Oxycodone/paracetamol

Oxycodone/paracetamol
Combination of
OxycodoneOpioid analgesic
ParacetamolAnilide analgesic
Names
Trade namesDepalgos, Endocet, Maxigesic, Percocet, Ratio-Oxycocet, Roxicet, others
Other namesOxycodone/acetaminophen, oxycodone/APAP
Clinical data
WHO AWaReUnlinkedWikibase error: ⧼unlinkedwikibase-error-statements-entity-not-set⧽
Pregnancy
category
  • US: C (Risk not ruled out)
    Routes of
    use    		By mouth
    External links
    AHFS/Drugs.compercocet
    Legal
    License data
    Legal status
    • AU: S2 (Pharmacy medicine) – S4, OTC
    • US: Schedule II

    Oxycodone/paracetamol, also known as oxycodone/acetaminophen, and sold under the brand name Percocet among others, is a combination of the opioid oxycodone with paracetamol (acetaminophen), used to treat moderate to severe short-term pain.[1] It comes in immediate and extended release formulations.[1] It is taken by mouth.[1]

    Common side effects include nausea and dizziness.[1] Other side effects may include addiction, sleepiness, itchiness, constipation, anaphylaxis, low blood pressure, and decreased breathing.[1] Use during pregnancy may result in neonatal opioid withdrawal syndrome in the baby.[1]

    The combination was approved for medical use in the United States in 1976.[1] In the United States it is a schedule II controlled substance.[2] It is available as a generic medication.[3] In the United States 90 tablets costs about 22 USD as of 2020.[4]

    Medical use

    It is used to treat moderate to severe short-term pain.[1] The harm of use in lower back pain of sudden onset; however, appear to be greater than the benefit.[5]

    History

    The United States Food and Drug Administration (FDA) first approved Percocet in 1976, under application ANDA 085106.[6]

    Society and culture

    Formulation

    As of August 2014, Endo International produces =the following dosages.[7] Percocet tablets are available in four combinations of oxycodone hydrochloride with 325 mg of paracetamol (acetaminophen), each having different appearances and usual maximum daily doses:[7][8]

    Due to the liver toxicity of paracetamol, the manufacturer and FDA dosage guidelines suggest no more than 4,000 mg total of paracetamol be taken per day, which would be 12 or fewer Percocet tablets per day as each one contains 325 mg.[9]

    Oxycodone hydrochloride (mg)Paracetamol (acetaminophen) (mg)Tablet colorTablet shapeTablet number
    2.5325pinkoval2.5
    5325whiteround0919
    7.5325peachround229
    10.0325whiteround44 104

    Deaths

    On June 30, 2009, an FDA advisory panel recommended that oxycodone/paracetamol, hydrocodone/paracetamol, and every other combination of acetaminophen with narcotic analgesics[10] be limited in their sales because of their contributions to an alleged 400 acetaminophen-related deaths in the U.S. each year, that were attributed to acetaminophen overdose and associated liver damage.[11]

    In December 2009, the Canadian Medical Association Journal reported a study finding a fivefold increase in oxycodone-related deaths in Ontario (mostly accidental) between 1991 and 2007 that led to a doubling of all opioid-related deaths in Ontario over the same period.[12][13][14]

    In March 2017, U.S. President Donald Trump initiated the Opioid and Drug Abuse Commission.[15] In July 2017, an interim report was published. Some excerpts:[16]

    As we have all seen, opioids are a prime contributor to our addiction and overdose crisis. In 2015, nearly two-thirds of drug overdoses were linked to opioids like Percocet, OxyContin, heroin, and fentanyl. [...] Americans consume more opioids than any other country in the world. In fact, in 2015, the amount of opioids prescribed in the U.S. was enough for every American to be medicated around the clock for three weeks.

    Since 1999, the number of opioid overdoses in America have quadrupled according to the CDC. Not coincidentally, in that same period, the amount of prescription opioids in America have quadrupled as well. This massive increase in prescribing has occurred despite the fact that there has not been an overall change in the amount of pain Americans have reported in that time period. We have an enormous problem that is often not beginning on street corners; it is starting in doctor's offices and hospitals in every state in our nation. [...]

