Oxycodone and Aspirin (Percodan) - Uses, Dose, SIde effects, MOA

Oxycodone and aspirin (Percodan) is a combination pill of a salicylate (Aspirin) and opioid analgesic (Oxycodone). It is used in the management of moderate to severe pain that does not respond adequately to non-steroidal analgesics.

Oxycodone and aspirin Uses:

Pain management:
- Management of pain severe enough to need an opioid analgesic and for which no alternative treatments are enough.
- Limitations of use: Reserve for use in patients for whom alternative treatment options (eg, nonopioid analgesics) are not effective, not tolerated, or would be otherwise inadequate.

Oxycodone and aspirin (Percodan) Dose in Adults

Oxycodone and aspirin (Percodan) Dose in Pain management:

Oral: starting: One tablet (oxycodone 4.835 mg/aspirin 325 mg) every 6 hours as needed for pain; maximum: 12 tablets (oxycodone 58.02 mg/aspirin 3,900 mg) per day.
Discontinuation of therapy:
- When discontinuing chronic opioid therapy, the dose should be slowly tapered down.
- An optimal universal tapering schedule for all patients has not been established.
- Proposed schedules range from slow (eg, 10% reductions per week) to rapid (eg, 25% to 50% reduction every few days).
- Tapering schedules should be customized to minimize opioid withdrawal.
- An even slower taper may be appropriate in patients who are on opioids for a long duration (eg, years), especially in the final stage of tapering, whereas more rapid tapers may be needed in patients having severe side effects.
- Monitor carefully for signs/symptoms of withdrawal. If the patient displays withdrawal symptoms, consider slowing the taper schedule; alterations may involve increasing the interval between dose reductions, decreasing the amount of daily dose reduction, pausing the taper and resuming when the patient is ready, and/or coadministration of an alpha-2 agonist (eg, clonidine) to blunt withdrawal symptoms.
- Continue to offer nonopioid analgesics as required for pain management during the taper; consider nonopioid adjunctive treatments for withdrawal symptoms (eg, GI complaints, muscle spasms) as required.

Oxycodone and aspirin (Percodan) Dose in Children

Note:

Dosed based on total oxycodone content; titrate dose to adequate analgesic effects; one tablet contains oxycodone 4.835 mg and aspirin 325 mg.
Do not use aspirin in pediatric patients <18 years who have or who are recovering from chickenpox or flu symptoms (eg, viral illness) because of association with Reye syndrome.

Oxycodone and aspirin (Percodan) Dose in moderate to severe pain:

Children and Adolescents:
- Oral: Initial dose: 0.2 mg/kg/dose; doses typically given every 6 hours as required.
- The maximum initial oxycodone dose: 1 tablet (~5 mg/dose);
- The maximum daily aspirin dose: 4,000 mg/day (~12 tablets/day).

Oxycodone and aspirin (Percodan) Pregnancy Risk Category: D

[US Boxed Warning]

Neonatal opioid withdrawal syndrome can develop from prolonged opioid use during pregnancy.
This condition is life-threatening and must be treated according to neonatology experts' protocols.
Precautions should be taken if opioid use is required for prolonged periods in pregnant women.

Use of aspirin and oxycodone while breastfeeding

Breast milk contains aspirin and oxycodone.
The manufacturer does not recommend breast-feeding due to the risk of serious adverse reactions in nursing infants. Please consult individual agents.

Oxycodone and aspirin (Percodan) Dose in Kidney Disease:

GFR ≥10 mL/minute:
- There are no dosage adjustments provided in the manufacturer’s labeling; use cautiously.
GFR <10 mL/minute:
- Avoid use.

Oxycodone and aspirin (Percodan) Dose in Liver Disease:

Mild to moderate impairment:
- There are no dosage adjustments provided in the manufacturer’s labeling; use cautiously.
Severe impairment:
- Avoid use.

Side effects of Oxycodone and aspirin (Percodan):

Cardiovascular:
- Circulatory Depression
- Shock
Central Nervous System:
- Dizziness
- Dysphoria
- Euphoria
- Sedation
Dermatologic:
- Pruritus
Gastrointestinal:
- Constipation
Respiratory:
- Apnea
- Respiratory Depression

Contraindications to Oxycodone and aspirin (Percodan):

Hypersensitivity (eg, angioedema) to oxycodone, aspirin, or any component of the formulation;
Use in children and teens for viral infections with or without fever
Significant respiratory depression
Paralytic ileus, gastrointestinal obstruction (known or suspected);
Acute or severe bronchial asthma in unmonitored settings or without resuscitative devices;
Hemophilia.

