Author: Alex Thompson

Percocet: Uses, Dosage, Side Effects & Warnings

The solution, concentrated solution, tablet, and capsule are taken usually with or without food every 4 to 6 hours, either as needed for pain or as regularly scheduled medications. The extended-release tablets (Oxycontin) are taken every 12 hours with or without food. The extended-release capsules (Xtampza ER) are taken every 12 hours with food; eat the same amount of food with each dose. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand.

1. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection and it may be useful to regularly evaluate renal function.
2. Consider these risks when prescribing or dispensing oxycodone hydrochloride tablets.
3. Inform patients that PERCOCET may cause orthostatic hypotension and syncope.
4. The major circulating metabolite is noroxycodone with an AUC ratio of 0.6 relative to that of oxycodone.
5. Marked mydriasis rather than miosis may be seen due to hypoxia in overdose situations.

Physical dependence may lead to withdrawal side effects if treatment is stopped suddenly. However, severe withdrawal side effects can usually be prevented by gradually reducing the dose over a period of time before treatment is stopped completely. Inform patients that opioids could cause adrenal insufficiency, a potentially life-threatening condition.

Generic Name(S): oxycodone-acetaminophen

If someone accidentally swallows this drug, get medical help right away. Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. In rare cases, acetaminophen may cause a severe skin reaction that can be fatal.

Incremental increases should be gauged according to side effects to an acceptable level of analgesia. Management of respiratory depression may include close observation, supportive measures, and use of opioid antagonists, depending on the patient’s clinical status [see OVERDOSAGE]. When oxycodone is used for a long time, it may become habit-forming, causing mental or physical dependence. However, people who have continuing pain should not let the fear of dependence keep them from using narcotics to relieve their pain. Mental dependence (addiction) is not likely to occur when narcotics are used for this purpose.

If the level of pain increases after dosage stabilization, attempt to identify the source of increased pain before increasing the PERCOCET dosage. If unacceptable opioid-related adverse reactions are observed, consider reducing the dosage. Inform patients and caregivers about the various ways to obtain naloxone as permitted by individual state naloxone dispensing and prescribing regulations (e.g., by prescription, directly from a pharmacist, or as part of a community-based program).

Symptoms of overdose may include the following:

Suddenly stopping this medication may cause withdrawal, especially if you have used it for a long time or in high doses. Opioid antagonists, such as naloxone, are specific antidotes to respiratory depression resulting from opioid overdose. For clinically significant respiratory or circulatory depression secondary to opioid overdose, administer an opioid antagonist. If urgent use of an opioid is necessary, use test doses and frequent titration of small doses to treat pain while closely monitoring blood pressure and signs and symptoms of CNS and respiratory depression. If concomitant use is necessary, consider increasing the PERCOCET dosage until stable drug effects are achieved. If a CYP3A4 inducer is discontinued, consider PERCOCET dosage reduction and monitor for signs of respiratory depression.

These prescription medications are usually covered, at least in part, by insurance. You can prevent withdrawal if you lower your dose slowly, typically over a week so. Do not flush medications down the toilet or pour them into a drain unless instructed to do so. For more details, read the Medication Guide, or consult your pharmacist or local waste disposal company.

What should I know about storage and disposal of this medication?

To lessen the risk, take the smallest effective dose for the shortest possible time. Babies born to mothers who use this drug for a long time may develop severe (possibly fatal) withdrawal symptoms. Tell the doctor right away if you notice any symptoms in your newborn baby such as crying that doesn’t stop, slow/shallow breathing, irritability, shaking, vomiting, diarrhea, poor feeding, or difficulty gaining weight. “Drug-seeking” behavior is very common in persons with substance use disorders.

Medical Professionals

In addition, monitor patients for any changes in mood, emergence of suicidal thoughts, or use of other substances. It is important to ensure ongoing care of the patient and to agree on an appropriate tapering schedule and follow-up plan so that patient and provider goals and expectations are clear and realistic. When opioid analgesics are being discontinued due to a suspected substance use disorder, evaluate and treat the patient, or refer for evaluation and treatment of the substance use disorder. Treatment should include evidence-based approaches, such as medication assisted treatment of opioid use disorder.

To reduce the risk of respiratory depression, proper dosing and titration of oxycodone hydrochloride tablets are essential [see Dosage and Administration (2)]. Overestimating the oxycodone hydrochloride tablets dosage when converting patients from another opioid product can result in fatal overdose with the first dose. While serious, life-threatening, or fatal respiratory depression can occur at any time during the use of oxycodone hydrochloride tablets, the risk is greatest during the initiation of therapy or following a dosage increase. If the level of pain increases after dosage stabilization, attempt to identify the source of increased pain before increasing the oxycodone hydrochloride tablets dosage. If after increasing the dosage, unacceptable opioid-related adverse reactions are observed (including an increase in pain after a dosage increase), consider reducing the dosage [see Warnings and Precautions (5)]. Adjust the dosage to obtain an appropriate balance between management of pain and opioid-related adverse reactions.

A multimodal approach to pain management may optimize the treatment of chronic pain, as well as assist with the successful tapering of the opioid analgesic [see Warnings and Precautions (5.14), Drug Abuse and Dependence (9.3)]. The presence of risk factors for overdose should not prevent the proper management of pain in any given patient [see Warnings and Precautions (5.1, 5.2, 5.3)]. Inform patients that opioids could cause a rare but potentially life-threatening condition resulting from concomitant administration of serotonergic drugs. Warn patients of the symptoms of serotonin syndrome and to seek medical attention right away if symptoms develop. Instruct patients to inform their healthcare providers if they are taking, or plan to take serotonergic medications [see PRECAUTIONS; Drug Interactions]. Instruct patients to inform their healthcare providers if they are taking, or plan to take, serotonergic medication [see Drug Interactions (7)].

Initiate therapy in these patients with a lower than usual dosage of PERCOCET and titrate carefully. Monitor closely for adverse events such as respiratory depression, sedation, and hypotension [see CLINICAL PHARMACOLOGY]. These drugs are known to be substantially excreted by the kidney, and the risk of adverse reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function. If concomitant use is warranted, monitor patients for signs of diminished diuresis and/or effects on blood pressure and increase the dosage of the diuretic as needed. Educate patients and caregivers on how to recognize the signs and symptoms of an overdose.

If the response to an opioid antagonist is suboptimal or only brief in nature, administer additional antagonist as directed by the product’s prescribing information. Marked mydriasis rather than miosis may be seen with hypoxia in overdose situations. Ordinarily, nursing should not be undertaken while a patient is receiving PERCOCET because of the possibility of sedation and/or respiratory depression in the infant.