use of Oxylan may lead to Opioid Use Disorder (OUD). A higher dose and longer duration of opioid treatment can increase the risk of developing OUD. Abuse or intentional misuse of Oxylan may result in overdose and/or death. The risk of developing OUD is increased in patients with a personal or a family history (parents or siblings) of substance use disorders (including alcohol use disorder), in current tobacco users or in patients with a personal history of other mental health disorders (e.g. major depression, anxiety and personality disorders).
Before initiating treatment with Oxylan prolonged-release tablets and during the treatment, treatment goals and a discontinuation plan should be agreed with the patient (see section 4.2). Before and during treatment the patient should also be informed about the risks and signs of OUD. If these signs occur, patients should be advised to contact their physician.
Patients will require monitoring for signs of drug-seeking behavior (e.g. too early requests for refills). This includes the review of concomitant opioids and psycho-active drugs (like benzodiazepines). For patients with signs and symptoms of OUD, consultation with an addiction specialist should be considered.
Parenteral abuse
Abuse of oral dosage forms by parenteral administration can be expected to result in serious adverse events, which may be fatal.
Opioids are not first-line therapy for chronic non-malignant pain, nor are they recommended as the only treatment. Opioids should be used as part of a comprehensive treatment programme involving other medications and treatment modalities. Patients with chronic non-malignant pain should be monitored for signs of dependence or substance abuse. The attainment of treatment goals should be regularly checked in accordance with pain management guidelines. If appropriate, the dose is to be adjusted. In case the treatment objectives are not met, discontinuation of therapy should be considered.
The prolonged-release tablets must be swallowed whole, and not broken, crushed or chewed. The administration of broken, chewed or crushed prolonged-release oxycodone tablets leads to rapid release and absorption of a potentially fatal dose of oxycodone (see section 4.9).
Surgical procedures
As with all opioid preparations, oxycodone products should be used with caution following abdominal surgery as opioids are known to impair intestinal motility and should not be used until the physician is assured of normal bowel function. The use of oxycodone prolonged-release tablets is not recommended prior to and during the first 12-24 hours after surgical procedures. If further treatment with oxycodone is indicated, the dose should be adjusted to the new post-operative requirements.
Special care should be taken when oxycodone is used in patients undergoing bowel- surgery. Opioids should only be administered post-operatively when the bowel function has been restored.
Depending on the type and extent of the surgical procedure, the selected anesthetic method, other concomitant medication and the individual condition of the patient, the time of postoperative use of Oxylan prolonged-release tablets must be determined after carefully weighing the benefit and risk in each individual case.
The safety of Oxylan prolonged-release tablets used pre-operatively has not been established and can therefore not be recommended.
Opioids, such as oxycodone hydrochloride, may influence the hypothalamic-pituitary-adrenal or -gonadal axes. Some changes that can be seen include an increase in serum prolactin and decreases in plasma cortisol and testosterone. Clinical symptoms may manifest from these hormonal changes.
Children
Oxycodone hydrochloride prolonged-release tablets have not been studied in children younger than 12 years of age. The safety and efficacy of the tablets have not been demonstrated and the use in children younger than 12 years of age is therefore not recommended.
Patients with severe hepatic impairment
Patients with severe hepatic impairment should be closely monitored.
Hepatobiliary disorders
Oxycodone may cause dysfunction and spasm of the sphincter of Oddi, thus increasing the risk of biliary tract symptoms and pancreatitis. Therefore, oxycodone has to be administered with caution in patients with pancreatitis and diseases of the biliary tract.
Alcohol
Concomitant use of alcohol and Oxylan prolonged-release tablets may increase the undesirable effects of Oxylan prolonged-release tablets; concomitant use should be avoided. Oxylan prolonged-release tablets should be used with particular care in patients with a history of alcohol and drug abuse.
Anti-Doping Warning
The use of Oxylan may produce positive results in doping controls.
Use of Oxylan as a doping agent may become a health hazard.
Sodium
This medicine contains less than 1 mmol sodium (23 mg) per prolonged-release tablet, that is to say essentially 'sodium-free'.