There is not much evidence of cross-reactivity between opioids and allergenic opioids. Cross-sensitivity is possible due to similarities in chemical structure or pharmacologic effects.

Warnings and precautions

CNS depression:
- CNS depression can lead to impairment of mental or physical abilities.
- Patients should be cautious about performing tasks that require mental alertness, such as operating machinery or driving.
Constipation
- Patients with unstable angina or post-myocardial injury may experience constipation from Oxycodone.
- To reduce constipation, consider preventive measures such as stool softener or increased fiber.
Hypotension
- This medication may cause severe hypotension, including orthostatic hypotension, syncope, and heart disease.
- Patients with hypovolemia, cardiac disease (including acute MI), and drugs that can increase hypotensive effects (e.g phenothiazines or general sedatives) should be cautious.
- After starting or increasing the dose, monitor for hypotension.
- Patients with circulatory shock should not use this product.
Phenanthrene hypersensitivity:
- Patients with hypersensitivity reactions to other phenanthrene-derived opioid agonists (codeine/hydrodone/hydromorphone, hydromorphone/levorphanol, and oxymorphone) should be cautious.
Respiratory depression [US Boxed Warning]
- Oxycodone/aspirin may cause severe, life-threatening or fatal respiratory depression.
- Monitor for signs of respiratory depression during therapy, especially after an increase in dose.
- The sedative effects of opioids can be exacerbated by carbon dioxide retention due to opioid-induced respiratory depression.
Sensitivity to salicylates:
- Patients who are sensitive to tartrazine dyes, nasal Polyps, or asthma could be at greater risk for salicylate sensitivity.
Tinnitus
- If you develop tinnitus, or hearing loss, stop using the product.
Conditions abdominales:
- Patients with acute abdominal conditions may not be diagnosed or treated appropriately.
Adrenocortical Insufficiency
- Patients with adrenal insufficiency (including Addison disease) should be cautious.
- Long-term opioid abuse can lead to secondary hypogonadism. This could cause infertility, sexual dysfunction, mood disorders, and osteoporosis.
Insufficiency of the biliary tract:
- Patients with biliary impairment or acute pancreatitis should be cautious. Opioids may cause constriction in the sphincter.
Bleeding disorders:
- Patients with bleeding and platelet disorders should not take aspirin.
CNS depression/coma:
- Patients with impaired consciousness and coma should not be used as they are more susceptible to the intracranial effects CO retention.
Delirium tremens:
- Patients with delirium-tremens should be cautious.
Use of ethanol:
- Bleeding risks can be increased by excessive ethanol consumption (>3 drinks/day).
Gastrointestinal Disease:
- Patients with peptic ulcer disease or erosive gastritis should be cautious.
Head trauma
- Patients with intracranial injuries, intracranial lesions or elevated intracranial Pressure (ICP) should be cautious. Exaggerated ICP increases may occur.
Hepatic impairment
- Patients with severe impairment should be cautious.
Mental health conditions
- Patients with mental health conditions such as depression, anxiety disorders, and post-traumatic stress disorder (eg., depression, anxiety disorders, and post-traumatic stress disorder), should be cautious when using opioids for chronic pain. It is important to monitor patients closely for signs of overdose or opioid addiction.
Obesity:
- Patients who are obese or morbid should be treated with caution.
Prostatic hyperplasia/urinary restriction:
- Patients with prostatic hyperplasia or urinary stricture should be cautious.
Psychosis:
- Patients with toxic psychosis should be treated cautiously
Renal impairment
- Avoid use in patients suffering from renal dysfunction.
Respiratory disease
- Patients with severe chronic obstructive lung disease (or cor pulmonale) should be careful when using oxycodone.
- Also, patients with hypoxia, hypercapnia, significant respiratory depression or preexisting respiratory depression should be monitored, particularly when starting and titrating treatment.
- Critical respiratory depression can occur, even at therapeutic doses.
- You might consider using non-opioid analgesics for these patients.
Seizures:
- Patients with seizure disorders should be cautious.
Sleep-disordered breathing
- Patients with sleep-disordered or HF breathing should be advised to avoid opioids for chronic pain.
- Patients with severe or moderate sleep-disordered breathing should avoid opioids
Thyroid dysfunction:
- Patients with thyroid dysfunction should be cautious

