Oxycodone

Un article de Vev.

Modèle:Cleanup

Modèle:Drugbox Modèle:Distinguish

Oxycodone is a potentially addictive opioid analgesic medication synthesized from thebaine. It is a commonly used medication for treatment of pain in cancer patients.<ref>Ordonez Gallego A, Gonzalez Baron M, Espinosa Arranz E. Oxycodone: a pharmacological and clinical review. Clinical and Translational Oncology. 2007 May;9(5):298-307.</ref> It was developed in 1916 in Germany and introduced to the pharmaceutical market as Eukodal^® (also spelled Eucodal) and Dinarkon^®. Its chemical name is derived from codeine - the chemical structures are very similar, differing only in that the hydroxyl group of codeine has been oxidized (hence the "oxy" prefix) to a carbonyl group (as in ketones), hence the "-one" suffix, the 7,8-dihydro-feature (Codeine has a double-bond between those two carbons), and the hydroxyl group at carbon 14 (codeine has just a hydrogen there), hence "oxy"codone.

In the United States, oxycodone is a Schedule II controlled substance both as a single agent and in combination with products containing paracetamol (aka acetaminophen), ibuprofen or aspirin. It was first introduced to the US market in May 1939 and is the active ingredient in a number of pain medications commonly prescribed for the relief of moderate to heavy pain, either with inert binders (Oxycodone, Oxycontin) or supplemental binders such as acetaminophen (Percocet, Tylox) and aspirin (Percodan).

Oxycodone is a drug subject to abuse,<ref>Cicero TJ, Inciardi JA, Muñoz A. Trends in abuse of Oxycontin and other opioid analgesics in the United States: 2002-2004. Journal of Pain. 2005 Oct;6(10):662-72.</ref> and is included in the sections for the most strongly controlled substances that have a commonly accepted medical use under the German Betäubungsmittelgesetz (III) (narcotics law), the Swiss law of the same title, UK Misuse of Drugs Act (Class A), Canadian controlled substances act, Dutch Opium Law (List 1), Austrian Suchtmittelgesetz (Addictives Act), Australian, New Zealand, Japanese and South African controlled substance laws, to name but a few. It is also subject to international treaties controlling psychoactive drugs subject to abuse or dependence.

Chemistry

www.addictionsearch.com/treatment_articles/article/oxycodone-addiction_14.html]</ref>. The 14' hydroxy group increases potency by about 50% over hydrocodone.^{[citation needed]}//www.addictionsearch.com/treatment_articles/article/oxycodone-addiction_14.html]</ref>. The 14' hydroxy group increases potency by about 50% over hydrocodone.^{[citation needed]}

The chemical structure of oxycodone is the methylether of oxymorphone: 3-methyl-oxymorphone. It could also be described as 14-hydroxy-7,8-dihydro-codeinone. It is principally supplied as its hydrochloride salt: oxycodone hydrochloride. The terephtalate salt of oxycodone is present in some formulations such as Percodan as 7.6 per cent of the weight of the oxycodone salts content of the product, viz. 5 mg of oxycodone in Percodan is 4.62 mg hydrocloride and 0.38 mg terephtlalate. There does not appear to be a significant difference in the action of the salts. The hydrochloride-terephtalate mixture appears to be part of the original formulation of Percodan by its German manufacturers from more than 75 years ago.^{[citation needed]}

Other oxycodone salts used around the world include the phosphate, sulphate, pectinate, tartrate, bitartrate, citrate and iodide.

www.thatspoppycock.com/opiates/oxycodone.htm#pharm That's Poppycock! - Oxycodone: Pharmacology and Pharmacokinetics]</ref> Similar to codeine and hydrocodone, oxycodone requires demethylation by the cytochrome CYP2D6 enzyme in order to become activated and any analgesic effect to occur .<ref>Tyndale RF, Droll KP, Sellers EM. Genetically deficient CYP2D6 metabolism provides protection against oral opiate dependence. Pharmacogenetics. 1997 Oct;7(5):375-9.</ref>//www.thatspoppycock.com/opiates/oxycodone.htm#pharm That's Poppycock! - Oxycodone: Pharmacology and Pharmacokinetics]</ref> Similar to codeine and hydrocodone, oxycodone requires demethylation by the cytochrome CYP2D6 enzyme in order to become activated and any analgesic effect to occur .<ref>Tyndale RF, Droll KP, Sellers EM. Genetically deficient CYP2D6 metabolism provides protection against oral opiate dependence. Pharmacogenetics. 1997 Oct;7(5):375-9.</ref>