Alcohol
Alcohol may enhance the pharmacodynamic effects of Oxylan prolonged-release tablets; concomitant use should be avoided.
Centrally depressant drugs
There can be an enhanced CNS depressant effect during concomitant therapy with drugs which affect the CNS: gabapentinoids such as pregabalin,sedatives, hypnotics, antipsychotics, anaesthetics, phenothiazines, neuroleptic drugs, antidepressants, muscle relaxants, antihistamines, antiemetics and other opioids which may enhance the adverse drug reactions, especially respiratory depression.
Concomitant administration of oxycodone with serotonin agents, such as a Selective Serotonin Re-uptake Inhibitor (SSRI) or a Serotonin Norepinephrine Re-uptake Inhibitor (SNRI) may cause serotonin toxicity. The symptoms of serotoin toxicity may include mental-status changes (e.g., agitation, hallucinations, coma), autonomic instability (e.g., tachycardia, labile blood pressure, hyperthermia), neuromuscular abnormalities (e.g., hyperreflexia, incoordination, rigidity), and/or gastrointestinal symptoms (e.g., nausea, vomiting, diarrhoea). Oxycodone should be used with caution and the dosage may need to be reduced in patients using these medications.
Sedative medicines such as benzodiazepines or related drugs
The concomitant use of opioids with sedative medicines such as benzodiazepines or related drugs increases the risk of sedation, respiratory depression, coma and death because of additive CNS depressant effect. The dose and duration of concomitant use should be limited (see section 4.4).
Anticholinergics (e.g. antipsychotics, antihistamines, antiemetics, antiparkinson medicines) can enhance the anticholinergic undesirable effects of oxycodone (such as constipation, dry mouth or micturition disorders).
Monoaminoxidase (MAO) inhibitors are known to interact with opioid analgesics, producing CNS excitation or depression with hyper- or hypotensive crisis (see section 4.4). Oxycodone should be used with caution in patients administered MAO- inhibitors or who have received MAO-inhibitors during the last two weeks (see section 4.4).
Clinically relevant changes in International Normalized Ratio (INR) in both directions have been observed in individuals if coumarin anticoagulants are co- applied with Oxylan prolonged-release tablets.
Interactions via the CYP system
Oxycodone is metabolised mainly by CYP3A4, with a contribution from CYP2D6. The activities of these metabolic pathways may be inhibited or induced by various co- administered drugs or dietary elements.
CYP3A4 inhibitors, such as macrolide antibiotics (e.g. clarithromycin, erythromycin and telithromycin), azole-type antifungals (e.g. ketoconazole, voriconazole, itraconazole, and posaconazole), protease inhibitors (e.g. boceprevir, ritonavir, indinavir, nelfinavir and saquinavir), cimetidine and grapefruit juice may reduce the clearance of oxycodone which could result in an increase of oxycodone plasma concentrations. Therefore the oxycodone dose may need to be adjusted accordingly.
• Some specific examples are provided below: Itraconazole, a potent CYP3A4 inhibitor, administered as 200 mg orally for five days, increased the AUC of oral oxycodone. On average, the AUC was approximately 2.4 times higher (range 1.5 - 3.4).
• Voriconazole, a CYP3A4 inhibitor, administered as 200 mg twice-daily for four days (400 mg given as first two doses), increased the AUC of oral oxycodone. On average, the AUC was approximately 3.6 times higher (range 2.7 - 5.6).
• Telithromycin, a CYP3A4 inhibitor, administered as 800 mg orally for four days, increased the AUC of oral oxycodone. On average, the AUC was approximately 1.8 times higher (range 1.3 – 2.3).
• Grapefruit juice, a CYP3A4 inhibitor, administered as 200 ml three times a day for five days, increased the AUC of oral oxycodone. On average, the AUC was approximately 1.7 times higher (range 1.1 – 2.1).
CYP3A4 inducers, such as rifampicin, carbamazepine, phenytoin and St John's Wort may induce the metabolism of oxycodone and cause an increased clearance of oxycodone which could result in a reduction of oxycodone plasma concentrations.
The oxycodone dose may need to be adjusted accordingly.