Oxycodone and aspirin: Drug Interaction

Risk Factor C (Monitor therapy)
Agents with Antiplatelet Properties (e.g., P2Y12 inhibitors, NSAIDs, SSRIs, etc.)	May enhance the adverse/toxic effect of Salicylates. Increased risk of bleeding may result.
Agents with Antiplatelet Properties (e.g., P2Y12 inhibitors, NSAIDs, SSRIs, etc.)	May enhance the antiplatelet effect of other Agents with Antiplatelet Properties.
Ajmaline	Salicylates may enhance the adverse/toxic effect of Ajmaline. Specifically, the risk for cholestasis may be increased.
Alendronate	Aspirin may enhance the adverse/toxic effect of Alendronate. Specifically, the incidence of upper gastrointestinal adverse events may be increased
Alizapride	May enhance the CNS depressant effect of CNS Depressants.
Ammonium Chloride	May increase the serum concentration of Salicylates.
Amphetamines	May enhance the analgesic effect of Opioid Agonists.
Angiotensin-Converting Enzyme Inhibitors	Salicylates may enhance the nephrotoxic effect of Angiotensin-Converting Enzyme Inhibitors. Salicylates may diminish the therapeutic effect of Angiotensin-Converting Enzyme Inhibitors.
Anticholinergic Agents	May enhance the adverse/toxic effect of Opioid Agonists. Specifically, the risk for constipation and urinary retention may be increased with this combination.
Anticoagulants	Agents with Antiplatelet Properties may enhance the anticoagulant effect of Anticoagulants. Exceptions: Bemiparin; Enoxaparin; Heparin.
Anticoagulants	Salicylates may enhance the anticoagulant effect of Anticoagulants.
Aprepitant	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Benzbromarone	Salicylates may diminish the therapeutic effect of Benzbromarone.
Blood Glucose Lowering Agents	Salicylates may enhance the hypoglycemic effect of Blood Glucose Lowering Agents.
Bosentan	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Brimonidine (Topical)	May enhance the CNS depressant effect of CNS Depressants.
Bromopride	May enhance the CNS depressant effect of CNS Depressants.
Calcium Channel Blockers (Nondihydropyridine)	May enhance the antiplatelet effect of Aspirin.
Cannabidiol	May enhance the CNS depressant effect of CNS Depressants.
Cannabis	May enhance the CNS depressant effect of CNS Depressants.
Cephalothin	Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Cephalothin. Specifically, the risk for bleeding may be increased.
Chlorphenesin Carbamate	May enhance the adverse/toxic effect of CNS Depressants.
Clofazimine	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Collagenase (Systemic)	Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Collagenase (Systemic). Specifically, the risk of injection site bruising and/or bleeding may be increased.
Corticosteroids (Systemic)	Salicylates may enhance the adverse/toxic effect of Corticosteroids (Systemic). These specifically include gastrointestinal ulceration and bleeding. Corticosteroids (Systemic) may decrease the serum concentration of Salicylates. Withdrawal of corticosteroids may result in salicylate toxicity.
CYP3A4 Inducers (Moderate)	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
CYP3A4 Inhibitors (Moderate)	May enhance the adverse/toxic effect of OxyCODONE. CYP3A4 Inhibitors (Moderate) may increase the serum concentration of OxyCODONE. Serum concentrations of the active metabolite Oxymorphone may also be increased.
Deferasirox	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Deoxycholic Acid	Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Deoxycholic Acid. Specifically, the risk for bleeding or bruising in the treatment area may be increased.
Desmopressin	Opioid Agonists may enhance the adverse/toxic effect of Desmopressin.
Dimethindene (Topical)	May enhance the CNS depressant effect of CNS Depressants.
Diuretics	Opioid Agonists may enhance the adverse/toxic effect of Diuretics. Opioid Agonists may diminish the therapeutic effect of Diuretics.
Dronabinol	May enhance the CNS depressant effect of CNS Depressants.
Duvelisib	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Erdafitinib	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Erdafitinib	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Fat Emulsion (Fish Oil Based	May enhance the adverse/toxic effect of Agents with Antiplatelet Properties.
Felbinac	May enhance the adverse/toxic effect of Aspirin.
Fosaprepitant	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Fosnetupitant	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Gastrointestinal Agents (Prokinetic	Opioid Agonists may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic).
Glucosamine	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Gold Sodium Thiomalate	Aspirin may enhance the adverse/toxic effect of Gold Sodium Thiomalate. Specifically, liver function tests may be elevated when these agents are combined.
Heparin	Aspirin may enhance the anticoagulant effect of Heparin.
Ibritumomab Tiuxetan	Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Ibritumomab Tiuxetan. Both agents may contribute to impaired platelet function and an increased risk of bleeding.
Ibrutinib	May enhance the adverse/toxic effect of Agents with Antiplatelet Properties.
Inotersen	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Ivosidenib	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Kava Kava	May enhance the adverse/toxic effect of CNS Depressants.
