Percocet (Oxycodone and acetaminophen) - Uses, Dosage

Percocet (Oxycodone and acetaminophen) is an analgesic medicine used orally to treat moderate to severe pain.

Percocet (Oxycodone and acetaminophen) Uses:

Pain management
- Extended-release:
  - Management of acute pain severe enough to require opioid treatment and for which alternative treatment options are not enough.
- Immediate release:
  - Endocet, Primlev:
    - for moderate to fairly severe pain that cannot be adequately treated by other methods but is severe enough to necessitate an opioid analgesic.
  - Percocet:
    - if the pain is severe enough to need the use of opioids and alternate treatments are insufficient.
- Limitations of use:
  - Reserved for cases where alternative pain management options (eg, nonopioid analgesics) are not effective, not tolerated, or would be otherwise inadequate.

Percocet Dose in Adults

Note:
- The initial dose is according to the oxycodone content; however, the maximum per day dose is based on the acetaminophen content.

Percocet Dose in Pain management:

Extended-release:
- Oral: Usual dose: 2 tablets every 12 hours; the second initial dose may be administered as early as 8 hours after the first initial dose if needed; subsequent doses are to be administered 2 tablets every 12 hours.
- Do not exceed acetaminophen 4 g/day.
- NOTE: Because they have different pharmacokinetic characteristics that influence how frequently patients should take their medications, oxycodone/acetaminophen ER and other oxycodone/acetaminophen formulations cannot be substituted for one another.
Immediate-release:
- Oral: It is important to titrate doses for the right analgesic effects.
- Initial dose, based on oxycodone content: 5 mg (moderate pain) or 10 to 20 mg (severe pain) or 2.5 to 10 mg (drug manufacturer's labeling).
- Doses typically are given every 4 to 6 hours as required.
- Do not exceed acetaminophen 4 g/day.
Discontinuation of therapy:
- When stopping chronic opioid medication, the dose should be reduced gradually.
- There isn't yet a consensus on the ideal tapering timeline for everyone.
- The suggested schedules range from gradual (10% dose decreases per week, for example) to abrupt (25–50% dose reductions every few days).
- Individualized tapering schedules should be used to reduce opioid withdrawal while taking into account the aims and issues unique to the patient as well as the pharmacokinetics of the opioid being reduced.
- Patients who have been taking opioids for a long time (years, for example) may benefit from an even slower decline, especially in the last stages of decreasing, whereas those who are having significant side events may benefit from more fast taper.
- Watch out for withdrawal symptoms and indicators.
- Reduce the tapering timetable if the patient starts to experience withdrawal symptoms;
- The taper can be modified by extending the time between dose reductions, decreasing daily dose drops, stopping it until the patient is ready to resume it, and/or coadministering an alpha-2 agonist (such as clonidine) to cover withdrawal symptoms.
- Keep offering nonopioid analgesics as required for pain management during tapering of dose;
- consider nonopioid adjunctive treatments for withdrawal symptoms (eg, GI complaints, muscle spasm) as desired.

Percocet Dose in Children

Note:
- Doses based on total oxycodone content;
- titrate dose to appropriate analgesic effects;
- The maximum recommended daily dose of acetaminophen is 75 mg/kg/day, not to exceed 4000 mg/day, and not to exceed 5 doses in a 24-hour period.

Percocet Dose in the treatment of moderate Pain:

Children and Adolescents:
- Oral: 0.1 to 0.2 mg/kg/dose, normally administered every 4 to 6 hours as needed; every 6 hours is recommended on the manufacturer's label;
- 5 mg/dose is the maximum starting oxycodone dosage.

Percocet Dose in Severe Pain:

Children and Adolescents:
- First dose: Oral, 0.2 mg/kg/dose, normally administered every 4 to 6 hours as needed; every 6 hours is advised on the manufacturer's labelling;
- 10 mg is the maximum starting oxycodone dosage.

Pregnancy Risk Factor C

Long-term opiate use during pregnancy can result in opioid withdrawal syndrome in the newborn. [US Boxed Warning] If it is not treated right away, this could be fatal. Management must adhere to the neonatologists' guidelines.
Counsel the pregnant woman about the possibility of opioid withdrawal syndrome in the neonate if an opioid is needed for a prolonged period during pregnancy.
For more information, refer to the individual monographs.