Percocet tablets (oxycodone with acetaminophen) are routinely prescribed for post-operative pain control. Oxycodone is also used in treatment of moderate to severe chronic pain. Both immediate-release and sustained-release oxycodone are now available (OxyNorm and OxyContin in the UK). There are no comparative trials showing that oxycodone is more effective than any other opioid.<ref>Calman K. Doyle D, Hanks G, Eds. Oxford Textbook of Palliative Medicine, third edition. Oxford: Oxford University Press, 2004.</ref> In palliative care, morphine remains the gold standard.<ref>Calman K. Doyle D, Hanks G, Eds. Oxford Textbook of Palliative Medicine, third edition. Oxford: Oxford University Press, 2004.</ref> However, it can be useful as an alternative opioid if a patient has troublesome adverse effects with morphine.

www.fda.gov/cder/foi/label/2006/020553s056lbl.pdf] However, on 23 May 2007, the 15 mg, 30 mg, 45 mg, and 60 mg strengths were withdrawn, leaving only the original 10 mg, 20 mg, 40 mg, and 80 mg strengths in the United States and the additional 160 mg strength in Canada. Package Insert - OxyContin</ref> (although note that not all of these dosages are marketed in the USA) and, due to its sustained-release mechanism, is effective for eight to twelve hours. The 160 mg tablets were removed from sale due to problems with overdose, but have been re-introduced for limited use under strict medical supervision. On October 18, 2006, the FDA gave approval for three new dosage strengths, 15mg, 30mg, and 45mg.<ref>[1] New Drug Application - FDA</ref> OxyNorm is available in 5, 10, and 20 mg capsules and tablets; also as a 1 mg/1 ml liquid in 250 ml bottles and as a 10 mg/1 ml concentrated liquid in 100 ml bottles. Available in Europe and other areas outside the United States, Proladone® suppositories contain 15 mg of oxycodone pectinate and other suppository strengths under this and other trade names are less frequently encountered. Injectable oxycodone hydrochloride or tartrate is available in ampoules and multi-dose phials in many European countries and to a lesser extent various places in the Pacific Rim. For this purpose, the most common trade names are Eukodol and Eucodol.//www.fda.gov/cder/foi/label/2006/020553s056lbl.pdf] However, on 23 May 2007, the 15 mg, 30 mg, 45 mg, and 60 mg strengths were withdrawn, leaving only the original 10 mg, 20 mg, 40 mg, and 80 mg strengths in the United States and the additional 160 mg strength in Canada. Package Insert - OxyContin</ref> (although note that not all of these dosages are marketed in the USA) and, due to its sustained-release mechanism, is effective for eight to twelve hours. The 160 mg tablets were removed from sale due to problems with overdose, but have been re-introduced for limited use under strict medical supervision. On October 18, 2006, the FDA gave approval for three new dosage strengths, 15mg, 30mg, and 45mg.<ref>[2] New Drug Application - FDA</ref> OxyNorm is available in 5, 10, and 20 mg capsules and tablets; also as a 1 mg/1 ml liquid in 250 ml bottles and as a 10 mg/1 ml concentrated liquid in 100 ml bottles. Available in Europe and other areas outside the United States, Proladone® suppositories contain 15 mg of oxycodone pectinate and other suppository strengths under this and other trade names are less frequently encountered. Injectable oxycodone hydrochloride or tartrate is available in ampoules and multi-dose phials in many European countries and to a lesser extent various places in the Pacific Rim. For this purpose, the most common trade names are Eukodol and Eucodol.

Nausea, drowsiness, constipation, lightheadedness, rash or itchiness, dizziness, and emotional mood disorders are the most frequently reported side effects. Other side effects can also include dry mouth and slightly decreased testosterone levels in men. Oxycodone accumulates in patients with renal or liver impairment, and dose reductions may be needed.