Larotrectinib	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Lesinurad	Aspirin may diminish the therapeutic effect of Lesinurad.
Limaprost	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Lofexidine	May enhance the CNS depressant effect of CNS Depressants. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs.
Loop Diuretics	Salicylates may diminish the diuretic effect of Loop Diuretics. Loop Diuretics may increase the serum concentration of Salicylates.
Magnesium Sulfate	May enhance the CNS depressant effect of CNS Depressants.
MetyroSINE	CNS Depressants may enhance the sedative effect of MetyroSINE.
Minocycline	May enhance the CNS depressant effect of CNS Depressants.
Multivitamins/Fluoride (with ADE)	May enhance the antiplatelet effect of Aspirin. Aspirin may decrease the serum concentration of Multivitamins/Fluoride (with ADE). Specifically, aspirin may decrease the absorption of ascorbic acid.
Multivitamins/Minerals (with ADEK, Folate, Iron)	May enhance the antiplatelet effect of Aspirin. Aspirin may decrease the serum concentration of Multivitamins/Minerals (with ADEK, Folate, Iron). Specifically, aspirin may decrease absorption of ascorbic acid.
Multivitamins/Minerals (with AE, No Iron)	May enhance the antiplatelet effect of Aspirin. Aspirin may decrease the serum concentration of Multivitamins/Minerals (with AE, No Iron). Specifically, aspirin may decrease the absorption of ascorbic acid.
Nabilone	May enhance the CNS depressant effect of CNS Depressants.
Netupitant	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Nicorandil	Aspirin may enhance the adverse/toxic effect of Nicorandil. Specifically, the risk of gastrointestinal ulceration and hemorrhage may be increased.
Obinutuzumab	Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Obinutuzumab. Specifically, the risk of serious bleeding-related events may be increased.
Omega-3 Fatty Acids	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Palbociclib	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Pegvisomant	Opioid Agonists may diminish the therapeutic effect of Pegvisomant.
Pentosan Polysulfate Sodium	May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. Specifically, the risk of bleeding may be increased by concurrent use of these agents.
Pentoxifylline	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Piribedil	CNS Depressants may enhance the CNS depressant effect of Piribedil.
Potassium Phosphate	May increase the serum concentration of Salicylates.
Pramipexole	CNS Depressants may enhance the sedative effect of Pramipexole.
Probenecid	Salicylates may diminish the therapeutic effect of Probenecid.
Prostacyclin Analogues	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Ramosetron	Opioid Agonists may enhance the constipating effect of Ramosetron.
RifAMPin	May decrease the serum concentration of OxyCODONE.
ROPINIRole	CNS Depressants may enhance the sedative effect of ROPINIRole.
Rotigotine	CNS Depressants may enhance the sedative effect of Rotigotine.
Rufinamide	May enhance the adverse/toxic effect of CNS Depressants. Specifically, sleepiness and dizziness may be enhanced.
Salicylates	Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Salicylates. Increased risk of bleeding may result.
Salicylates	May enhance the anticoagulant effect of other Salicylates.
Sarilumab	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Selective Serotonin Reuptake Inhibitors	May enhance the antiplatelet effect of Aspirin.
Serotonin Modulators	Opioid Agonists may enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Exceptions: Nicergoline.
Serotonin/Norepinephrine Reuptake Inhibitors	May enhance the antiplatelet effect of Aspirin.
Siltuximab	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Simeprevir	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Spironolactone	Aspirin may diminish the therapeutic effect of Spironolactone.
St John's Wort	May decrease the serum concentration of OxyCODONE.
Succinylcholine	May enhance the bradycardic effect of Opioid Agonists.
Tetrahydrocannabinol	May enhance the CNS depressant effect of CNS Depressants.
Tetrahydrocannabinol and Cannabidiol	May enhance the CNS depressant effect of CNS Depressants.
Thrombolytic Agents	Agents with Antiplatelet Properties may enhance the anticoagulant effect of Thrombolytic Agents.
Thrombolytic Agents	Salicylates may enhance the adverse/toxic effect of Thrombolytic Agents. An increased risk of bleeding may occur.
Tiludronate	Aspirin may decrease the serum concentration of Tiludronate.
Tipranavir	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Tocilizumab	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Valproate Products	Salicylates may increase the serum concentration of Valproate Products.
Vitamin E (Systemic	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Risk Factor D (Consider therapy modification)
Alcohol (Ethyl)	May enhance the adverse/toxic effect of Aspirin. Specifically, alcohol may increase the bleeding risk of aspirin. Alcohol (Ethyl) may diminish the therapeutic effect of Aspirin. Specifically, alcohol may interfere with the controlled release mechanism of extended release aspirin. Management: Monitor patients who drink 3 or more alcoholic drinks a day for increased bleeding while taking aspirin. Counsel patients about the risk of bleeding and discourage such consumption. Give extended release aspirin 2 hours before, or 1 hour after, alcohol.