    In 2016, specific states witnessed an escalating number of overdose deaths due to heroin and/or fentanyl(s), in some states vastly exceeding deaths due to prescription opioids.

    In 2015, 27 million people reported current use of illegal drugs or abuse of prescription drugs. Despite this self-reporting, only 10 percent of the nearly 21 million citizens with a substance use disorder (SUD) receive any type of specialty treatment according to the most recent National Survey on Drug Use and Health. This is contributing greatly to the increase of deaths from overdose.

    See also

    References

    1. 1 2 3 4 5 6 7 8 "Oxycodone and Acetaminophen (Professional Patient Advice)". Drugs.com. Archived from the original on 20 May 2020. Retrieved 12 November 2020.
    2. ↑ Mancano, Michael; Gallagher, Jason (2010). Frequently Prescribed Medications. Jones & Bartlett Learning. p. 8. ISBN 978-0-7637-8117-0. Archived from the original on 2021-07-10. Retrieved 2020-11-12.
    3. ↑ Hamilton, Richard J. (2009). Tarascon Pharmacopoeia 2010 Professional Desk Reference Edition. Jones & Bartlett Learning. p. 15. ISBN 978-0-7637-7769-2. Archived from the original on 2021-07-10. Retrieved 2020-11-12.
    4. ↑ "Percocet Prices, Coupons & Savings Tips". GoodRx. Archived from the original on 26 April 2020. Retrieved 12 November 2020.
    5. ↑ Morgan, DJ; Dhruva, SS; Wright, SM; Korenstein, D (1 November 2016). "2016 Update on Medical Overuse: A Systematic Review". JAMA internal medicine. 176 (11): 1687–1692. doi:10.1001/jamainternmed.2016.5381. PMID 27654002.
    6. ↑ "Drugs@FDA. FDA approved drug products (searchable database)". U.S. Food and Drug Administration, Center for Drug Evaluation and Research. Archived from the original on 2012-08-14. Retrieved 2009-03-30.
    7. 1 2 "Percocet oxycodone and acetaminophen tablets USP" (PDF). Endo Pharmaceuticals. May 2011. Archived from the original (PDF) on August 6, 2012. Retrieved October 20, 2012.
    8. ↑ "PERCOCET- oxycodone hydrochloride and acetaminophen tablet". Endo Pharmaceuticals. August 2014. Archived from the original on 2016-10-28.
    9. ↑ "Percocet - FDA prescribing information, side effects and uses". Archived from the original on 2016-09-23. Retrieved 2016-09-23.
    10. ↑ "FDA May Restrict Acetaminophen". WebMD. Archived from the original on 2011-03-21. Retrieved 2010-04-15.
    11. ↑ Harris G (2009-07-01). "Ban Is Advised on 2 TopPills for Pain Relief". The New York Times. Archived from the original on 2011-12-01. Retrieved 2010-05-22.
    12. ↑ Dhalla IA, Mamdani MM, Sivilotti ML, Kopp A, Qureshi O, Juurlink DN (December 2009). "Prescribing of opioid analgesics and related mortality before and after the introduction of long-acting oxycodone". CMAJ. 181 (12): 891–6. doi:10.1503/cmaj.090784. PMC 2789126. PMID 19969578.
    13. ↑ Fischer B, Rehm J (December 2009). "Deaths related to the use of prescription opioids". CMAJ. 181 (12): 881–2. doi:10.1503/cmaj.091791. PMC 2789122. PMID 19969577.
    14. ↑ "Deaths from opioid use have doubled; five-fold increase in oxycodone deaths". Canadian Medical Association Journal. December 7, 2009. Archived from the original on July 19, 2012. Retrieved May 31, 2012.
    15. ↑ "Presidential Executive Order Establishing the President's Commission on Combating Drug Addiction and the Opioid Crisis". 29 March 2017. Archived from the original on 30 March 2017. Retrieved 11 August 2017.
    16. ↑ "PDF" (PDF). Archived from the original (PDF) on 2017-08-13. Retrieved 2017-08-11.
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