History

Modèle:Refimprovesect Oxycodone is an opioid agonist, and as such is a variation on an ancient theme beginning with the simple consumption or smoking of the alkaloid-bearing parts of Papaver somniferum, the opium poppy, first cultivated circa 3400 BC in lower Mesopotamia. Ancient Persians, Sumerians, Assyrians, Babylonians, and Egyptians found that smoking the extract derived from the seedpods yielded a pleasurable, peaceful feeling throughout the body. The Sumerians called the poppy plant "Hul Gil" or "joy plant". Cultivation and use spread quickly to the rest of the Persian Gulf, Levant and the Arabian Peninsula, eventually reaching India and China.

Oxycodone was first synthesized in a German laboratory in 1916, a few years after the German pharmaceutical company Bayer had stopped the mass production of heroin due to addiction and abuse by both patients and physicians. It was hoped that a thebaine-derived drug would retain the analgesic effects of morphine and heroin with less of the euphoric effect which led to addiction and over-use. To some extent this was achieved, as oxycodone does not "hit" the central nervous system with the same immediate punch as heroin or morphine do and it does not last as long. The subjective experience of a "high" was still reported for oxycodone, however, and it made its way into medical usage in small increments in most Western countries until the introduction of the OxyContin preparation radically boosted oxycodone use.^{[citation needed]}

The introduction of OxyContin in 1995 resulted in increasing patterns of abuse.^{[citation needed]} Unlike Percocet, whose potential for abuse is limited by the presence of paracetamol, OxyContin contains only oxycodone and inert filler. Abusers simply crush the tablets, then either ingest the resulting powder orally, intranasally, via intravenous, intramuscular or subcutaneous injection (by dissolving the powder), or rectally to achieve rapid absorption into the bloodstream. Injection of OxyContin is particularly dangerous since it contains binders which enable the time release of the drug.Modèle:Or The vast majority of OxyContin-related deaths are attributed to ingesting substantial quantities of oxycodone in combination with another depressant of the central nervous system such as alcohol or benzodiazepines.^{[citation needed]} While high doses of oxycodone can be fatal to an opiate-naïve individual in and of itself, lethal overdoses of only oxycodone rarely occur. It was once thought that opioids would be less subject to recreational use when one or more additional analgesics are added, since, for example, the amount of paracetamol present in higher doses of Percocet causes stomach upset and liver damage. However, it has been demonstrated that abusers seeking the euphoric "high" are not deterred by these potential side effects or toxicities. Abusers soon discovered that extremely simple methods to separate the ingredients exist, particularly due to the widely disparate solubility of the alkaloids and analgesics in water ("cold water extraction").

Oxycodone has similar effects to morphine and heroin, and appeals to the same abuse community. Armed robberies of pharmacies where the robber demanded only OxyContin, not cash, have occurred. In some areas, particularly the eastern U.S., OxyContin has been the drug of greatest concern to enforcement authorities, although trustworthy data on the actual incidence of "Oxy abuse" have been difficult to establish.

police.byu.edu/community%20education/drugalert/oxycontinfacts.htm">http://police.byu.edu/community%20education/drugalert/oxycontinfacts.htm</ref> Between 1994 and 2001, there was a reported 352% increase in ER visits related to all forms of oxycodone usage.<ref name="Beardsley, P., Aceto, M., Cook, C., Bowman, E., Newman, J., & Harris, L. (2004). Discriminative Stimulus, Reinforcing, Physical Dependence, and Antinociceptive Effects of Oxycodone in Mice, Rats, and Rhesus Monkeys. Experimental and Clinical Psychopharmacology, 12(3), 163-172.">http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=15301633</ref>//police.byu.edu/community%20education/drugalert/oxycontinfacts.htm">http://police.byu.edu/community%20education/drugalert/oxycontinfacts.htm</ref> Between 1994 and 2001, there was a reported 352% increase in ER visits related to all forms of oxycodone usage.<ref name="Beardsley, P., Aceto, M., Cook, C., Bowman, E., Newman, J., & Harris, L. (2004). Discriminative Stimulus, Reinforcing, Physical Dependence, and Antinociceptive Effects of Oxycodone in Mice, Rats, and Rhesus Monkeys. Experimental and Clinical Psychopharmacology, 12(3), 163-172.">http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=15301633</ref>