Alvimopan	Opioid Agonists may enhance the adverse/toxic effect of Alvimopan. This is most notable for patients receiving long-term (i.e., more than 7 days) opiates prior to alvimopan initiation. Management: Alvimopan is contraindicated in patients receiving therapeutic doses of opioids for more than 7 consecutive days immediately prior to alvimopan initiation.
Apixaban	Aspirin may enhance the adverse/toxic effect of Apixaban. Specifically, the risk for bleeding may be increased. Management: Carefully consider risks and benefits of this combination and monitor closely.
Bemiparin	Agents with Antiplatelet Properties may enhance the anticoagulant effect of Bemiparin. Management: Avoid concomitant use of bemiparin with antiplatelet agents. If concomitant use is unavoidable, monitor closely for signs and symptoms of bleeding.
Blonanserin	CNS Depressants may enhance the CNS depressant effect of Blonanserin.
Carbonic Anhydrase Inhibitors	Salicylates may enhance the adverse/toxic effect of Carbonic Anhydrase Inhibitors. Salicylate toxicity might be enhanced by this same combination. Management: Avoid these combinations when possible.Dichlorphenamide use with high-dose aspirin as contraindicated. If another combination is used, monitor patients closely for adverse effects. Tachypnea, anorexia, lethargy, and coma have been reported. Exceptions: Brinzolamide; Dorzolamide.
Chlormethiazole	May enhance the CNS depressant effect of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used.
CNS Depressants	May enhance the CNS depressant effect of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.
CYP3A4 Inducers (Strong)	May increase the metabolism of CYP3A4 Substrates (High risk with Inducers). Management: Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated. Consult appropriate manufacturer labeling.
CYP3A4 Inhibitors (Strong	May enhance the adverse/toxic effect of OxyCODONE. CYP3A4 Inhibitors (Strong) may increase the serum concentration of OxyCODONE. Serum concentrations of the active metabolite oxymorphone may also be increased.
Dabigatran Etexilate	Aspirin may enhance the adverse/toxic effect of Dabigatran Etexilate. Specifically, the risk for bleeding may be increased. Management: Carefully consider risks and benefits of this combination and monitor closely; Canadian labeling states that low dose aspirin could be considered, but the use of antiplatelets are not recommended for stroke prevention in patients with atrial fibrillation.
Dabrafenib	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Seek alternatives to the CYP3A4 substrate when possible. If concomitant therapy cannot be avoided, monitor clinical effects of the substrate closely (particularly therapeutic effects).
Dasatinib	May enhance the anticoagulant effect of Agents with Antiplatelet Properties. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs.
Droperidol	May enhance the CNS depressant effect of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Exceptions to this monograph are discussed in further detail in separate drug interaction monographs.
Edoxaban	Aspirin may enhance the adverse/toxic effect of Edoxaban. Specifically, the risk of bleeding may be increased. Aspirin may increase the serum concentration of Edoxaban. Management: Carefully consider the anticipated risks and benefits of this combination. If combined, increased monitoring for bleeding is recommended.
Enoxaparin	Agents with Antiplatelet Properties may enhance the anticoagulant effect of Enoxaparin. Management: Discontinue antiplatelet agents prior to initiating enoxaparin whenever possible. If concomitant administration is unavoidable, monitor closely for signs and symptoms of bleeding.
Enzalutamide	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Concurrent use of enzalutamide with CYP3A4 substrates that have a narrow therapeutic index should be avoided. Use of enzalutamide and any other CYP3A4 substrate should be performed with caution and close monitoring.
Flunitrazepam	CNS Depressants may enhance the CNS depressant effect of Flunitrazepam.
Ginkgo Biloba	May enhance the anticoagulant effect of Salicylates. Management: Consider alternatives to this combination of agents. Monitor for signs and symptoms of bleeding (especially intracranial bleeding) if salicylates are used in combination with ginkgo biloba.
Herbs (Anticoagulant/Antiplatelet Properties) (eg, Alfalfa, Anise, Bilberry)	May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. Bleeding may occur. Management: Avoid combination when possible. If used, monitor more closely for evidence of bleeding. Discontinue herbal products with anticoagulant or antiplatelet actions 2 weeks prior to surgical, dental, or invasive procedures.
Herbs (Anticoagulant/Antiplatelet Properties) (eg, Alfalfa, Anise, Bilberry)	May enhance the adverse/toxic effect of Salicylates. Bleeding may occur.
Hyaluronidase	Salicylates may diminish the therapeutic effect of Hyaluronidase. Management: Patients receiving salicylates (particularly at larger doses) may not experience the desired clinical response to standard doses of hyaluronidase. Larger doses of hyaluronidase may be required.