Use of oxycodone or acetaminophen while breastfeeding

Breast milk contains oxycodone, acetaminophen, and other substances.
The manufacturer does not recommend breastfeeding due to the risk of serious adverse reactions in breastfeeding infants. Refer to the individual monographs.

Percocet Dose in Kidney Disease:

Extended-release:
- Initial dose: One tablet every 12 hours; adjust the dose as needed.
Immediate release:
- The labelling on the medication from the manufacturer does not mention dosage adjustments.
- Take with care, start at the low end of the dosing range, titrate cautiously, and keep a close eye on things.

Percocet Dose in Liver Disease:

Extended-release:
- Initial dose: One tablet every 12 hours; adjust the dose as needed.
Immediate release:
- The labelling on the medication from the manufacturer does not mention dosage adjustments. Take with care, start at the low end of the dosing range, titrate cautiously, and keep a close eye on things.

Common Side Effects of Percocet (Oxycodone and acetaminophen):

Central nervous system:
- Dizziness
Gastrointestinal:
- Nausea

Less Common Side Effects of Percocet (Oxycodone and acetaminophen):

Cardiovascular:
- Peripheral Edema
Central Nervous System:
- Headache
- Drowsiness
- Fatigue
- Insomnia
Dermatologic:
- Skin Rash
- Erythema
- Excoriation
- Pruritus
- Skin Blister
Endocrine & Metabolic:
- Hot Flash
Gastrointestinal:
- Vomiting
- Constipation
- Diarrhea
- Dyspepsia
- Xerostomia
Genitourinary:
- Dysuria
Hepatic:
- Increased Liver Enzymes
Respiratory:
- Cough

Percocet Side effects (Frequency unknown):

Cardiovascular:
- Circulatory Depression
- Hypotension
- Shock
Central Nervous System:
- Dysphoria
Dermatologic:
- Erythematous Dermatitis
Hematologic & Oncologic:
- Hemolytic Anemia
- Neutropenia
- Pancytopenia
- Thrombocytopenia
Respiratory:
- Apnea
- Respiratory Depression

Contraindications to Percocet (Oxycodone and acetaminophen):

Hypersensitivity to oxycodone, Acetaminophen or any other component of the formulation (eg, anaphylaxis);
Significant respiratory depression
Acute or severe bronchial asthma (in a setting without monitoring or in the absence de resuscitative devices);
Paralytic ileus, GI obstruction (known or suspected).

Additional contraindications specific to product types: Endocet, Primlev: Hypercarbia

There is not much evidence of cross-reactivity between opioids and allergens. Cross-sensitivity cannot be ruled out because of similarities in chemical structures and/or pharmacologic effects.

Canadian labeling:Additional contraindications not listed in the US labeling:

Severe hepatic impairment or active liver disease
Suspected surgical abdomen (eg acute appendicitis, pancreatitis)
Mild pain can be managed with pain medication;
Chronic obstructive Airway; cor Pulmonale
acute alcoholism, delirium tremens, or convulsive disorders;
severe CNS depression,
Increased cerebrospinal and intracranial pressure
or head injury
Concurrent use within 14 days of MAOI therapy or with it;
Pregnant women and during labor and birth;
Breastfeeding