In Australia OxyContin is covered by the PBS, and a patient can potentially get up to sixty tablets for as little as $4.90AUD in total. The NSW Rural Doctors Network notes "Some patients who are legitimately prescribed strong opioids, by a pain clinic or for a terminal condition, will sell part, or all, of their prescription on the illicit drug market to augment their income" and "‘Doctor shopping’ data for 1999/2000 for Australia show that a total volume of 262 923 codeine compound analgesics and narcotic prescriptions were written for 8780 known abusers. These patients saw more than 15 separate doctors in 1 year. The cost of these prescription drugs for 3000 patients, in NSW alone, was $759 954. The problem is, however, much more widespread than these figures indicate. Many more patients avoid detection by requesting private prescriptions, and are not reflected in official government statistics. There are a large number of these white-collar drug users, adding incalculably to a huge www.nswrdn.com.au/client_images/6700.pdf">http://www.nswrdn.com.au/client_images/6700.pdf</ref>. This has led to Federal tightening of restrictions from May 2006 (see Regulation below).//www.nswrdn.com.au/client_images/6700.pdf">http://www.nswrdn.com.au/client_images/6700.pdf</ref>. This has led to Federal tightening of restrictions from May 2006 (see Regulation below).

police.byu.edu/community%20education/drugalert/oxycontinfacts.htm">http://police.byu.edu/community%20education/drugalert/oxycontinfacts.htm http://police.byu.edu/community%20education/drugalert/oxycontinfacts.htm</ref> The most commonly diverted dosages are the 40mg and 80mg strengths.<ref name="http://police.byu.edu/community%20education/drugalert/oxycontinfacts.htm">http://police.byu.edu/community%20education/drugalert/oxycontinfacts.htm http://police.byu.edu/community%20education/drugalert/oxycontinfacts.htm</ref>//police.byu.edu/community%20education/drugalert/oxycontinfacts.htm">http://police.byu.edu/community%20education/drugalert/oxycontinfacts.htm http://police.byu.edu/community%20education/drugalert/oxycontinfacts.htm</ref> The most commonly diverted dosages are the 40mg and 80mg strengths.<ref name="http://police.byu.edu/community%20education/drugalert/oxycontinfacts.htm">http://police.byu.edu/community%20education/drugalert/oxycontinfacts.htm http://police.byu.edu/community%20education/drugalert/oxycontinfacts.htm</ref>

Manufacturer and patents

Modèle:Refimprovesect

www.pharma.com/pressroom/news/20050608.htm">http://www.pharma.com/pressroom/news/20050608.htm http://www.pharma.com/pressroom/news/20050608.htm</ref> Purdue, however, had already made negotiations with another pharmaceutical company (IVAX Pharmaceuticals) to distribute their brand OxyContin in a generic form. This contract was severed, and currently Watson Pharmaceuticals is the exclusive U.S. distributor of the generic versions of OxyContin Tablets. The agreement stipulates that "Purdue will manufacture and supply oxycodone HCI controlled-release tablets to Watson, which will market, sell, and distribute the authorized generic product in 10, 20, 40, and 80 milligram dosages in the United States".<ref name="http://www.pharma.com/pressroom/news/20051028.htm">http://www.pharma.com/pressroom/news/20051028.htm http://www.pharma.com/pressroom/news/20051028.htm</ref>//www.pharma.com/pressroom/news/20050608.htm">http://www.pharma.com/pressroom/news/20050608.htm http://www.pharma.com/pressroom/news/20050608.htm</ref> Purdue, however, had already made negotiations with another pharmaceutical company (IVAX Pharmaceuticals) to distribute their brand OxyContin in a generic form. This contract was severed, and currently Watson Pharmaceuticals is the exclusive U.S. distributor of the generic versions of OxyContin Tablets. The agreement stipulates that "Purdue will manufacture and supply oxycodone HCI controlled-release tablets to Watson, which will market, sell, and distribute the authorized generic product in 10, 20, 40, and 80 milligram dosages in the United States".<ref name="http://www.pharma.com/pressroom/news/20051028.htm">http://www.pharma.com/pressroom/news/20051028.htm http://www.pharma.com/pressroom/news/20051028.htm</ref>