HYDROcodone	CNS Depressants may enhance the CNS depressant effect of HYDROcodone. Management: Avoid concomitant use of hydrocodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.
Lorlatinib	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Avoid concurrent use of lorlatinib with any CYP3A4 substrates for which a minimal decrease in serum concentrations of the CYP3A4 substrate could lead to therapeutic failure and serious clinical consequences.
Methotrexate	Salicylates may increase the serum concentration of Methotrexate. Salicylate doses used for prophylaxis of cardiovascular events are not likely to be of concern.
Methotrimeprazine	CNS Depressants may enhance the CNS depressant effect of Methotrimeprazine. Methotrimeprazine may enhance the CNS depressant effect of CNS Depressants. Management: Reduce adult dose of CNS depressant agents by 50% with initiation of concomitant methotrimeprazine therapy. Further CNS depressant dosage adjustments should be initiated only after clinically effective methotrimeprazine dose is established.
MiFEPRIStone	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Management: Minimize doses of CYP3A4 substrates, and monitor for increased concentrations/toxicity, during and 2 weeks following treatment with mifepristone. Avoid cyclosporine, dihydroergotamine, ergotamine, fentanyl, pimozide, quinidine, sirolimus, and tacrolimus.
Mitotane	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Doses of CYP3A4 substrates may need to be adjusted substantially when used in patients being treated with mitotane.
Monoamine Oxidase Inhibitors	OxyCODONE may enhance the serotonergic effect of Monoamine Oxidase Inhibitors. This could result in serotonin syndrome. Management: Seek alternatives when possible. Avoid use of oxycodone/naltrexone during and within 14 days after monoamine oxidase inhibitor treatment. Non-US labeling for some oxycodone products states that such use is contraindicated.
Nalmefene	May diminish the therapeutic effect of Opioid Agonists. Management: Avoid the concomitant use of nalmefene and opioid agonists. Discontinue nalmefene 1 week prior to any anticipated use of opioid agonistss. If combined, larger doses of opioid agonists will likely be required.
Naltrexone	May diminish the therapeutic effect of Opioid Agonists. Management: Seek therapeutic alternatives to opioids. See full drug interaction monograph for detailed recommendations.
Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective)	Aspirin may enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective). Management: Concurrent use of aspirin at doses beyond cardioprotective levels is not recommended. While concurrent use of low-dose aspirin with a COX-2 inhibitor is permissable, patients should be monitored closely for signs/symptoms of GI ulceration/bleeding.
Nonsteroidal Anti-Inflammatory Agents (Nonselective)	May enhance the adverse/toxic effect of Salicylates. An increased risk of bleeding may be associated with use of this combination. Nonsteroidal Anti-Inflammatory Agents (Nonselective) may diminish the cardioprotective effect of Salicylates. Salicylates may decrease the serum concentration of Nonsteroidal Anti-Inflammatory Agents (Nonselective).
Perampanel	May enhance the CNS depressant effect of CNS Depressants. Management: Patients taking perampanel with any other drug that has CNS depressant activities should avoid complex and high-risk activities, particularly those such as driving that require alertness and coordination, until they have experience using the combination.
PHENobarbital	May enhance the CNS depressant effect of OxyCODONE. PHENobarbital may decrease the serum concentration of OxyCODONE. Management: Avoid use of oxycodone and phenobarbital when possible. Monitor for respiratory depression/sedation. Because phenobarbital is also a strong CYP3A4 inducer, monitor for decreased oxycodone efficacy and withdrawal if combined.
PRALAtrexate	Salicylates may increase the serum concentration of PRALAtrexate. Salicylate doses used for prophylaxis of cardiovascular events are unlikely to be of concern.
Primidone	May enhance the CNS depressant effect of OxyCODONE. Primidone may decrease the serum concentration of OxyCODONE. Management: Avoid use of oxycodone and primidone when possible. Monitor for respiratory depression/sedation. Because primidone is also a strong CYP3A4 inducer, monitor for decreased oxycodone efficacy and withdrawal if combined.
Rivaroxaban	Aspirin may enhance the adverse/toxic effect of Rivaroxaban. Specifically, the risk of bleeding may be increased. Management: Carefully consider risks and benefits of this combination and monitor closely.
Sincalide	Drugs that Affect Gallbladder Function may diminish the therapeutic effect of Sincalide. Management: Consider discontinuing drugs that may affect gallbladder motility prior to the use of sincalide to stimulate gallbladder contraction.
Sodium Oxybate	May enhance the CNS depressant effect of CNS Depressants. Management: Consider alternatives to combined use. When combined use is needed, consider minimizing doses of one or more drugs. Use of sodium oxybate with alcohol or sedative hypnotics is contraindicated.