Some specific examples are provided below:
• St John's Wort, a CYP3A4 inducer, administered as 300 mg three times a day for fifteen days, reduced the AUC of oral oxycodone. On average, the AUC was approximately 50% lower (range 37-57%).
• Rifampicin, a CYP3A4 inducer, administered as 600 mg once daily for seven days, reduced the AUC of oral oxycodone. On average, the AUC was approximately 86% lower.
Drugs that inhibit CYP2D6 activity, such as paroxetine and quinidine, may cause decreased clearance of oxycodone which could lead to an increase in oxycodone plasma concentrations.
Use of this medicinal product should be avoided to the extent possible in patients who are pregnant or lactating.
Fertility
No human data on the effect of oxycodone on fertility are available. Studies in rats have not shown any effects upon fertility (see section 5.3).
Pregnancy
There are limited data from the use of oxycodone in pregnant women. Infants born to mothers who have received opioids during the last 3 to 4 weeks before giving birth should be monitored for respiratory depression. Withdrawal symptoms may be observed in the newborns of mothers undergoing treatment with oxycodone.
Breast-feeding
Oxycodone may be secreted in breast milk and may cause sedation and respiratory depression in the newborn. Oxycodone should, therefore, not be used in breastfeeding mothers.
Oxycodone may impair the ability to drive and use machines. This is particularly likely at the initiation of treatment with oxycodone, after dose increase or changes in therapy, and if oxycodone is combined with alcohol or other CNS depressants.
With stable therapy, a general ban on driving a vehicle is not necessary. The treating physician must assess the individual situation.
Oxycodone can cause respiratory depression, miosis, bronchial spasms and spasms of the smooth muscles and can suppress the cough reflex.
Drug dependence
Repeated use of Oxylan prolonged-release tablets can lead to drug dependence, even at therapeutic doses. The risk of drug dependence may vary depending on a patient's individual risk factors, dosage, and duration of opioid treatment (see section 4.4).
The most frequently reported undesirable effects are nausea (especially at the beginning of treatment) and constipation.
Respiratory depression is the chief hazard of an opioid overdose and occurs predominantly in elderly or debilitated patients. Opioids may cause severe hypotension in susceptible individuals.
The adverse reactions considered at least possibly related to treatment are listed below by system organ class and absolute frequency. Within each frequency grouping, undesirable effects are presented in order of decreasing seriousness.
Very common (≥ 1/10)
Common (≥ 1/100 to < 1/10)
Uncommon (≥ 1/1,000 to < 1/100)
Rare (≥ 1/10,000 to < 1/1,000)
Very rare (< 1/10,000)
Not known (cannot be estimated from the available data)
Infections and parasitic diseases
Rare: Herpes simplex
Immune system disorders:
Uncommon: hypersensitivity
Not known: anaphylactic responses
Blood and lymphatic system disorders
Rare: lymphadenopathy
Endocrine disorders
Uncommon: syndrome of inappropriate antidiuretic hormone secretion
Metabolism and nutrition disorders
Common: decreased appetite
Uncommon: dehydration
Rare: increased appetite
Psychiatric disorders
Common: anxiety, confusion, depression, decreased activity, restlessness, psychomotor hyperactivity, insomnia, nervousness, abnormal thinking
Uncommon: agitation, affect lability, euphoric mood, dysphoria, perception disturbances (e.g hallucinations, depersonalisation), decreased libido, drug dependence (see section 4.4)
Not known: aggression
Nervous system disorders
Very common: somnolence, sedation, dizziness, headache
Common: tremor, lethargy
Uncommon: amnesia, seizures (particularly (particularly in epileptic patients or patients with tendency to convulsions), impaired concentration, migraine, increased muscle tone, hypoaesthesia, involuntary muscle contraction, impaired coordination, speech disorders, syncope, paraesthesia, dysgeusia
Not known: hyperalgesia
Eye disorders
Uncommon: visual impairment, miosis
Ear and labyrinth disorders
Uncommon: hearing impairment, vertigo
Cardiac disorders
Uncommon: palpitation (in the context of withdrawal syndrome), supraventricular tachycardia
Vascular disorders
Uncommon: vasodilatation