www.fedcir.gov/opinions/04-1189.pdf]</ref> that affirmed-in-part, vacated-in-part, and remanded-in-part their prior decision. The court concluded "The trial court's judgment that the patents-in-suit are unenforceable due to inequitable conduct is vacated, and the case is remanded for further proceedings consistent with this opinion. The trial court's judgment of infringement is affirmed." Purdue Pharma LP has since announced resolution of its infringement suits with Endo (August 28, 2006<ref>Company Press Release at http://www.purduepharma.com/pressroom/news/20060828-1.htm</ref>), Teva (October 19, 2006<ref>Company Press Release at http://www.purduepharma.com/pressroom/news/20061016.htm</ref>), and IMPAX (May 25, 2007<ref>Company Press Release at http://www.purduepharma.com/pressroom/news/20070402.htm</ref>). Endo and Teva each agreed to cease selling generic oxycontin. IMPAX negotiated a temporary, and potentially renewable, license.//www.fedcir.gov/opinions/04-1189.pdf]</ref> that affirmed-in-part, vacated-in-part, and remanded-in-part their prior decision. The court concluded "The trial court's judgment that the patents-in-suit are unenforceable due to inequitable conduct is vacated, and the case is remanded for further proceedings consistent with this opinion. The trial court's judgment of infringement is affirmed." Purdue Pharma LP has since announced resolution of its infringement suits with Endo (August 28, 2006<ref>Company Press Release at http://www.purduepharma.com/pressroom/news/20060828-1.htm</ref>), Teva (October 19, 2006<ref>Company Press Release at http://www.purduepharma.com/pressroom/news/20061016.htm</ref>), and IMPAX (May 25, 2007<ref>Company Press Release at http://www.purduepharma.com/pressroom/news/20070402.htm</ref>). Endo and Teva each agreed to cease selling generic oxycontin. IMPAX negotiated a temporary, and potentially renewable, license.

police.byu.edu/community%20education/drugalert/oxycontinfacts.htm">http://police.byu.edu/community%20education/drugalert/oxycontinfacts.htm http://police.byu.edu/community%20education/drugalert/oxycontinfacts.htm</ref> Purdue also exports OxyContin to wholesale distributors in Mexico and Canada. However, they have experienced increasing levels of illicit drug trafficking with the distribution outside of the U.S. that has led to certain responsive actions. The pill exported to Mexico is stamped with the letters "EX" instead of the customary "OC," and similarly the pills to Canada read "CDN" Purdue stopped exporting to Canada in 2001, and instead Canada imports the drug from a manufacturer in England. Despite these problems, OxyContin is one of the leading opioid painkillers on the market. In 2001, OxyContin was the highest sold drug of its kind, and in 2000, over 6.5 million prescriptions were written.<ref name="http://www.drugpolicy.org/drugbydrug/oxycontin/">http://www.drugpolicy.org/drugbydrug/oxycontin/ http://www.drugpolicy.org/drugbydrug/oxycontin/</ref>//police.byu.edu/community%20education/drugalert/oxycontinfacts.htm">http://police.byu.edu/community%20education/drugalert/oxycontinfacts.htm http://police.byu.edu/community%20education/drugalert/oxycontinfacts.htm</ref> Purdue also exports OxyContin to wholesale distributors in Mexico and Canada. However, they have experienced increasing levels of illicit drug trafficking with the distribution outside of the U.S. that has led to certain responsive actions. The pill exported to Mexico is stamped with the letters "EX" instead of the customary "OC," and similarly the pills to Canada read "CDN" Purdue stopped exporting to Canada in 2001, and instead Canada imports the drug from a manufacturer in England. Despite these problems, OxyContin is one of the leading opioid painkillers on the market. In 2001, OxyContin was the highest sold drug of its kind, and in 2000, over 6.5 million prescriptions were written.<ref name="http://www.drugpolicy.org/drugbydrug/oxycontin/">http://www.drugpolicy.org/drugbydrug/oxycontin/ http://www.drugpolicy.org/drugbydrug/oxycontin/</ref>

Regulation of oxycodone (and opioids in general) differs according to country, with different places focusing on different parts of the "supply chain".

In Australia a General Practitioner can prescribe for short term treatment without consulting another practitioner or government body. Ongoing treatment requires approval from their state Health Department.

Only twenty tablets are normally available per prescription on the Pharmaceutical Benefits Scheme, Australia's government-funded pharmaceutical insurance system. Prescriptions for larger quantities require prior approval from Medicare Australia. These prescriptions (i.e. for chronic pain or cancer patients) require the prescriber to have referred the patient to another medical practitioner to confirm the need for ongoing treatment with narcotic analgesics.