Stiripentol	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Management: Use of stiripentol with CYP3A4 substrates that are considered to have a narrow therapeutic index should be avoided due to the increased risk for adverse effects and toxicity. Any CYP3A4 substrate used with stiripentol requires closer monitoring.
Sucroferric Oxyhydroxide	May decrease the serum concentration of Aspirin. Management: Administer aspirin at least 1 hour before administration of sucroferric oxyhydroxide.
Suvorexant	CNS Depressants may enhance the CNS depressant effect of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended.
Talniflumate	Aspirin may enhance the adverse/toxic effect of Talniflumate. Management: When possible, consider alternatives to this combination. Concurrent use is generally not recommended.
Tapentadol	May enhance the CNS depressant effect of CNS Depressants. Management: Avoid concomitant use of tapentadol and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.
Ticagrelor	Aspirin may enhance the antiplatelet effect of Ticagrelor. Aspirin may diminish the therapeutic effect of Ticagrelor. More specifically, the benefits of ticagrelor relative to clopidogrel may be diminished in adult patients receiving daily aspirin doses greater than 100-150 mg daily. Management: Avoid daily aspirin doses greater than 100 mg in adults receiving ticagrelor. Canadian recommendations are to avoid adult daily aspirin doses greater than 150 mg. Daily low-dose aspirin (U.S.: 75-100 mg; Canada: 75-150 mg) is recommended.
Varicella Virus-Containing Vaccines	Salicylates may enhance the adverse/toxic effect of Varicella Virus-Containing Vaccines. Reye's Syndrome may develop.
Vitamin K Antagonists (eg, warfarin)	Salicylates may enhance the anticoagulant effect of Vitamin K Antagonists.
Voriconazole	May enhance the adverse/toxic effect of OxyCODONE. Voriconazole may increase the serum concentration of OxyCODONE. Management: A reduced oxycodone dose may be necessary with concurrent voriconazole. Increased frequency and duration of monitoring for oxycodone-related adverse effects is recommended.
Zolpidem	CNS Depressants may enhance the CNS depressant effect of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol.
Risk Factor X (Avoid combination)
Azelastine (Nasal)	CNS Depressants may enhance the CNS depressant effect of Azelastine (Nasal).
Bromperidol	May enhance the CNS depressant effect of CNS Depressants.
Conivaptan	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Dexibuprofen	Aspirin may enhance the adverse/toxic effect of Dexibuprofen. Dexibuprofen may diminish the cardioprotective effect of Aspirin.
Dexketoprofen	Salicylates may enhance the adverse/toxic effect of Dexketoprofen. Dexketoprofen may diminish the therapeutic effect of Salicylates. Salicylates may decrease the serum concentration of Dexketoprofen. Management: The use of high-dose salicylates (3 g/day or more in adults) together with dexketoprofen is inadvisable. Consider administering dexketoprofen 30-120 min after or at least 8 hrs before cardioprotective doses of aspirin to minimize any possible interaction.
Eluxadoline	Opioid Agonists may enhance the constipating effect of Eluxadoline.
Floctafenine	May enhance the adverse/toxic effect of Aspirin. An increased risk of bleeding may be associated with use of this combination. Floctafenine may diminish the cardioprotective effect of Aspirin.
Fusidic Acid (Systemic)	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Idelalisib	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Influenza Virus Vaccine (Live/Attenuated)	May enhance the adverse/toxic effect of Salicylates. Specifically, Reye's syndrome may develop.
Ketorolac (Nasal)	May enhance the adverse/toxic effect of Aspirin. An increased risk of bleeding may be associated with use of this combination. Ketorolac (Nasal) may diminish the cardioprotective effect of Aspirin.
Ketorolac (Systemic)	May enhance the adverse/toxic effect of Aspirin. An increased risk of bleeding may be associated with use of this combination. Ketorolac (Systemic) may diminish the cardioprotective effect of Aspirin.
Macimorelin	Aspirin may diminish the diagnostic effect of Macimorelin.
Omacetaxine	Aspirin may enhance the adverse/toxic effect of Omacetaxine. Specifically, the risk for bleeding-related events may be increased. Management: Avoid concurrent use of aspirin with omacetaxine in patients with a platelet count of less than 50,000/uL.
Opioids (Mixed Agonist / Antagonist)	May diminish the analgesic effect of Opioid Agonists. Management: Seek alternatives to mixed agonist/antagonist opioids in patients receiving pure opioid agonists, and monitor for symptoms of therapeutic failure/high dose requirements (or withdrawal in opioid-dependent patients) if patients receive these combinations.
Orphenadrine	CNS Depressants may enhance the CNS depressant effect of Orphenadrine.
Oxomemazine	May enhance the CNS depressant effect of CNS Depressants.
Paraldehyde	CNS Depressants may enhance the CNS depressant effect of Paraldehyde.
Sulfinpyrazone	Salicylates may decrease the serum concentration of Sulfinpyrazone.
Thalidomide	CNS Depressants may enhance the CNS depressant effect of Thalidomide.
Urokinase	Agents with Antiplatelet Properties may enhance the anticoagulant effect of Urokinase.