Rare: hypotension, orthostatic hypotension
Respiratory, thoracic and mediastinal disorder
Common: dyspnoea, bronchospasm
Uncommon: respiratory depression, increased coughing
Not known: central sleep apnoea syndrome
Gastrointestinal disorders
Very common: constipation, nausea, vomiting
Common: dry mouth, rarely accompanied by thirst and difficulty swallowing; abdominal pain, diarrhoea, dyspepsia
Uncommon: dysphagia, mouth ulcerations, gingivitis, stomatitis, flatulence, eructation, ileus
Rare: melaena, gingival bleeding, tooth dirsorders
Not known: dental caries
Hepatobiliary disorders
Uncommon: increase hepatic enzymes
Not known: cholestasis, biliary colic, sphincter of Oddi dysfunction
Skin and subcutaneous tissue disorders
Very common: pruritus
Common: rash, hyperhidrosis
Uncommon: dry skin
Rare: urticaria, manifestations of herpes simplex, increased photosensitivity
Renal and urinary disorders
Uncommon: micturition disturbances (urinary retention, but also increased urge to urinate)
Rare: haematuria
Reproductive system and breast disorders
Uncommon: reduced libido, erectile dysfunction, hypoganadism
Not known: amenorrhoea
General disorders and administration site conditions
Common: asthenia, tiredness
Uncommon: chills, malaise, pain (e.g. chest pain), oedema, peripheral oedema, physical dependence with withdrawal symptoms, drug tolerance, thirst
Rare: weight changes (increase or decrease), cellulitis
Not known: drug withdrawal syndrome neonatal
Injury, poisoning and procedural complications
Uncommon: injuries from accidents
Paediatric population
The frequency, type and severity of adverse reactions in adolescents (12 to 18 years of age) appear similar to those in adults (see section 5.1).
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorization of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the national reporting system:
Yellow Card Scheme
Website: www.mhra.gov.uk/yellowcard
Symptoms
Acute overdose with oxycodone can be manifested by miosis, respiratory depression, somnolence progressing to stupor or coma, hypotonia, drop in blood pressure and death. In severe cases circulatory collapse, bradycardia and non-cardiogenic lung oedema may occur; abuse of high doses of strong opioids such as oxycodone can be fatal. Toxic leukoencephalopathy has been observed with oxycodone overdose.
Therapy
Primary attention must be given to the establishment of a patent airway and institution of assisted or controlled ventilation.
Pure opioid antagonist such as naloxone (0.4-2 mg intravenous) serve as specific antidotes in the treatment of opioid overdose. Administration of single doses must be repeated depending on the clinical situation at intervals of 2 to 3 minutes. Intravenous infusion of 2 mg of naloxone in 500 ml isotonic saline or 5% dextrose solution (corresponding to 0.004 mg naloxone/ml) is possible. The rate of infusion should be adjusted to the previous bolus injections and the response of the patient.
Gastric lavage can be taken into consideration. The administration of activated charcoal (50 g for adults, 10 -15 g for children) should be considered within 1 hour, if a substantial amount has been ingested within 1 hour, provided the airway can be protected. It may be reasonable to assume that late administration of activated charcoal may be beneficial for prolonged-release preparations; however there is no evidence to support this.
For speeding up the passage a suitable laxative (e.g. a PEG-based solution) may be useful.
Supportive measures (artificial respiration, oxygen supply, administration of vasopressors and infusion therapy) should, if necessary, be applied in the treatment of accompanying circulatory shock. Upon cardiac arrest or cardiac arrhythmias, cardiac massage or defibrillation may be indicated. If necessary, assisted ventilation as well as maintenance of water and electrolyte balance.
Ask anything about Oxylan 10mg prolonged-release tablets. The assistant answers only from this leaflet — if the leaflet does not cover it, it will say so. It does not give medical advice.
Answers come from the patient leaflet published on the electronic medicines compendium (emc). They are not medical advice. Ask a pharmacist or your GP if you are unsure. For urgent help call NHS 111, or 999 in an emergency.
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