Pharmacists must record all incoming purchases of oxycodone products, and maintain a register of all prescription sales for inspection by their state Health Department on request. In addition details of all Pharmaceutical Benefits Scheme prescriptions for oxycodone are sent to Medicare Australia. This data allows Medicare Australia to assist prescribers to identify doctor-shoppers via a telephone hotline.

In Canada, Oxycodone is a controlled substance under Schedule I of the Controlled Drugs and Substances Act (CDSA). Every person who seeks or obtains the substance without disclosing authorization to obtain such substances 30 days prior to obtaining another prescription from a practitioner is guilty of an indictable offence and liable to imprisonment for a term not exceeding seven years. Possession for purpose of trafficking is guilty of an indictable offence and liable to imprisonment for life.

www.deadiversion.usdoj.gov/drugs_concern/oxycodone/oxycontin_faq.htm">http://www.deadiversion.usdoj.gov/drugs concern/oxycodone/oxycontin faq.htm</ref> Part of the regulation of prescription drugs is connected to their marketing and advertising. The FDA has authority over this sector under the Food, Drug, and Cosmetic (FD&C) Act and its implementing regulations. The Division of Drug Marketing, Advertising, and Communications (DDMAC) is "responsible for regulating prescription drug advertising and promotion," and has a "mission to protect the public health by ensuring that prescription drug information is truthful, balanced, and accurately communicated".<ref name="http://www.fda.gov/ola/2002/oxycontin0212.html">http://www.fda.gov/ola/2002/oxycontin0212.html</ref> Simplified, Oxycodone is a schedule II controlled substance, which means to be filled there must be a written prescription which cannot have refills, nor can it be called in to a pharmacy by a physician.//www.deadiversion.usdoj.gov/drugs_concern/oxycodone/oxycontin_faq.htm">http://www.deadiversion.usdoj.gov/drugs concern/oxycodone/oxycontin faq.htm</ref> Part of the regulation of prescription drugs is connected to their marketing and advertising. The FDA has authority over this sector under the Food, Drug, and Cosmetic (FD&C) Act and its implementing regulations. The Division of Drug Marketing, Advertising, and Communications (DDMAC) is "responsible for regulating prescription drug advertising and promotion," and has a "mission to protect the public health by ensuring that prescription drug information is truthful, balanced, and accurately communicated".<ref name="http://www.fda.gov/ola/2002/oxycontin0212.html">http://www.fda.gov/ola/2002/oxycontin0212.html</ref> Simplified, Oxycodone is a schedule II controlled substance, which means to be filled there must be a written prescription which cannot have refills, nor can it be called in to a pharmacy by a physician.

In Germany only Physicians (Ärzte) can prescribe Oxycodone which is sold by Mundipharma as Oxygesic. These physicians need to have a special BtM (Betäubungsmittel/English: Controlled Substance) number. Not all physicians have BtM numbers. BtM prescriptions are handled very cautiously and the central Federal Opium Bureau (Bundesopiumstelle) records all traffic. The BtM prescription has a different appearance from a regular prescription and includes three copies; one for the prescribing physician, one for the pharmacy and one for the BOP. Currently, 100 x 40mg Oxygesic tablets cost around €410. Oxygesic is sold as 10mg, 20mg, 40mg and 80mg tablets.

In Hong Kong, oxycodone is regulated under Schedule 1 of Hong Kong's Chapter 134 Dangerous Drugs Ordinance. It can only be used legally by health professionals and for university research purposes. The substance can be given by pharmacists under a prescription. Anyone who supplies the substance without a prescription can be fined $10,000(HKD). The penalty for trafficking or manufacturing the substance is a $5,000,000 (HKD) fine and/or life imprisonment. Possession of the substance for consumption without license from the Department of Health is illegal with a $1,000,000 (HKD) fine and/or 7 years of jail time.