Monitoring Parameters:

Pain relief,
respiratory and mental status,
blood pressure;
bowel function;
signs/symptoms of misuse, abuse, and addiction;
signs or symptoms of hypogonadism or hypoadrenalism with longterm use.

Alternate recommendations:

Chronic pain (long-term therapy outside of end-of-life or palliative care, active cancer treatment, sickle cell disease, or medication-assisted treatment for opioid use disorder):
Assess benefits/risks of opioid therapy within 1 to 4 weeks of treatment initiation and with dose increases.
Re-evaluate benefits/risks every 3 months during therapy or more frequently in patients at increased risk of overdose or opioid use disorder.
Urine drug testing is recommended before starting and re-checking should be considered at least annually (includes controlled prescription medications and illicit drugs of abuse).
State prescription drug monitoring program (PDMP) data should be reviewed by clinicians before beginning and periodically during therapy (frequency ranging from every prescription to every 3 months).

How to administer Oxycodone and aspirin (Percodan)?

Administer with or without meals.

Mechanism of action of Oxycodone and aspirin (Percodan):

Oxycodone

The CNS is affected by opiate receptors.
This causes inhibition of ascending pain pathways and alters the perception and response to pain.

Aspirin:

It inhibits platelet accumulation by irreversible inhibition platelet cyclooxygenase.
This in turn, inhibits the production of prostaglandins A and thromboxane.

International Brand Names of Oxycodone and aspirin:

Percodan
TEVA-Oxycodan

Oxycodone and aspirin Brand Names in Pakistan:

No Brands Available in Pakistan.

Oxycodone and Aspirin (Percodan) - Uses, Dose, SIde effects, MOA

Oxycodone and aspirin Uses:

Pain management:

Oxycodone and aspirin (Percodan) Dose in Adults

Oxycodone and aspirin (Percodan) Dose in Pain management:

Discontinuation of therapy:

Oxycodone and aspirin (Percodan) Dose in Children

Oxycodone and aspirin (Percodan) Dose in moderate to severe pain:

Children and Adolescents:

Oxycodone and aspirin (Percodan) Pregnancy Risk Category: D

Use of aspirin and oxycodone while breastfeeding

Oxycodone and aspirin (Percodan) Dose in Kidney Disease:

GFR ≥10 mL/minute:

GFR <10 mL/minute:

Oxycodone and aspirin (Percodan) Dose in Liver Disease:

Mild to moderate impairment:

Severe impairment:

Side effects of Oxycodone and aspirin (Percodan):

Cardiovascular:

Central Nervous System:

Dermatologic:

Gastrointestinal:

Respiratory:

Contraindications to Oxycodone and aspirin (Percodan):

Warnings and precautions

CNS depression:

Constipation

Hypotension

Phenanthrene hypersensitivity:

Respiratory depression [US Boxed Warning]

Sensitivity to salicylates:

Tinnitus

Conditions abdominales:

Adrenocortical Insufficiency

Insufficiency of the biliary tract:

Bleeding disorders:

CNS depression/coma:

Delirium tremens:

Use of ethanol:

Gastrointestinal Disease:

Head trauma

Hepatic impairment

Mental health conditions

Obesity:

Prostatic hyperplasia/urinary restriction:

Psychosis:

Renal impairment

Respiratory disease

Seizures:

Sleep-disordered breathing

Thyroid dysfunction:

Monitoring Parameters:

How to administer Oxycodone and aspirin (Percodan)?

Mechanism of action of Oxycodone and aspirin (Percodan):

International Brand Names of Oxycodone and aspirin:

Oxycodone and aspirin Brand Names in Pakistan:

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