Warnings and precautions

CNS depression:
- CNS depression can lead to mental and physical impairments.
- Patients must be aware of the dangers involved in driving, operating machinery, or other activities that require mental alertness.
Constipation
- Patients with unstable angina or post-MI may experience constipation from Oxycodone.
- To reduce constipation, consider preventive measures such as stool softener or increased fiber.
Hepatotoxicity: [US Boxed Warning]
- Acute liver failure cases have been associated with acetaminophen use. Sometimes, this can result in liver transplantation or death.
- The majority of hepatic damage cases involve multiple acetaminophen-containing products and are associated with daily dosages of acetaminophen greater than 4 g.
- Alcohol usage, a history of liver disease, and the use of many acetaminophen-containing drugs all raise risk.
- Some patients have suffered liver damage from chronic daily doses of alcohol in their adult lives.
Hypersensitivity and anaphylactic reactions
- Acetaminophen has been shown to cause hypersensitivity and anaphylactic reactions.
- If you experience symptoms of hypersensitivity or allergic reactions, discontinue use immediately.
Hypotension
- Hypotension can be severe (including orthostatic hypotension, syncope), and patients with cardiovascular disease (including acute MI) should be cautious.
- After dose titration or initiation, monitor for hypotension symptoms.
- Patients with circulatory shock should not use this product.
Phenanthrene hypersensitivity:
- Oxycodone should be used with extreme caution in patients with hypersensitivity/ Allergy reactions to other phenanthrene-derivative opioid agonists drugs i.e codeine, hydrocodone, hydromorphone, levorphanol, oxymorphone.
Respiratory depression [US Boxed Warning]
- It is possible to develop severe, life-threatening or fatal respiratory depression.
- You should monitor your respiratory health closely, especially when you start therapy or increase the dose.
- Crushing, chewing, or dissolving oxycodone/acetaminophen ER might cause a potentially deadly amount of oxycodone to be released and absorbed quickly. Instead, swallow the medication whole.
- The sedating effects that opioid-induced respiratory depression can cause carbon dioxide retention may be exaggerated by opioid-induced carbon dioxide retention.
Reactions to skin:
- Rarely have severe and potentially fatal skin reactions been caused by acetaminophen.
- The first sign of a skin rash should prompt you to stop treatment.
Conditions abdominales:
- This may make it difficult to diagnose or follow the clinical course of acute abdominal disorders.
Adrenocortical Insufficiency
- Patients with adrenal insufficiency (including Addison disease) should exercise caution.
- Opioid long-term use can cause secondary hypogonadism. This could lead to infertility and sexual dysfunction.
Insufficiency of the biliary tract:
- Patients with biliary dysfunction (including acute pancreatitis) should be cautious. Opioids may cause constriction to the sphincter.
CNS depression and coma
- Patients with CNS depression and coma should not be given this medication. They are more susceptible to the intracranial effects CO retention.
Delirium tremens:
- Patients with delirium-tremens should be taken with caution
G6PD deficiency:
- Acetaminophen should be used with caution in cases of G6PD deficiency.
Head trauma
- In the event of a head injury, brain lesion, or increased intracranial pressure, extreme caution should be exercised. There can also be an exacerbation of elevation.
Hepatic impairment
- Hepatic patients need to exercise caution.
- When you have alcoholic liver disease, be cautious.
- The chance of developing liver damage may increase if you drink more than three alcoholic beverages daily.
Mental health conditions
- Patients with mental health conditions should be cautious when using opioids for chronic pain (eg depression, anxiety disorders or post-traumatic stress disorder). This is because of the increased risk of opioid overdose and opioid dependence.
- It is advised to monitor your health more often.
Obesity:
- Patients who are severely obese should be taken with caution
Prostatic hyperplasia/urinary restriction:
- Patients with prostatic hyperplasia or urinary stricture should be cautious.
Psychosis:
- Patients with toxic psychosis should be treated with caution.
Renal impairment
- Patients with impaired renal function should be cautious.
Respiratory disease
- It is important to exercise caution when using this medication. Also, be aware of respiratory depression in COPD and cor pulmonale.
- Even with therapeutic doses, critical respiratory depression can occur.
- You might consider other non-opioid analgesics for such patients.
Seizures:
- Patients with seizure disorders should be cautious.
- may cause or exacerbate seizures.
Sleep-disordered breathing
- Patients with sleep-disordered breathing risk factors, such as HF or obesity, should exercise caution when using this medication for chronic pain.
- Those with mild to severe respiratory disorders during sleep should not use opioids.
Thyroid dysfunction:
- Patients with thyroid dysfunction should be cautious.