Controversies

www.mapinc.org/drugnews/v01/n1702/a06.html</ref><ref>http://www.mapinc.org/drugnews/v01/n1124/a04.html</ref><ref>http://www.mapinc.org/drugnews/v01/n1052/a08.html</ref>//www.mapinc.org/drugnews/v01/n1702/a06.html</ref><ref>http://www.mapinc.org/drugnews/v01/n1124/a04.html</ref><ref>http://www.mapinc.org/drugnews/v01/n1052/a08.html</ref>

www.legalnewsline.com/news/194919-purdue-pleads-guilty-will-pay-634-million-in-fines</ref> The pleas were entered in United States District Court in Abingdon.//www.legalnewsline.com/news/194919-purdue-pleads-guilty-will-pay-634-million-in-fines</ref> The pleas were entered in United States District Court in Abingdon. The Purdue Frederick Company, Inc., and the three executives have admitted that Purdue fraudulently marketed OxyContin by falsely claiming that OxyContin was less addictive, less subject to abuse, and less likely to cause withdrawal symptoms than other pain medications when there was no medical research to support these claims and without Food and Drug Administration approval of these claims.

www.azcentral.com/arizonarepublic/business/articles/0509biz-oxycontin0509.html</ref>//www.azcentral.com/arizonarepublic/business/articles/0509biz-oxycontin0509.html</ref>

On the other hand, modification of dosing intervals for extended-release opioid tablets is a fairly common method of dose titration in cases of moderate to extreme chronic pain. The alternative q12h (every 12 hours) schedule can very well require a higher dose per 24 hours of the agent, not only wasting medication and intensifying side effects but also often causing toxicity to supervene before adequate analgesia is achieved. For example, in the US and Europe, instructions for other OxyContin-type drugs mention that an 8 or even 6 hour dosing interval as preferable to ramping up the q12h dose to achieve adequate analgesia. Many OxyContin prescription recipients cannot tolerate the gastrointestinal effects of morphine and/or the hallucinogenic effects of high-dose fentanyl. Others may have difficulty obtaining oxymorphone preparations and/or having their insurance pay for them. This leaves few other options in the US for extended-release strong opioid administration (see Palladone discussion in article on hydromorphone)^{[citation needed]}.

See Also

• Opioid
• Codeine
• Hydrocodone
• Oxymorphone
• Drug addiction
• Thebaine
• Percodan

References

gsm.about.com/compact/showpics.asp?monotype=full&cpnum=457&r=6078&gname=Oxycodone Images of various preparations of Oxycodone and Oxycodone controlled release]//gsm.about.com/compact/showpics.asp?monotype=full&cpnum=457&r=6078&gname=Oxycodone Images of various preparations of Oxycodone and Oxycodone controlled release] www.minervamedica.it/pdf/R02Y2005/R02Y2005N07A0451.pdf Oxycodone: Pharmacological profile and clinical data in chronic pain management] minervamedica.it. Minerva Anestesiologica, 2005;71:451-60. [pdf file]//www.minervamedica.it/pdf/R02Y2005/R02Y2005N07A0451.pdf Oxycodone: Pharmacological profile and clinical data in chronic pain management] minervamedica.it. Minerva Anestesiologica, 2005;71:451-60. [pdf file] www.minervamedica.it/pdf/R02Y2005/R02Y2005N07A0451.pdf Oxycodone: Pharmacological profile and clinical data in chronic pain management] minervamedica.it. Minerva Anestesiologica, 2005;71:451-60. [pdf file]//www.drugs.com/pdr/percocet_tablets.html Percocet Drug Information] from Thomson Healthcare database www.minervamedica.it/pdf/R02Y2005/R02Y2005N07A0451.pdf Oxycodone: Pharmacological profile and clinical data in chronic pain management] minervamedica.it. Minerva Anestesiologica, 2005;71:451-60. [pdf file]//www.reuters.com/article/healthNews/idUSWBT00695020070510?src=051007_1225_DOUBLEFEATURE_ Oxycontin makers and executives plead guilty to coverup of dangers and addictive qualities] www.minervamedica.it/pdf/R02Y2005/R02Y2005N07A0451.pdf Oxycodone: Pharmacological profile and clinical data in chronic pain management] minervamedica.it. Minerva Anestesiologica, 2005;71:451-60. [pdf file]//www.nytimes.com/2007/06/17/magazine/17pain-t.html?pagewanted=1 "When Is a Pain Doctor a Drug Pusher?' New York Times 6-17-2007] Modèle:Analgesicsde:Oxycodon es:Oxicodona fr:Oxycodone it:Ossicodone hu:Oxikodon nl:Oxycodon ja:オキシコドン pl:Oksykodon simple:Oxycodone fi:Oksikodoni sv:Oxykodon th:ออกซิโคโดน