Oxycodone and acetaminophen (paracetamol): Drug Interaction

Risk Factor C (Monitor therapy)
Alizapride	May enhance the CNS depressant effect of CNS Depressants.
Amphetamines	May enhance the analgesic effect of Opioid Agonists.
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.
Aprepitant	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
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.
Busulfan	Acetaminophen may increase the serum concentration of Busulfan.
Cannabidiol	May enhance the CNS depressant effect of CNS Depressants.
Cannabis	May enhance the CNS depressant effect of CNS Depressants.
Chlorphenesin Carbamate	May enhance the adverse/toxic effect of CNS Depressants.
Clofazimine	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
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.
Dapsone (Topical)	May enhance the adverse/toxic effect of Methemoglobinemia Associated Agents.
Deferasirox	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
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).
Flucloxacillin	Acetaminophen's negative or hazardous effects might be exacerbated. Particularly, there may be an elevated risk for large anion gap metabolic acidosis.
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).
Imatinib	Acetaminophen may intensify Imatinib's hepatotoxic effects.
Isoniazid	Acetaminophen's negative or hazardous effects might be exacerbated.
Ivosidenib	May lower the serum level of CYP3A4 substrates (High risk with Inducers).
Kava Kava	CNS depressants' harmful or toxic effects could be increased.
Larotrectinib	May elevate CYP3A4 substrates' serum concentration (High risk with Inhibitors).
Local Anesthetics	The harmful or toxic effects of local anaesthetics may be increased by methemoglobinemia associated agents. In particular, there may be an elevated risk for methemoglobinemia.
Lofexidine	CNS depressants may have an enhanced CNS depressant impact. Management: Separate drug interaction monographs go into further detail about the medications indicated as exceptions to this book.
Magnesium Sulfate	CNS depressants may have an enhanced CNS depressant impact.
MetyraPONE	Acetaminophen serum concentration can rise. More crucially, metyrapone may change the metabolism of acetaminophen towards the oxidative pathway, which results in a hepatotoxic metabolite. This is because it inhibits the conjugative route of metabolism.
MetyroSINE	The sedative effects of metyroSINE may be strengthened by CNS depressants.
Minocycline	CNS depressants may have an enhanced CNS depressant impact.
Mipomersen	Acetaminophen may intensify Mipomersen's hepatotoxic effects.
Nabilone	CNS depressants may have an enhanced CNS depressant impact.
Netupitant	May elevate CYP3A4 substrates' serum concentration (High risk with Inhibitors).
Nitric Oxide	May intensify the harmful/toxic effects of agents associated with methemoglobinemia. Combinations of these medications may make substantial methemoglobinemia more likely. In the event that nitric oxide is combined with other medications, keep an eye out for any symptoms of methemoglobinemia in patients, such as hypoxia and cyanosis.
Palbociclib	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Pegvisomant	Opioid Agonists may diminish the therapeutic effect of Pegvisomant.
Phenylephrine (Systemic)	Phenylephrine's serum levels may rise after the use of acetaminophen (Systemic).
Piribedil	Piribedil's CNS depressing effects may be enhanced by other CNS depressants.
Pramipexole	The sedative effects of pramipexole might be enhanced by CNS depressants.
Prilocaine	The harmful or toxic effects of Prilocaine may be increased by methemoglobinemia associated agents. Combinations of these medications may make substantial methemoglobinemia more likely. Management: When prilocaine is combined with other medications known to cause the development of methemoglobinemia, patients should be watched for symptoms (such as hypoxia and cyanosis). When giving these medicines to newborns, avoid using lidocaine or prilocaine.
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.
Sarilumab	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Selective Serotonin Reuptake Inhibitors	CNS Depressants may enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors. Specifically, the risk of psychomotor impairment may be enhanced.
Serotonin Modulators	Opioid Agonists may enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Exceptions: Nicergoline.
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).
Sodium Nitrite	The harmful or toxic effects of sodium nitrite may be amplified by methemoglobinemia-associated agents. Combinations of these medications may make substantial methemoglobinemia more likely.
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.
Tocilizumab	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Vitamin K Antagonists (eg, warfarin)	The anticoagulant action of vitamin K antagonists may be enhanced by acetaminophen. This seems most likely when taking acetaminophen at levels above 1.3 or 2 g/day for several days in a row.
Risk Factor D (Consider therapy modification)
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.
Blonanserin	CNS Depressants may enhance the CNS depressant effect of Blonanserin.
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.
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	Acetaminophen may intensify Dasatinib's hepatotoxic effects. Acetaminophen serum levels may rise in response to dasatinib.
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.
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.
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.
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.
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.
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.
Probenecid	Acetaminophen serum concentration can rise. Moreover, probenecid may reduce the production of at least one significant non-toxic metabolite, potentially raising the risk of the toxic NAPQI metabolite's production.
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.
SORAfenib	Acetaminophen may intensify SORAfenib's hepatotoxic effects. Acetaminophen serum levels may rise in response to SORAfenib.
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.
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.
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.
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).
Eluxadoline	Opioid Agonists may enhance the constipating effect of Eluxadoline.
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).
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.
Thalidomide	CNS Depressants may enhance the CNS depressant effect of Thalidomide.

Monitoring Parameters:

Pain relief
Status of the lungs and mental.
Blood pressure
Bowel function
Signs and symptoms of abuse, misuse, or addiction
Signs and symptoms of hypogonadism/hypoadrenalism

Alternate suggestions:

Chronic pain management is long-term treatment that does not include end-of life or palliative care.
It can also be used for active cancer treatment, sickle cells disease, and medication-assisted treatment of opioid abuse disorder.
Assess the benefits and risks of opioid therapy within one to four weeks after initiation.
Patients at high risk for overdose or those with opioid addiction should be re-evaluated 3 times per month.
Before initiating any drug treatment, it is recommended that urine drug testing be done.
Re-checking should occur at least once a year. This includes controlled prescription drugs and illicit drugs of abuse.
Clinicians should review state prescription drug monitoring program data (PDMP) before initiation, and periodically during therapy (frequency ranging between every prescription to every three months).

How to administer Percocet (Oxycodone and acetaminophen)?

Extended-release:

Without regard to food, administer.
One Extended-release tablet should be swallowed whole at a time; do not split, chew, dissolve, or crush them.
The uncontrolled release of oxycodone that results from breaking, chewing, crushing, cutting, dissolving, or splitting ER pills can cause overdose or death.

Mechanism of action of Percocet (Oxycodone and acetaminophen):

Oxycodone:
- The central nervous system attaches to the opiate receptors, producing inhibition of ascending pain pathways, altering pain perception and response.
- It causes generalized CNS depression.
Acetaminophen:
- The activation of the CNS's descending serotonergic inhibitory pathway is believed to be responsible for the analgesic effect, although this has not been fully explained.
- There may also be interactions with other nociceptive system.
- Antipyresis is caused by inhibition of the hypothalamic temperature-regulating center.

International Brands of Oxycodone and acetaminophen:

Endocet
Percocet
Primlev
Xartemis XR
Percocet-5
Plexicodim
Tylenol Oxy

Oxycodone and acetaminophen Brand Names in Pakistan:

No Brands Available in Pakistan. Napadoc contains paracetamol + codeine + Caffeine

Percocet (Oxycodone and acetaminophen) - Uses, Dosage

Percocet (Oxycodone and acetaminophen) Uses:

Pain management

Percocet Dose in Adults

Percocet Dose in Pain management:

Extended-release:

Immediate-release:

Discontinuation of therapy:

Percocet Dose in Children

Percocet Dose in the treatment of moderate Pain:

Children and Adolescents:

Percocet Dose in Severe Pain:

Children and Adolescents:

Pregnancy Risk Factor C

Use of oxycodone or acetaminophen while breastfeeding

Percocet Dose in Kidney Disease:

Extended-release:

Immediate release:

Percocet Dose in Liver Disease:

Extended-release:

Immediate release:

Common Side Effects of Percocet (Oxycodone and acetaminophen):

Central nervous system:

Gastrointestinal:

Less Common Side Effects of Percocet (Oxycodone and acetaminophen):

Cardiovascular:

Central Nervous System:

Dermatologic:

Endocrine & Metabolic:

Gastrointestinal:

Genitourinary:

Hepatic:

Respiratory:

Percocet Side effects (Frequency unknown):

Cardiovascular:

Central Nervous System:

Dermatologic:

Hematologic & Oncologic:

Respiratory:

Contraindications to Percocet (Oxycodone and acetaminophen):

Additional contraindications specific to product types: Endocet, Primlev: Hypercarbia

Canadian labeling:Additional contraindications not listed in the US labeling:

Warnings and precautions

CNS depression:

Constipation

Hepatotoxicity: [US Boxed Warning]

Hypersensitivity and anaphylactic reactions

Hypotension

Phenanthrene hypersensitivity:

Respiratory depression [US Boxed Warning]

Reactions to skin:

Conditions abdominales:

Adrenocortical Insufficiency

Insufficiency of the biliary tract:

CNS depression and coma

Delirium tremens:

G6PD deficiency:

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:

Alternate suggestions:

How to administer Percocet (Oxycodone and acetaminophen)?

Mechanism of action of Percocet (Oxycodone and acetaminophen):

Oxycodone:

Acetaminophen:

International Brands of Oxycodone and acetaminophen:

Oxycodone and acetaminophen Brand Names in Pakistan:

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