www.legalnewsline.com/news/194919-purdue-pleads-guilty-will-pay-634-million-in-fines</ref> The pleas were entered in United States District Court in Abingdon.//www.legalnewsline.com/news/194919-purdue-pleads-guilty-will-pay-634-million-in-fines</ref> The pleas were entered in United States District Court in Abingdon. The Purdue Frederick Company, Inc., and the three executives have admitted that Purdue fraudulently marketed OxyContin by falsely claiming that OxyContin was less addictive, less subject to abuse, and less likely to cause withdrawal symptoms than other pain medications when there was no medical research to support these claims and without Food and Drug Administration approval of these claims.

www.azcentral.com/arizonarepublic/business/articles/0509biz-oxycontin0509.html</ref>//www.azcentral.com/arizonarepublic/business/articles/0509biz-oxycontin0509.html</ref>

On the other hand, modification of dosing intervals for extended-release opioid tablets is a fairly common method of dose titration in cases of moderate to extreme chronic pain. The alternative q12h (every 12 hours) schedule can very well require a higher dose per 24 hours of the agent, not only wasting medication and intensifying side effects but also often causing toxicity to supervene before adequate analgesia is achieved. For example, in the US and Europe, instructions for other OxyContin-type drugs mention that an 8 or even 6 hour dosing interval as preferable to ramping up the q12h dose to achieve adequate analgesia. Many OxyContin prescription recipients cannot tolerate the gastrointestinal effects of morphine and/or the hallucinogenic effects of high-dose fentanyl. Others may have difficulty obtaining oxymorphone preparations and/or having their insurance pay for them. This leaves few other options in the US for extended-release strong opioid administration (see Palladone discussion in article on hydromorphone)^{[citation needed]}.

See Also

• Opioid
• Codeine
• Hydrocodone
• Oxymorphone
• Drug addiction
• Thebaine
• Percodan

References

gsm.about.com/compact/showpics.asp?monotype=full&cpnum=457&r=6078&gname=Oxycodone Images of various preparations of Oxycodone and Oxycodone controlled release]//gsm.about.com/compact/showpics.asp?monotype=full&cpnum=457&r=6078&gname=Oxycodone Images of various preparations of Oxycodone and Oxycodone controlled release] www.minervamedica.it/pdf/R02Y2005/R02Y2005N07A0451.pdf Oxycodone: Pharmacological profile and clinical data in chronic pain management] minervamedica.it. Minerva Anestesiologica, 2005;71:451-60. [pdf file]//www.minervamedica.it/pdf/R02Y2005/R02Y2005N07A0451.pdf Oxycodone: Pharmacological profile and clinical data in chronic pain management] minervamedica.it. Minerva Anestesiologica, 2005;71:451-60. [pdf file] www.minervamedica.it/pdf/R02Y2005/R02Y2005N07A0451.pdf Oxycodone: Pharmacological profile and clinical data in chronic pain management] minervamedica.it. Minerva Anestesiologica, 2005;71:451-60. [pdf file]//www.drugs.com/pdr/percocet_tablets.html Percocet Drug Information] from Thomson Healthcare database www.minervamedica.it/pdf/R02Y2005/R02Y2005N07A0451.pdf Oxycodone: Pharmacological profile and clinical data in chronic pain management] minervamedica.it. Minerva Anestesiologica, 2005;71:451-60. [pdf file]//www.reuters.com/article/healthNews/idUSWBT00695020070510?src=051007_1225_DOUBLEFEATURE_ Oxycontin makers and executives plead guilty to coverup of dangers and addictive qualities] www.minervamedica.it/pdf/R02Y2005/R02Y2005N07A0451.pdf Oxycodone: Pharmacological profile and clinical data in chronic pain management] minervamedica.it. Minerva Anestesiologica, 2005;71:451-60. [pdf file]//www.nytimes.com/2007/06/17/magazine/17pain-t.html?pagewanted=1 "When Is a Pain Doctor a Drug Pusher?' New York Times 6-17-2007] Modèle:Analgesicsde:Oxycodon es:Oxicodona fr:Oxycodone it:Ossicodone hu:Oxikodon nl:Oxycodon ja:オキシコドン pl:Oksykodon simple:Oxycodone fi:Oksikodoni sv:Oxykodon th:ออกซิโคโดน